Three African nations launched the first public rollouts of a revolutionary HIV prevention injection on Monday, marking a historic milestone in the fight against the epidemic on the continent hardest hit by the disease.
South Africa, Eswatini, and Zambia began administering lenacapavir, a twice-yearly injection that has demonstrated remarkable effectiveness in preventing HIV transmission – reducing risk by more than 99.9 percent and functioning essentially as a powerful vaccine.
The launch comes at a critical time for the region. In South Africa alone, one in five adults lives with HIV, while eastern and southern Africa account for approximately 52% of the world’s 40.8 million people living with HIV, according to 2024 UNAIDS data.
“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, the United Nations health agency, said in a statement.
The South African rollout is being overseen by a Wits University research unit as part of an initiative funded by Unitaid. While officials did not specify how many people received the first doses, a broader national rollout is expected next year.
Neighboring Zambia and Eswatini received 1,000 doses last month through a U.S. program and launched the drug during World AIDS Day ceremonies on Monday.
The initiative represents a significant step forward, though challenges remain. The drug currently costs approximately R480 000 per person annually in the United States – a price point that puts it far out of reach for most people in affected regions.
Under a new program, manufacturer Gilead Sciences has committed to providing lenacapavir at no profit to two million people in high HIV-burden countries over the next three years. However, critics argue this falls well short of actual need and that market pricing remains prohibitive for widespread access.
Relief may come in 2027, when generic versions of lenacapavir are expected to become available at approximately R684 per year in more than 100 countries. These affordable alternatives will be made possible through agreements negotiated by Unitaid and the Gates Foundation with Indian pharmaceutical companies.
The new injection addresses significant limitations in current HIV prevention methods. While pre-exposure prophylaxis (PrEP) has been available for over a decade, its reliance on daily pills has limited its impact on reducing global infections. The twice-yearly injection schedule of lenacapavir promises to dramatically improve adherence and effectiveness.
The rollout represents a watershed moment in HIV prevention, offering new hope for reducing transmission rates in the regions most affected by the epidemic.
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