Immaculate Nyamwija counsels a woman about HIV prevention.
Nyamwija is the founder of a Mbarara-based organisation known as Action for Improved Health and Wealth.
It offers HIV support services to women who would face discrimination elsewhere.
That support is much needed here in Mbarara, a city in western Ugandan city, where the HIV rate is higher than the national average.
But there is a new drug that could stop that rate from climbing.
In 2025, the United States approved the world’s only twice-a-year shot to prevent HIV, the first step in an anticipated global rollout that could protect millions – although it’s unclear how many in the U.S. and abroad will get access to the powerful new option.
While a vaccine to prevent HIV is still needed, some experts say the shot made by Gilead Sciences — a drug called lenacapavir — could be the next best thing.
It nearly eliminated new infections in two groundbreaking studies of people at high risk, better than daily preventive pills they can forget to take.
But here in Mbarara there is a shortage of lenacapavir, and people are instead often offered cabotegravir, a pre-exposure prophylaxis administered every two months.
Nyamwija says that recent funding cuts and the reluctance of HIV infected people to seek medical advice early, mean they don't see a medic until they are very ill:
“We used to have outreaches whereby these outreaches were bringing services nearer to the communities - CBOs (community based organisations), community peers working hand in hand with the health facilities. And they bring in these hotspot outreaches, they test people, they give PreP.
"But due to the funding cuts those activities are no longer happening and many people have poor health seeking behaviours. If I am not sick, if I am not feeling headache, I cannot go to the facility, but HIV will just be in there as you are waiting to get the headache and the diarrhoea, it is already spreading to another person.”
Uganda is a country with roughly 1.5 million living with HIV.
Mbarara’s HIV rate stands at 10 percent, double the national average, according to the most recent survey.
Health authorities now say infection trends are driven largely by people paying for sex in urban hot spots like Mbarara, with condom use low and inconsistent.
Tarsisio Biryeija, a nursing officer working as a counsellor at Mbarara Health Centre IV, says that many people are not aware of the risks associated with unprotected sex.
"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 says.
Health authorities identified Mbarara as one of the priority areas for deploying lenacapavir after Uganda last year was included on the list of countries the United States government would help to access the drug.
In Uganda, an East African country of roughly 45 million people, the few thousands of available doses have been rationed across the country, sent to remote districts like Lira, in the north, and Mbarara.
Dorcus Twinabaitu, a clinician who identified herself as Mbarara’s HIV/AIDS focal person, says that lenacapavir is “the way to go, unless something even better comes on board” for HIV prevention.
'Breathing space'
Mbarara has its own red-light district, known as Kijungu.
Lenacapavir is highly demanded by sex workers because it allows them “breathing space” before they must be injected again, Nyamwija says.
“They want Len (lenacapavir) because you see it is long lasting. Six months at least can give someone a breathing space and again, Len, once they inject it in your body it is good, because it is not like these pills that you are carrying everyday,” she says.
Lisa Mutoni is a Rwandan woman who didn't want to show her face on camera because her family and friends don't know that she is a sex worker.
Mutoni says she insists on using condoms when men enter her room, disappointing some who try to remove or tear the condom while having sex.
She took daily oral prevention pills she for a year before she was enrolled on cabotegravir.
She would prefer the convenience of the lenacapavir injection, but it is rarely available.
“I go there, to check if it is there, they tell me that it is finished,” she says.
Mutoni says access to lenacapavir would benefit sex workers who sometimes shift elsewhere for five months or longer, not having to remember to take a daily pill would help many to protect themselves more effectively.
Mutoni gets counseling and other support, including condoms, from Action for Improved Health and Wealth.
The US and the Global Fund want to purchase lenacapavir for up to 3 million people by the end of 2028.
While the 2026 projection is to reach 600,000 people in 24 countries, by mid-September 430,000 doses — 327,000 initiation doses and 103,000 continuation doses — had been delivered, with national programs reporting more than 118,000 people receiving lenacapavir, according to the Global Fund.
Drugmaker Gilead said in a statement to the AP that it shares “the sense of urgency" on expanding access to lenacapavir.
That statement said Gilead will provide “no-profit lenacapavir supply through our partnerships with the Global Fund and PEPFAR while licensed generic manufacturers scale production, with initial generic supply expected in late 2026 and widespread generic availability expected in 2027.”