Six-Month HIV Prevention Injection Rolled Out

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A groundbreaking HIV-prevention injection is being introduced in South Africa, Eswatini and Zambia, marking the first public rollout of the treatment in Africa — the region with the highest HIV burden in the world.

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The injectable drug, lenacapavir, is administered twice a year and has shown remarkable results, reducing the risk of HIV transmission by more than 99.9%. Experts have described it as functioning almost like a powerful vaccine due to its long-lasting protection.

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In South Africa — where an estimated one in five adults lives with HIV — the rollout is being overseen by a Wits University research unit as part of a Unitaid-funded initiative. Unitaid confirmed that the first individuals have now begun receiving the 6-monthly injection, placing the country among the first low- and middle-income nations to access the treatment outside clinical trials.

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While Unitaid did not disclose how many people received the initial doses, the drug’s cost in the United States — around $28,000 (over R500,000) per person annually — has raised concerns about global accessibility. A wider national rollout in South Africa is expected next year.

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Neighbouring Zambia and Eswatini, which each received 1,000 doses last month through a United States-backed programme, were expected to launch their public rollouts during World AIDS Day commemorations.

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As part of the programme, Gilead Sciences, the drug’s manufacturer, has committed to supplying lenacapavir at no profit to two million people across high-burden countries over the next three years. However, health activists argue that this supply falls far short of the actual need.

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According to UNAIDS 2024 data, eastern and southern Africa account for 52% of the 40.8 million people living with HIV globally.

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More affordable generic versions of lenacapavir are expected from 2027, through agreements facilitated by Unitaid and the Bill & Melinda Gates Foundation with manufacturers in India. These generics are expected to cost about $40 per year, improving access across more than 100 countries.

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Although pre-exposure prophylaxis (PrEP) has been available for over a decade, the requirement of a daily pill has limited its uptake. Health experts believe the new twice-yearly injection could be a game-changer in preventing new infections across the continent.

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