In a landmark move for public health, three African nations have initiated the first public rollouts of a revolutionary HIV prevention injection. This long-acting shot, requiring administration only twice a year, promises to dramatically alter the fight against a disease that disproportionately affects the continent.
A New Era in HIV Prevention Begins
On Monday, December 1st, which marked World AIDS Day, South Africa, Eswatini, and Zambia began administering the groundbreaking drug lenacapavir. This event represents the first time this innovative prevention tool has been made available through public health programs in Africa, the region bearing the world's highest HIV burden.
Currently, most people at risk of HIV rely on daily oral pills for pre-exposure prophylaxis (PrEP). While effective, the need for daily adherence has limited its overall impact on reducing global infection rates. The new injection offers a powerful alternative. Clinical trials have shown that lenacapavir reduces the risk of contracting HIV by more than 99.9%, making its protective function similar to a highly effective vaccine.
Rollout Details and Initial Implementation
The initial phase of this historic rollout is being closely watched. In South Africa, where approximately one in five adults lives with HIV, the process is being overseen by a Wits University research unit. This effort is part of an initiative funded by Unitaid, the United Nations global health agency.
Unitaid confirmed the milestone, stating, "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 exact number of people who received the first doses was not immediately disclosed.
Neighbouring Zambia and Eswatini received 1,000 doses last month as part of a program supported by the United States. They officially launched the administration of the drug during their World AIDS Day ceremonies.
Addressing Cost and Accessibility Challenges
A significant hurdle remains the cost of the drug. In the United States, lenacapavir carries a price tag of about $28,000 per person annually, a figure far beyond the reach of most healthcare systems and individuals in Africa. Under a current access program, the manufacturer, Gilead Sciences, has agreed to supply the drug at no profit for up to two million people in high-burden countries over three years.
However, health advocates argue this commitment falls short of the actual need. The long-term solution lies in the production of generic versions. Through agreements negotiated by Unitaid and the Bill & Melinda Gates Foundation with Indian pharmaceutical companies, generic lenacapavir is expected to become available from 2027 at a projected cost of around $40 per year in over 100 countries.
The need for scalable solutions is urgent. According to 2024 UNAIDS data, eastern and southern Africa are home to roughly 52% of the 40.8 million people living with HIV worldwide. South Africa is planning a broader national rollout of the injection in the coming year, signaling a strong commitment to adopting this new technology.
This shift from a daily pill to a twice-yearly injection represents one of the most significant advances in HIV prevention in over a decade. It offers hope for substantially curbing new infections, especially among populations where daily pill-taking is challenging, potentially turning the tide in the decades-long battle against the HIV epidemic.
