Six-Month HIV Prevention Injection Rolled Out

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.

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.

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.

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.

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.

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.

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

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.

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.