Long-acting PrEP (LEN) is moving closer to introduction in Eswatini and Zambia, with early country-level planning processes now underway.
In March and April 2026, Global Black Gay Men Connect convened national stakeholders in both countries for initial inception meetings, bringing together Ministries of Health, National AIDS Councils, implementing partners, and key population (KP) and LGBTQI community representatives. These meetings mark the beginning of country-level alignment on priorities, demand creation strategies, and implementation approaches for long-acting PrEP.
While LEN has the potential to expand prevention choice—particularly for people who face challenges with daily oral PrEP—its impact will depend on more than availability. Early discussions highlighted a central issue: whether communities trust the product, understand how it works, and are able to access it within systems often shaped by stigma and structural barriers.
What stood out in both convenings was the effort to bring government, partners, and community voices into the same space at the outset of planning—something that does not consistently happen in meaningful ways. The discussions reflected both the opportunity and the complexity of introducing a new prevention option within existing systems.
One participant reflected on the significance of the convening:
“This meeting was important. In restricted contexts, there are few spaces and opportunities that bring civil society, government, private sector, and multilateral organizations together to discuss something as important as PrEP. We are talking about demand creation, getting community members on board—we don’t want to create demand in a vacuum.”
— Chivuli Ukwimi, MPH, Luthando Initiative
Across both convenings, there was a clear and consistent message: the introduction of long-acting PrEP cannot repeat past patterns where prevention tools were technically available, but not meaningfully accessible to the people who needed them most.
Discussions on demand creation reflected a notable shift. Rather than focusing solely on information dissemination, stakeholders emphasized trust as a central determinant of uptake. In both Eswatini and Zambia, there was strong alignment on the importance of peer-led communication, the need for stigma-free service environments, and the limitations of generic messaging for key populations. Participants also highlighted the importance of sequencing—ensuring that demand generation is aligned with supply realities and that systems are prepared before rollout begins.
Because when access breaks down, trust does too.
Designing with Communities
A central feature of both convenings was the emphasis on co-creation. Rather than developing approaches in isolation, government, community representatives, and implementing partners worked together to identify barriers and shape responses grounded in lived experience.
Several priorities emerged across both settings: peer-led approaches as a primary and trusted channel for engagement; more flexible, differentiated service delivery models; stronger use of social and community networks; and improved linkages between community structures and health facilities. Across discussions, there was a shared recognition that uptake is more likely when communities are involved not only as beneficiaries, but as active contributors to design and implementation.
A GBGMC program lead emphasized the importance of community engagement:
“Making sure that key populations at the community level have knowledge of PrEP and can access comprehensive services is critical. We will implement activities such as forums for communities to discuss product introduction, specifically LEN, ensuring that community perspectives inform policy and HIV prevention options.”
— Bheki Sithole, Program Manager, Product Introduction, GBGMC
Why This Matters Now
This moment is critical. Countries are preparing to introduce long-acting prevention options while continuing to navigate persistent challenges, including stigma, uneven access, and health system constraints.
Early planning processes suggest that the effectiveness of LEN will depend not only on product availability, but on how well rollout is aligned with community realities. If introduction moves ahead without sufficient attention to trust, readiness, and access, uptake is likely to remain limited—regardless of the promise of the intervention itself.
What Comes Next
Through the EQUAL-PrEP initiative, funded by the Elton John AIDS Foundation and led by Global Black Gay Men Connect, efforts are underway to support a coordinated, community-informed approach to long-acting PrEP introduction in Eswatini and Zambia.
This includes continued engagement with national stakeholders, strengthening demand creation strategies, and supporting alignment between community priorities and service delivery systems. As countries move closer to rollout, the focus remains on ensuring that communities are informed, included, and able to access prevention options in ways that reflect their needs and realities.
Because the success of long-acting PrEP will ultimately be determined not by its availability, but by who it reaches—and who it leaves behind.
