South Africa, Eswatini and Zambia on Monday became the first countries in Africa to administer lenacapavir, a groundbreaking injectable drug that reduces the risk of HIV infection by more than 99.9%, effectively functioning as a long-acting vaccine.
The twice-yearly injection marks the most powerful HIV prevention tool ever made publicly available and was launched on World AIDS Day in the three countries hardest hit by the epidemic.
In South Africa, which has the world’s largest HIV burden with one in five adults living with the virus, the first doses were given under a Unitaid-funded programme led by the Wits Reproductive Health and HIV Institute (Wits RHI).
“The first individuals have begun using lenacapavir for HIV prevention in South Africa… marking real-world use of the six-monthly injectable in low- and middle-income countries for the first time,” Unitaid said in a statement.
Neighbouring Eswatini and Zambia each received 1,000 doses through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and officially launched the drug at national World AIDS Day events. In Eswatini’s Hhukwini constituency, dozens of people queued for the shot amid music and celebrations.
“Today marks a turning point in our national HIV response,” Eswatini Prime Minister Russell Dlamini said. “This injection gives us fresh hope and a powerful tool to protect our citizens.”
Manufacturer Gilead Sciences has pledged to supply lenacapavir at no profit to two million people in high-burden countries over the next three years under the PEPFAR programme. However, South Africa – despite participating in the drug’s clinical trials – is excluded from U.S. donations.
A senior U.S. State Department official said Washington expects South Africa, as an upper-middle-income country, to fund its own supply.
The list price in the United States is approximately $28,000 per person per year. Generic versions, expected from 2027 through licensing agreements with Indian manufacturers facilitated by Unitaid and the Bill & Melinda Gates Foundation, are projected to cost around $40 per patient annually in more than 100 low- and middle-income countries.
Eastern and southern Africa account for 52% of the world’s 40.8 million people living with HIV. Health advocates warn that current donation volumes fall far short of need and have called for faster, broader access to the game-changing prevention method.
Previous daily oral PrEP pills have been available for over a decade but have had limited uptake due to adherence challenges. Lenacapavir’s six-month dosing schedule is expected to dramatically improve coverage and impact.