Africa has begun administering a groundbreaking HIV-prevention injection that experts say could transform public health across the continent. South Africa, Eswatini, and Zambia launched the first public rollouts of lenacapavir on Monday, marking the drug’s debut in regions with the world’s highest HIV burden.
Lenacapavir, taken twice a year, has demonstrated more than 99.9% effectiveness in preventing HIV transmission, giving it the functional strength of a long-acting vaccine. Health officials say this is the most significant breakthrough in HIV prevention in decades.
South Africa Leads the Rollout
South Africa, where one in five adults lives with HIV, is at the centre of the launch. A Wits University research team is overseeing deployment under a programme funded by Unitaid, a United Nations health agency working to expand access to critical medicines.
Unitaid said, “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.” The agency did not disclose how many people have received the initial doses, but a broader national rollout is slated for next year.
Regional Expansion Underway
Zambia and Eswatini received 1,000 doses each last month through a U.S.-backed initiative and were expected to officially begin administering the drug during World AIDS Day events on Monday. Under this programme, manufacturer Gilead Sciences committed to supplying lenacapavir at no profit to two million people across high-burden countries over three years.
Critics argue that this commitment falls short of current needs, noting that the U.S. market price of $28,000 per person annually places the drug far beyond reach for most patients.
Affordability and the Road to Generics
Eastern and southern Africa account for 52% of the world’s 40.8 million people living with HIV, according to 2024 UNAIDS data, underscoring the urgency of affordable rollout across the region. Relief may arrive in 2027 when generic versions, priced at about $40 per year, are expected to become available in over 100 countries.
For more than a decade, HIV prevention efforts leaned heavily on daily PrEP pills, but adherence challenges limited their global impact. A twice-yearly injection, experts say, could significantly boost uptake and protection.