South Africa, Eswatini and Zambia have begun administering a pioneering HIV-prevention injection, marking the first public rollout of the treatment in Africa the region with the world’s highest HIV burden.
The twice-yearly injection, known as lenacapavir, has been shown to reduce the risk of HIV transmission by more than 99.9%, offering protection comparable to a highly effective vaccine.
In South Africa, where roughly one in five adults is living with HIV, the rollout is being overseen by a Wits University research unit as part of a Unitaid-funded initiative.
“The first individuals have begun using lenacapavir for HIV prevention in South Africa, making it among the first real-world uses of the six-monthly injectable in low- and middle-income countries,” Unitaid said in a statement. The agency did not confirm how many people received the initial doses. A broader national rollout is planned for next year.
Zambia and Eswatini, which received 1,000 doses each last month through a US-backed programme, were also expected to introduce the drug during World AIDS Day events on Monday.
Under the programme, manufacturer Gilead Sciences has committed to providing lenacapavir at no profit to two million people in high-burden countries over the next three years. However, critics argue that this falls far short of regional needs and note that the drug’s US market price about $28,000 per person per year is far beyond the reach of most Africans.
According to UNAIDS 2024 data, eastern and southern Africa account for 52% of the 40.8 million people living with HIV globally.
Generic versions of lenacapavir are expected to become available from 2027 at an estimated cost of around $40 per year, following agreements between Unitaid, the Gates Foundation and Indian pharmaceutical manufacturers.
PrEP has been available for more than a decade, but its reliance on daily tablets has limited uptake making the long-acting injection a potential game-changer in the fight against new HIV infections.