Crystal Dike
South Africa, Eswatini and Zambia on Monday began administering a groundbreaking new HIV-prevention injection in the first public rollouts of the drug in Africa, the region with the world’s highest HIV burden.
The drug, lenacapavir, taken twice a year, has been shown in clinical trials to reduce the risk of HIV transmission by more than 99.9 per cent, making it functionally comparable to a highly effective vaccine.
In South Africa, where about one in five adults lives with HIV, the rollout is being overseen by a University of the Witwatersrand (Wits) research unit under an initiative funded by Unitaid, a United Nations-backed global 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 six-monthly injectable in low- and middle-income countries,” Unitaid said in a statement on Monday.
Unitaid did not disclose how many people have received the initial doses. In the United States, lenacapavir costs about $28,000 per person annually, though a wider national rollout in South Africa is expected next year.
Neighbouring Zambia and Eswatini received 1,000 doses in November under a United States-supported programme and formally launched the drug during World AIDS Day activities on Monday.
Under the programme, manufacturer Gilead Sciences has agreed to supply lenacapavir at no profit to two million people in high-burden countries over three years.
However, public health advocates have criticised the limited supply, noting that it falls far short of actual demand and that current market prices remain unaffordable for most people in low-income settings.
According to 2024 data from UNAIDS, eastern and southern Africa account for about 52 per cent of the 40.8 million people living with HIV worldwide.
Generic versions of lenacapavir are expected to become available from 2027 at an estimated cost of about $40 per person per year in more than 100 countries, following licensing agreements between Unitaid, the Bill and Melinda Gates Foundation, and Indian pharmaceutical manufacturers.
While pre-exposure prophylaxis (PrEP) has been used globally for over a decade to prevent HIV infection, its reliance on daily pills has limited its overall impact. Health experts say the long-acting injectable could significantly strengthen global HIV prevention efforts.