The first consignment of lenacapavir—Gilead Sciences’ long-acting injectable designed to prevent HIV infection—has arrived in Zambia and Eswatini, marking the initial rollout under a new U.S.-supported access initiative aimed at countries facing severe HIV burdens. U.S. officials and Gilead representatives confirmed that approximately 1,000 doses were delivered last Thursday, split evenly between the two southern African nations.
Lenacapavir, which is administered twice a year, is considered a major breakthrough in HIV prevention, especially for regions with limited healthcare access and high infection rates. Sub-Saharan Africa continues to account for the majority of global HIV cases, and public health experts say the introduction of long-acting options could significantly reduce new infections if scaled effectively.
South Africa Excluded From U.S.-Funded Supply
Despite having the world’s largest HIV-positive population—about eight million people, roughly 20% of adults—South Africa will not receive U.S.-funded lenacapavir doses. Jeremy Lewin, the senior State Department official overseeing foreign assistance, explained that Washington expects countries with stronger domestic resources to independently finance procurement.
“Every country is encouraged to support its own populations, especially those with the means to do so. U.S.-funded doses will not be going to South Africa,” Lewin told journalists during a briefing on Monday.
Tensions between Washington and Pretoria have escalated in recent months. President Donald Trump has publicly criticized South Africa’s government, including clashing with President Cyril Ramaphosa over widely debunked allegations concerning land seizures and violence against white farmers. The Trump administration has also withdrawn key aid commitments, removed South Africa’s ambassador, and condemned its genocide case filed against Israel at the International Court of Justice.
A Key Pillar in a New Global Strategy
The State Department announced in September that the U.S. would support the introduction of lenacapavir “at cost” in high-burden HIV countries with a target of reaching two million people over three years. Under this model, Gilead supplies the drug to the Global Fund and PEPFAR without profit, lowering the financial barrier for governments with limited budgets.
Lewin has indicated that agreements are already in place with 12 participating countries, though the full list has not yet been disclosed.
Gilead’s CEO, Daniel O’Day, said during a media call on Tuesday that the company is working with additional governments and has submitted regulatory applications in Rwanda, Tanzania, Botswana, and several other African states.
“Lenacapavir offers a transformative opportunity,” he said. “If countries act quickly and deploy it widely, we can dramatically accelerate progress toward ending HIV as a public health threat.”
Peter Sands, Executive Director of the Global Fund, echoed this sentiment, calling the drug “a game-changer” and emphasizing the urgency of rapid implementation.
Impact of Recent U.S. Aid Disruptions
The rollout comes after a turbulent period for global HIV programs. Early in his administration, President Trump imposed a 90-day freeze on foreign aid and halted USAID grants, significantly slowing PEPFAR-related activities. In June, Reuters reported that these funding cuts had already reduced access to prevention drugs relied on by millions—including marginalized groups such as sex workers and men who have sex with men.
Health organizations warn that any gaps in preventive treatment could undermine decades of progress in reducing infection rates.
As Zambia and Eswatini begin administering the initial doses of lenacapavir, public health officials say the next challenge will be ensuring sustained supply, rapid regulatory approvals across the region, and national commitment to adopting the new prevention regimen at scale.
Source:Africa Publicity
