Step 1: When a disease is in equilibrium, the number of existing cases (prevalence) builds up from the rate of new cases multiplied by how long each case lasts.
Step 2: This is captured by $P = I \times D$, so we simply combine the new-case rate with the mean duration.
Step 3: Plugging in an incidence of $4/1000$ and an average duration of $2$ years gives \[P = \frac{4}{1000} \times 2 = \frac{8}{1000}.\]
Step 4: So twice the annual incidence accumulates because each case persists for two years, giving a prevalence of 8 per 1000.
\[\boxed{8/1000}\]