Several African countries are introducing lenacapavir, a long-acting PrEP injection manufactured by Gilead, given twice a year to prevent HIV. Eswatini was the first country to receive the rollout; the nation has about 220,000 people living with HIV, which is 23.4 per cent of its population. A pilot programme ran at five sites from December 2025 to February this year and distribution expanded to 27 sites, reaching an estimated 3,000 people. Officials said roughly two thirds of recipients were women, and the initial stock ran low because demand outpaced supply.
Humanitarian groups reported very small allocations. Médecins Sans Frontières said it received 70 doses at one clinic in Eswatini and used them within weeks, while a clinic in Kenya worked with fewer than 40 doses. In April, Gilead and distribution partners PEPFAR and the Global Fund pledged to extend supplies to an additional one million people in low- and middle-income countries, bringing the total commitment to three million people over three years. Gilead’s chief executive said the company was supplying lenacapavir to those partners at no profit. Large-scale rollout of generic versions by other manufacturers is expected from 2027.
MSF criticised the extra supply as "a tiny fraction of what’s needed" and noted that Argentina, Brazil, Mexico and Peru were excluded from the generic licensing deal; those excluded countries account for a quarter of new HIV infections. MSF said it was told to procure the drug through the Global Fund when it tried to buy directly and pointed out the US price of about US$28,000 per patient per year. In Kenya an initial consignment of 21,000 starter doses arrived in February, with continuation doses expected and further pledges announced; the first phase began in March across 15 high-burden counties, with an estimated annual patient cost of 7,800 Kenyan Shillings (US$60). Community groups and organisations working in informal settlements warned that transport costs, lost wages, clinic waits and low awareness will limit uptake.
One community group in Nairobi’s Kibera slum said its sites were not included in phase one and is working as a bridge to improve access by strengthening referral paths, training staff and pushing for priority for adolescent girls and young women. It called for deeper subsidies, small transport stipends and faster data-sharing between clinics. The group is also building links with Kenya’s Population-Based Integrated Disease Surveillance programme to monitor safety and support more equitable uptake.
- Calls for deeper subsidies and targeted waivers
- Requests for small transport stipends
- Need for fast data-sharing between clinics
Difficult words
- rollout — gradual introduction and distribution of a product
- recipient — person who receives something, for example treatmentrecipients
- allocation — part of a supply given to someone or somewhereallocations
- pledge — to promise to give or provide somethingpledged
- generic — not brand-name; produced by other manufacturers
- subsidy — money that reduces cost for users or servicessubsidies
- uptake — the number of people who start using something
- surveillance — continuous collection and analysis of health data
- stipend — small regular payment to help with expensesstipends
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Discussion questions
- How could deeper subsidies and small transport stipends change access to the injection in informal settlements?
- What role would faster data-sharing between clinics play in achieving more equitable uptake?
- What problems arise when some middle-income countries are excluded from generic licensing deals?
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