Biannual HIV prevention shots rollout in Africa

South Africa, Eswatini, and Zambia have started administering a new HIV-prevention injection, marking the first public availability of the drug in Africa, the region with the highest global HIV prevalence. Lenacapavir, administered twice a year, has demonstrated a reduction in HIV transmission risk by over 99.9%, effectively functioning as a highly potent preventive measure.

In South Africa, where one in five adults is living with HIV, the rollout is being managed by a research unit at Wits University as part of an initiative funded by Unitaid, an international organization that promotes equitable access to medical innovations. Unitaid highlighted that this marks one of the first real-world uses of the six-month injectable in low- and middle-income countries.

The study will enroll 2,000 participants and follow them for at least a year to assess the injection's effectiveness in real-life conditions, according to Saiqa Mullick of the Wits Reproductive Health and HIV Institute (RHI). A nationwide rollout is planned for next year, beginning with 400,000 doses supplied through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Neighboring Zambia and Eswatini received 1,000 doses last month through a U.S. program and launched the drug during World AIDS Day events. In Eswatinis Hhukwini constituency, residents gathered in large numbers at a celebratory event featuring music and dance. Prime Minister Russell Dlamini called it a "turning point in the national HIV response," describing the injection as "a fresh hope and a powerful tool to protect citizens."

In Zambia, hundreds of people marched to Chawama township in Lusaka to commemorate the rollout. Health Minister Elijah Muchima encouraged HIV-positive volunteers to visit local hospitals to receive the injection, emphasizing that it offers "renewed hope to young people and vulnerable populations."

Under the U.S. program, the manufacturer Gilead Sciences has agreed to supply lenacapavir at no profit to two million people in high HIV-burden countries over three years. However, the U.S. will not provide doses to South Africa despite its involvement in clinical trials, citing that the country has sufficient resources to fund its own supply. This decision has drawn criticism from experts who highlighted South Africa's significant contributions to research on the drug.

Critics also point out that the U.S. deliveries fall short of demand and that the drug's market price of $28,000 per year per person in the United States is unattainable for most Africans. Eastern and southern Africa account for roughly 52% of the 40.8 million people living with HIV worldwide. Zambia has around 1.4 million people living with HIV and 30,000 new infections annually, while Eswatini, with a population of 1.2 million, has approximately 220,000 cases.

UNAIDS Executive Director Winnie Byanyima criticized the limited access, urging pharmaceutical companies to prioritize Africa's needs. WHO Director-General Tedros Adhanom Ghebreyesus warned that recent funding cuts threaten progress in the fight against HIV and called for rapid expansion of lenacapavir use. Generic versions are expected to be available by 2027 at an estimated $40 per year in over 100 countries, thanks to agreements facilitated by Unitaid and the Gates Foundation with Indian manufacturers.

Pre-exposure prophylaxis (PrEP) has been a standard preventive tool for over a decade, but its daily pill requirement has limited its impact on global HIV infection rates. The introduction of a twice-yearly injection is expected to overcome these barriers and significantly enhance prevention efforts.

Author: Sophia Brooks