A new era in HIV prevention has commenced across Southern Africa with the landmark public rollout of lenacapavir, a groundbreaking injectable medication demonstrating unprecedented efficacy against HIV transmission. The revolutionary prevention tool, administered just twice annually, has shown remarkable 99.9% effectiveness in clinical trials, positioning it as a functional equivalent to a powerful vaccine against the virus.
South Africa, Eswatini, and Zambia initiated their respective programs on World AIDS Day, marking the first real-world implementation of this long-acting preventive solution in low- and middle-income nations. The Wits University research unit in South Africa—where approximately 20% of adults live with HIV—spearheaded the rollout through an initiative funded by Unitaid, the United Nations global health agency.
The launch ceremonies featured significant public engagement, with dozens lining up for injections in Eswatini’s Hhukwini constituency amid celebratory songs and dances. Eswatini’s Prime Minister Russell Dlamini declared the development “a turning point in our national HIV response” that provides “fresh hope and a powerful tool to protect our citizens.”
Despite the enthusiasm, significant challenges remain regarding accessibility and cost. The medication carries a staggering $28,000 annual price tag per person in the United States, raising concerns about affordability in resource-limited settings. Under a current arrangement, manufacturer Gilead Sciences has committed to providing lenacapavir at no profit to two million people in high-HIV burden countries over three years through a US program.
Notably, South Africa—despite its participation in clinical trials—will not receive doses through this initiative due to ongoing policy disagreements between Washington and Pretoria. A senior US State Department official indicated that countries with substantial means should fund their own prevention programs.
Health advocates emphasize the critical need for expanded access throughout Eastern and Southern Africa, which accounts for 52% of the global HIV burden according to 2024 UNAIDS data. The region continues to face severe challenges, with Zambia reporting approximately 1.4 million people living with HIV and 30,000 new infections annually.
The future outlook appears promising, with generic versions expected to become available by 2027 through agreements between Unitaid, the Gates Foundation, and Indian pharmaceutical companies. These generic alternatives are projected to cost approximately $40 annually, potentially transforming HIV prevention accessibility across more than 100 countries.