MBARARA, Uganda — A shortage of lenacapavir in Mbarara is limiting access to a twice-yearly HIV-prevention injection that sex workers and other people at elevated risk say would be more convenient than existing options.

Health authorities have identified Mbarara as a priority area for lenacapavir deployment. However, Uganda’s limited available doses have been rationed nationally and distributed to districts including Mbarara and Lira.

People seeking HIV prevention in Mbarara are often offered cabotegravir instead. The pre-exposure prophylaxis, or PrEP, is administered every two months, while lenacapavir is designed to provide protection for six months.

Demand exceeds supply

Immaculate Nyamwija, founder of Action for Improved Health and Wealth, said sex workers are particularly interested in lenacapavir because it reduces the need to take medication every day or return for frequent injections.

“They want Len (lenacapavir) because you see it is long lasting. Six months at least can give someone a breathing space,” Nyamwija said.

Lisa Mutoni, a Rwandan woman working as a sex worker, said she has sought the injection but was told it was unavailable. “I go there, to check if it is there, they tell me that it is finished,” she said.

Mutoni receives counselling, condoms and other support from Action for Improved Health and Wealth. She previously took daily oral HIV-prevention pills for a year before being enrolled on cabotegravir.

Mbarara’s HIV rate is reported at 10 percent, twice Uganda’s national average, according to the most recent survey cited in the report. Health authorities say infection trends are driven largely by commercial sex in urban hot spots such as Mbarara, where condom use is low and inconsistent.

Mbarara, in western Uganda, has a red-light district known as Kijungu. Tarsisio Biryeija, a nursing officer and counsellor at Mbarara Health Centre IV, said nightlife and unprotected sex continue to create risks.

“People go and enjoy their money, we have gotten these institutions (nightclubs) that are nearby us and when it comes to weekend, people go and enjoy without knowing that HIV is around the corner,” he said.

Wider rollout planned

Lenacapavir was approved by the United States in 2025 as the world’s only twice-a-year shot to prevent HIV. The source report says the medicine nearly eliminated new infections in two studies involving people at high risk and performed better than daily preventive pills in those studies.

Dorcus Twinabaitu, a clinician who identified herself as Mbarara’s HIV/AIDS focal person, described lenacapavir as “the way to go, unless something even better comes on board” for HIV prevention.

Uganda has roughly 1.5 million people living with HIV. Nyamwija said funding cuts had also ended outreach programmes that previously brought HIV testing and prevention services closer to communities through community-based organisations and peer workers.

“But due to the funding cuts those activities are no longer happening and many people have poor health seeking behaviours,” she said.

The Global Fund reported that 430,000 lenacapavir doses had been delivered by mid-September, including 327,000 initiation doses and 103,000 continuation doses. National programmes reported that more than 118,000 people had received the medicine.

The United States and the Global Fund aim to purchase lenacapavir for up to 3 million people by the end of 2028. Gilead Sciences, which makes the drug, said it would provide supplies at no profit through partnerships with the Global Fund and PEPFAR while licensed generic manufacturers increase production.

Gilead said initial generic supplies are expected in late 2026, with widespread availability anticipated in 2027. Until supply expands, people in Mbarara seeking longer-lasting HIV prevention may continue to face limited access to lenacapavir.