South Africa, Eswatini, and Zambia on Monday began administering a revolutionary HIV-prevention injection, marking the drug’s first public rollout in Africa, the region with the world’s highest HIV burden.
The injectable drug, lenacapavir, is taken twice a year and has demonstrated a more than 99.9% reduction in HIV transmission risk, making it functionally comparable to a powerful vaccine.
First doses administered in South Africa
In South Africa—where one in five adults is living with HIV—a Wits University research unit led the rollout, funded by Unitaid, a United Nations health agency.
“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,” Unitaid confirmed.
The agency did not disclose how many people received the initial doses. In the United States, the drug costs around $28,000 per person annually, though a wider national rollout across South Africa is expected next year.
Zambia and Eswatini also launch programmes
Neighbouring Zambia and Eswatini received 1,000 doses each last month under a U.S.-supported programme. Both countries were expected to officially launch the injection during World AIDS Day ceremonies on Monday.
Under this programme, manufacturer Gilead Sciences has agreed to supply lenacapavir at no profit to two million people in high HIV-burden countries over the next three years.
However, experts argue this commitment falls short of the true need, and the drug’s current market price remains inaccessible for most people.
Cheaper generic versions expected from 2027
Eastern and southern Africa account for 52% of the world’s 40.8 million people living with HIV, according to 2024 UNAIDS data.
To improve access, generic versions of lenacapavir are expected by 2027, priced at around $40 per year across more than 100 countries. This will be made possible through agreements between Unitaid, the Bill & Melinda Gates Foundation, and Indian pharmaceutical manufacturers.
A major advance beyond daily PrEP pills
Pre-exposure prophylaxis (PrEP) has been used globally for more than a decade, but the need for daily pill adherence has limited its effectiveness. The twice-yearly injection could dramatically increase uptake and help curb new infections across high-risk regions.
