The drug, which is taken twice a year, has been shown to reduce HIV transmission by over 99.9 percent, functioning similarly to a potent vaccine. In South Africa, where one in five adults lives with HIV, a Wits University research unit led the rollout under an initiative funded by Unitaid, aimed at ensuring equitable access to medical innovations.
“The first individuals have begun using lenacapavir for HIV prevention in South Africa… making it among the first real-world use of the six-monthly injectable in low- and middle-income countries,” Unitaid said, though the number of initial recipients was not disclosed. A broader national rollout is expected next year.
Neighbouring Zambia and Eswatini received 1,000 doses last month through a U.S. program and launched the drug on World AIDS Day. In Eswatini, Prime Minister Russell Dlamini hailed the injection as a “powerful tool to protect our citizens,” while Zambia’s Health Minister Elijah Muchima encouraged HIV-positive volunteers to access the jab.
Under the program, manufacturer Gilead Sciences will provide lenacapavir at no profit to two million people in high-HIV-burden countries over three years. However, the U.S. will not provide doses to South Africa despite its participation in clinical trials, citing the country’s ability to fund the drug independently.
Critics warn that limited availability and high market prices put the drug out of reach for most Africans. Eastern and Southern Africa account for 52% of the 40.8 million people living with HIV worldwide, with Zambia alone recording 1.4 million people living with HIV and 30,000 new infections each year.
WHO Chief Tedros Adhanom Ghebreyesus warned that progress against HIV is “now at risk” and called for rapid scale-up of lenacapavir. Generic versions are expected by 2027, at around $40 per year, through agreements facilitated by Unitaid and the Gates Foundation with Indian pharmaceutical companies.
Lenacapavir offers an alternative to daily pre-exposure prophylaxis (PrEP), whose reliance on daily pills has limited its impact on global HIV infections.
This rollout marks a milestone in HIV prevention in Africa, potentially transforming the fight against a virus that continues to affect millions across the continent.