Eswatini, a small kingdom in southern Africa, has become the first African country to receive lenacapavir, a groundbreaking HIV prevention injection. This twice-yearly shot, developed by Gilead Sciences, offers near-total protection against HIV, a virus that has claimed the lives of millions across the continent. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has partnered with the Global Fund to introduce this life-saving medication to 10 high-risk African countries, with a goal of reaching at least 2 million people by 2027. The U.S. approved lenacapavir in June, and Eswatini, with its high HIV incidence, is the first to receive it.
The U.S. initially planned to distribute 250,000 doses this year, but due to early demand, this number was increased to 325,000. This is a significant step in the fight against HIV, as over 25 million people across Africa are living with the virus. In Eswatini, approximately 6,000 high-risk individuals will benefit from the initial rollout, primarily to prevent mother-to-child HIV transmission. The country currently has over 200,000 HIV-positive individuals, with most receiving treatment funded by PEPFAR.
However, the introduction of lenacapavir has sparked debate. Civil society groups in South Africa, the most advanced economy in sub-Saharan Africa, have criticized Gilead for excluding local manufacturers from voluntary licensing agreements, despite their involvement in clinical trials. This has raised questions about access and manufacturing rights. The steep price reduction from over $28,000 per person annually in the U.S. to approximately $40 for lower-income countries is a positive step, but the limited supplies when South Africa begins its rollout in 2026 are a concern. The World Health Organization has approved lenacapavir as an additional HIV prevention option, and UNAIDS has praised long-acting injectables as a 'fresh option' to combat HIV infections.
