Malawi rolls out injectable HIV prevention drug amid hope and caution

Malawi – Patrick Chakwana, 50, has lived with HIV since 1999, when there was no effective treatment and the message to those diagnosed was blunt: "AIDS Kills". Today, as Malawi becomes one of the latest African countries to launch Lenacapavir, a twice-yearly injectable drug that prevents HIV infection, Chakwana's reaction is one of hope, tempered by caution.

Issued on: 18/07/2026 - 12:35Modified: 18/07/2026 - 12:36

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"I've faced stigma from the community and workplaces," the soft-spoken man, who sat at a desk in a small office off the road connecting the tea-growing district of Thyolo with the commercial city of Blantyre, told RFI in an interview.

Chakwana came out publicly with his status immediately after diagnosis, informing his workmates and community. The backlash from his employer was swift.

"When I revealed my HIV status, my boss said I would die, and it was the counselling I received from MSF (Médecins Sans Frontières) that kept me sane," he said. "When they learnt that I was attending meetings, I was taken to the police on the pretext that I wanted to destabilise the company."

In the years since, Chakwana has cycled through several antiretroviral drugs (ARVs) to manage his condition, each with different side effects: an early treatment he says caused inflammation in others, another that raised his body temperature and caused dizziness and unexplained anger, and his current medication, which he says causes minimal side effects.

Today, Chakwana is the director of Thunga Community Based Organisation, a local AIDS support NGO founded in 2004 by people living with the virus. The organisation, staffed by community volunteers including peer educators, offers home-based care, group and children's therapies, and outreach education.

It has recently been involved in the "find, test, treat and retain" drive.

A cautious welcome

Lenacapavir, known as LEN, was launched in Malawi on 2 July and has been recommended by the World Health Organization.

Unlike daily ARV pills, it offers long-acting HIV prevention with just two injections a year, a development advocates believe could significantly cut new infections.

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"We've received it with 100 percent approval, because we believe HIV cases will be significantly reduced, along with the number of defaulters," Chakwana said.

But he cautioned that public understanding is lagging behind the rollout. "There is an information gap, and people like us who have direct contact with people in the community are not properly briefed to relay the message."

Young people at risk

Malawi, in south-eastern Africa, is considered one of the countries with higher HIV infection rates, though cases have declined over the years due to interventions by the government and local and international charities.

In Thyolo district, where Chakwana lives and works, the prevalence rate remains disproportionately high, driven by social and economic factors. Nationally, adolescent girls and young women remain most at risk.

Maria Zuze, 49, an advocate with the Coalition of Women Living with HIV and AIDS – Malawi (COWLHA), said an injectable option is especially valuable for young people, who are becoming sexually active earlier than before and often struggle with the daily discipline, and stigma, of taking pills.

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Since she began working with people at risk of, or living with, HIV in 2004, Zuze has observed troubling patterns of denial and concealment.

"Many people, especially the young, don't accept their status," she said. "I know people living with the virus who don't disclose it and continue to have sex with others. Other women also hide it from their husbands for fear of divorce."

Advocates also pointed to another risk: people born with HIV who appear healthy due to consistent treatment sometimes engage in unprotected sex without informing partners.

Lessons from the past

Despite the promise of Lenacapavir, Zuze cautioned that clear communication will be essential to its success.

She drew a parallel with past challenges distributing Isoniazid, a drug used to treat and prevent tuberculosis. Some patients experienced side effects and, rather than reporting them, discarded their medication in tea fields.

"We are the ones who meet people, even in hard-to-reach areas, so we are better placed to gauge people's experiences and perceptions," she said, calling for advocates to be more closely involved in educating communities about the new drug.

For Chakwana, the goal remains simple. "We want the disease to end, and we believe it is possible. We need to reach communities, and the new drug is our solution because it will limit transmission, among other things."