Groundbreaking HIV Prevention: Biannual Lenacapavir Injections Launch in African Nations

In South Africa, one in five adults is living with HIV. (Representational)

South Africa, Eswatini and Zambia have initiated the first public rollouts of a revolutionary HIV-prevention injection in Africa, the continent bearing the highest HIV burden globally.

Lenacapavir, administered just twice yearly, demonstrates over 99.9 percent effectiveness in reducing HIV transmission risk, functioning essentially as a powerful vaccine equivalent.

In South Africa's significant HIV landscape, a research unit from Wits University coordinated the rollout as part of a Unitaid-funded United Nations health initiative.

"The first individuals have started receiving lenacapavir for HIV prevention in South Africa... making it among the earliest real-world applications of the six-monthly injectable in low- and middle-income countries," Unitaid announced in their statement.

The statement didn't specify recipient numbers for the initial doses of the drug, which costs $28,000 annually per person in the United States. A more extensive national implementation is anticipated next year.

Neighboring countries Zambia and Eswatini received 1,000 doses in the previous month through a US program and officially launched the drug during World AIDS Day events on Monday.

In Eswatini's Hhukwini constituency, numerous people queued for injections during a vibrant public ceremony featuring music and dancing.

"Today represents a pivotal moment in our national HIV response," Prime Minister Russell Dlamini stated, adding that the injection "provides fresh hope and a powerful protective tool for our citizens."

Under the US initiative, manufacturer Gilead Sciences has committed to supplying lenacapavir at cost to two million individuals in high-HIV-burden countries over three years.

However, Washington—currently at odds with Pretoria on various policy matters—will not provide doses to South Africa despite its involvement in clinical trials.

"Naturally, we encourage every country, particularly those like South Africa with substantial resources, to fund doses for their population," Jeremy Lewin, a senior US State Department official, informed reporters in late November.

Critics argue that US deliveries fall significantly short of actual needs and that the market price remains unaffordable for most individuals.

Eastern and southern Africa represent approximately 52 percent of the 40.8 million people living with HIV globally, according to 2024 UNAIDS data.

In Zambia alone, roughly 1.4 million people are living with HIV, with 30,000 new infections annually according to health ministry figures, while in Eswatini approximately 220,000 people live with the virus in the small kingdom of 1.2 million inhabitants.

Generic versions of lenacapavir are expected to become available from 2027 at approximately $40 per year in over 100 countries, through agreements established by Unitaid and the Gates Foundation with Indian pharmaceutical companies.

Pre-exposure prophylaxis, or PrEP, has been utilized for more than a decade for HIV prevention, but its dependence on daily pill regimens has restricted its impact on global infection rates.