A Breakthrough HIV Prevention Drug Reaches Africa

Five months after the United States approved a groundbreaking HIV-prevention drug, a major shift is unfolding across Southern Africa. Zambia and Eswatini—two countries with some of the highest HIV burdens in the world—have begun receiving the first shipments of lenacapavir, a long-acting injectable that can prevent HIV infection with just two doses per year.

This historic rollout is more than a scientific milestone. It is a statement of global equity, a sign that transformative innovations are no longer reserved for wealthy nations alone, and a lifeline for communities still grappling with high infection rates.

Why Zambia and Eswatini Are Critical to the Fight Against HIV

Eswatini: At the Frontline of the Epidemic

Eswatini has long carried one of the world’s heaviest HIV burdens:

• 25.9% of adults (15–49) are living with HIV.

• 4,000 new infections occur annually.

• Women are disproportionately affected, with an incidence rate of 1.11%, compared to 0.17% among men.

• The nation has achieved remarkable treatment success, attaining the 95–95–95 UNAIDS targets a full decade early:

  • 94% know their status

  • 97% are on treatment

  • 96% are virally suppressed

    
    

Despite this progress, the epidemic persists. Community activists like Hannie Dlamini, who helped establish early HIV networks, emphasize that prevention is the next frontier—especially for young women, who remain at high risk due to biological, social, and economic factors.

Zambia: High Infections Among Young People

Zambia’s HIV story reveals both major progress and lingering challenges:

• 1.4 million people are living with HIV.

• Adult prevalence stands at 10.8%.

• In 2024, the country recorded 23,000 new infections, more than one-third among adolescents and young adults.

• Alarmingly, young people aged 10–19 account for 50% of the new annual infections, and an estimated 90,000 adolescents are living with HIV.

• On the positive side, Zambia has achieved impressive treatment coverage:

  • 96% know their status

  • 98% are on treatment

  • 97% are virally suppressed

    
    

The urgency is clear: Zambia needs stronger prevention tools that fit the realities of young people’s lives—tools that do not rely on daily pills or risky negotiations of condom use.

The Drug: What Makes Lenacapavir a Game-Changer?

Lenacapavir is the first-ever twice-yearly injectable PrEP (pre-exposure prophylaxis)—a true breakthrough in HIV prevention.

Here’s why public health experts are calling it revolutionary:

• Only two injections per year are needed.

• It eliminates the difficulty of daily pill adherence, which has long hindered oral PrEP effectiveness.

• It offers discreet, stigma-free protection.

• It is especially suited for adolescent girls and young women, who often face barriers to consistent prevention.

Daniel O’Day, CEO of Gilead Sciences, called the African rollout a historic milestone:

“The arrival of the first doses of lenacapavir in Eswatini and Zambia marks an important milestone. For the first time, a new HIV medicine is reaching communities in sub-Saharan Africa in the same year as its U.S. approval.”

For a region where HIV has shaped generations, a semiannual injection could fundamentally shift the trajectory of the epidemic.

The U.S.-Backed Rollout: 500 Doses Each for Zambia and Eswatini

In an effort to ensure rapid uptake in high-burden countries, the U.S. State Department announced that Zambia and Eswatini will each receive 500 donated doses of lenacapavir.

This rollout is part of a broader alliance involving:

• PEPFAR (U.S. President’s Emergency Plan for AIDS Relief)

• The Global Fund

• Gilead Sciences

• Local Ministries of Health

• Community organizations

The goal is not simply to deliver a few thousand doses—it is to establish an effective pathway for long-term access across low- and middle-income countries.

Gilead has also signed royalty-free licensing agreements with generic manufacturers to eventually supply lenacapavir to 120 high-incidence, resource-limited countries, ensuring affordability in the coming years.

Why This Rollout Matters Now More Than Ever

1. A Lifeline for Young Women and Girls

In Eswatini and Zambia, young women shoulder a disproportionate share of new infections. Many face cultural, economic, and relationship dynamics that make traditional prevention nearly impossible.

A twice-yearly injection gives them autonomy—and safety.

2. A Tool for Ending New Infections

In both countries, the epidemic has shifted: treatment is strong, but prevention gaps remain. Lenacapavir directly targets this gap.

3. A New Model of Global Health Equity

For decades, African nations waited years—sometimes decades—for access to new medical innovations. The speed of lenacapavir’s arrival marks a shift toward fairness and urgency.

4. Better Adherence, Better Outcomes

Daily oral PrEP has always been effective—but real-world adherence is low. Long-acting PrEP removes this obstacle.

5. Community-Centered Implementation

From clinics to grassroots organizations, communities have helped shape how lenacapavir will be introduced, especially among adolescents and key populations.

Peter Sands, Executive Director of the Global Fund, puts it simply:

“If we deploy this innovation at scale and speed, we can transform prevention—not just for the few, but for entire communities at greatest risk.”

Challenges That Could Shape the Impact

While promising, the rollout is still vulnerable to several challenges:

Limited Initial Supply

The first donation—500 doses per country—is largely symbolic. True impact will require large-scale manufacturing and broader distribution.

Awareness Barriers

People need information and reassurance: What is this drug? Is it safe? Where can they get it?

Stigma and misinformation could slow uptake.

Health System Readiness

A twice-yearly injection requires trained staff, reliable supply chains, consistent follow-up, and community education.

Sustained Funding

Cost-sharing among donors, governments, and private partners must be secure. Budget cuts could undermine the entire rollout.

Equitable Access

The highest-risk groups—especially adolescent girls, young women, and key populations—must be centered in distribution strategies.

A Turning Point for HIV Prevention?

The arrival of lenacapavir in Zambia and Eswatini represents a powerful possibility: that ending new HIV infections is no longer a distant dream but a realistic public-health goal.

These initial shipments will not end the epidemic—but they can begin to shift its direction, especially if:

• Governments prioritize scale-up

• Communities embrace the new tool

• Donors sustain their funding commitments

• Health systems integrate injectable PrEP effectively

If done right, this could be the moment future generations look back on as a turning point—the moment innovation, equity, and political will converged.

A Chance to Change the Future

For Zambia and Eswatini, lenacapavir offers more than convenience. It offers hope.

Hope that young women will no longer carry the burden of new infections.

Hope that the next generation will grow up without fear of HIV.

Hope that scientific breakthroughs will finally reach the communities that need them most—when they need them.

The path ahead requires commitment, education, and bold investment. But for the first time in a long time, the future of HIV prevention looks radically different—and far more promising.