In a landmark moment for global health, South Africa, Eswatini, and Zambia have begun administering lenacapavir — a groundbreaking twice-yearly HIV-prevention injection shown to reduce transmission risk by more than 99.9 percent.
This makes the medicine functionally comparable to a highly effective vaccine.
The public rollout, announced on Monday, marks the first real-world use of the long-acting injectable in African nations, which collectively carry the highest HIV burden in the world.
Lenacapavir’s debut in South Africa was overseen by a Wits University research unit as part of an initiative funded by Unitaid, a United Nations health agency.
It is the first real-world use of the six-monthly injectable in low- and middle-income countries,” Unitaid said in a statement.
South Africa, where one in five adults lives with HIV, is expected to expand the rollout nationally next year. The organization did not disclose how many people received the first doses.
Neighboring Zambia and Eswatini received 1,000 doses each last month through a U.S. programme and officially launched the drug during World AIDS Day ceremonies. In Eswatini’s Hhukwini constituency, dozens gathered at a lively, music-filled public event to receive the injection.
Under the U.S. programme, manufacturer Gilead Sciences has committed to supplying lenacapavir at no profit to two million people in high-burden countries over three years. However, political tensions between Washington and Pretoria mean South Africa will not receive U.S.-funded doses, despite having hosted clinical trials for the drug.
“Countries like South Africa, that have significant means of their own, should fund doses for their own population,” said Jeremy Lewin, a senior U.S. State Department official.
Still, critics point out that the number of doses provided is far below actual need — and the current U.S. market price, $28,000 per person per year, makes it unattainable for most low-income regions.
Eastern and southern Africa remain the epicentre of the HIV epidemic, accounting for 52 percent of the 40.8 million people living with HIV globally, according to UNAIDS 2024 data. Zambia alone has about 1.4 million people living with HIV, with approximately 30,000 new infections each year. Eswatini, with a population of just 1.2 million, has around 220,000 people living with the virus.
Generic versions of lenacapavir are expected by 2027, priced at around $40 per year through agreements between Unitaid, the Gates Foundation, and Indian manufacturers. This could transform access across more than 100 countries.
For over a decade, HIV prevention has relied heavily on daily pre-exposure prophylaxis (PrEP) pills — an effective but adherence-dependent method. By contrast, a twice-yearly injection could drastically improve uptake and consistency, potentially reshaping the global HIV landscape.