Africa has begun administering a revolutionary HIV-prevention injection that offers 99.9 percent protection, in what experts describe as one of the most significant advances in the global HIV response in decades.
South Africa, Zambia, and Eswatini on Monday launched the first public rollout of lenacapavir, a twice-yearly injectable drug that functions much like a powerful vaccine and is expected to transform HIV prevention across the continent, which bears the world’s highest HIV burden.
Lenacapavir, developed by Gilead Sciences, has been shown to reduce the risk of HIV transmission by more than 99.9 percent. In South Africa—where roughly one in five adults lives with HIV—the initial rollout was overseen by a Wits University research unit as part of a Unitaid-funded initiative.
“The first individuals have begun using lenacapavir for HIV prevention in South Africa … making it among the first real-world use of the 6-monthly injectable in low- and middle-income countries,” Unitaid said in a statement. The agency did not disclose how many people received the initial doses. In the United States, the drug costs about $28,000 per person annually, though South Africa is expected to expand access nationally next year.
Zambia and Eswatini, which each received 1,000 doses under a U.S. programme in November, were expected to begin administering the injection during World AIDS Day events on Monday.
Under the programme, Gilead has committed to supplying lenacapavir at no profit to two million people over the next three years in countries with high HIV prevalence. Critics, however, say the commitment falls far short of demand and warn that the commercial price remains inaccessible for most Africans.
Eastern and southern Africa account for about 52 percent of the 40.8 million people living with HIV globally, according to UNAIDS 2024 data.
To address long-term affordability, generic versions of lenacapavir are expected to enter the market in 2027 at roughly $40 per person annually in more than 100 countries, following agreements brokered by Unitaid and the Gates Foundation with Indian pharmaceutical manufacturers.
Pre-exposure prophylaxis (PrEP) has been available for more than a decade, but widespread uptake has been hindered by its daily pill regimen—an obstacle lenacapavir’s twice-yearly injection seeks to overcome.
