A major milestone in the global fight against HIV was recorded on Monday as South Africa, Eswatini, and Zambia began administering lenacapavir—an innovative twice-yearly injection that has demonstrated extraordinary success in preventing transmission.
The introduction marks the first time the drug is being deployed publicly on the African continent, which continues to bear the heaviest burden of the global HIV epidemic.
Health authorities describe lenacapavir as a breakthrough: clinical trials show that the long-acting injectable reduces the risk of infection by more than 99.9 per cent, making it one of the most effective HIV-prevention tools ever developed and comparable to a potent vaccine in its protective ability.
In South Africa, where nearly 20 per cent of adults live with the virus—the initial rollout is being coordinated by a research unit at the University of the Witwatersrand as part of a wider programme backed by Unitaid, a United Nations health financing agency.
Unitaid confirmed that the first group of recipients had already begun using the injection, making South Africa among the earliest low- and middle-income countries to introduce the six-monthly treatment outside clinical trials.
The organisation did not disclose the exact number of people who received doses but said the move lays the groundwork for a nationwide scale-up expected in 2026.
In the United States, the drug costs as much as $28,000 annually per user—an amount that global health advocates warn is unaffordable for most people in high-burden regions.
Zambia and Eswatini, which received 1,000 doses through a U.S.-supported initiative in November, were also scheduled to begin administering the injection during their World AIDS Day observances.
Under agreements with the programme’s sponsors, the manufacturer, Gilead Sciences, has pledged to supply lenacapavir at no profit to two million people across high-burden countries over the next three years.
However, public-health groups argue that this commitment represents only a fraction of Africa’s true needs.
Eastern and southern Africa remain the global epicentre of the HIV epidemic, accounting for more than half of the 40.8 million people living with the virus worldwide, according to UNAIDS’ 2024 data.
Access is expected to improve significantly from 2027, when generic versions—priced at roughly $40 per year—are projected to enter the market under licensing agreements facilitated by Unitaid and the Bill & Melinda Gates Foundation with several Indian pharmaceutical manufacturers.
For more than a decade, HIV prevention has relied heavily on daily oral PrEP medication. Although effective, adherence challenges have limited its overall impact.
Health experts say lenacapavir’s long-acting nature could transform prevention strategies, especially for young women and other high-risk groups who face barriers to taking daily tablets.
The rollout is being hailed as a defining moment in Africa’s public-health response—one that could reshape the continent’s progress against HIV over the next decade.
