A New Tool in the HIV Prevention Arsenal

The global fight against HIV reached a major breakthrough this week as the United States, through the President’s Emergency Plan for AIDS Relief (PEPFAR), delivered the first international shipments of lenacapavir — a revolutionary long-acting injectable HIV prevention drug — to Zambia and Eswatini. Confirmed on Tuesday, November 18, 2025, each country received roughly 500 doses of the twice-yearly injection developed by Gilead Sciences.

This marks an extraordinary moment for global health: for the first time, a next-generation HIV prevention medicine is being deployed in sub-Saharan Africa within the same calendar year as its approval in the United States. The drug, taken only twice per year, has demonstrated near-total protection in clinical studies, with some trials reporting up to 100% effectiveness in preventing HIV infections.

While the commercial version currently costs $28,000 per person annually, a landmark agreement announced earlier this year between the Clinton Health Access Initiative (CHAI), the Gates Foundation, Wits RHI in South Africa, and generic manufacturers will lower the price to around $40 per year in 120 low- and middle-income countries by 2027 — a reduction to merely 0.1% of the original cost.

Implications for Kenya and East Africa

Although Kenya was not part of this first delivery phase, the development represents a turning point for the region. The Ministry of Health has already confirmed that Kenya plans to introduce lenacapavir nationwide by January 2026, pending final regulatory approval. NASCOP has begun developing rollout guidelines and has described the drug as “a significant milestone in our commitment to end HIV/AIDS as a public health threat by 2030.”

Regulatory submissions are also underway in Uganda and Tanzania, positioning East Africa as one of the earliest beneficiaries of the new prevention technology.

Experts across the region have hailed the arrival of a long-acting injectable as a potential game-changer for PrEP, especially for populations facing stigma, inconsistent access, and adherence challenges associated with daily oral pills. Unlike existing oral PrEP — which must be taken every day — lenacapavir offers six full months of protection with a single injection. This is particularly critical for:

• Adolescent girls and young women

• LGBTQ+ communities

• Sex workers

• People who inject drugs

• Populations in hard-to-reach rural areas

According to UNAIDS, Kenya has already met the 95-95-95 treatment targets (testing, treatment, and viral suppression), and enhanced prevention tools like lenacapavir could accelerate the country’s progress in reducing infections among vulnerable groups. Globally, about 1.3 million people still contract HIV annually, and more than 600,000 die of AIDS-related illnesses — underscoring the urgency of deploying more effective tools.

The Global Access Strategy

Lenacapavir’s delivery to Zambia and Eswatini is part of a broader international partnership involving PEPFAR, the Global Fund, CHAI, Gilead Sciences, and philanthropic foundations. Gilead has committed to supply the drug at no profit for up to two million people until generic versions become widely available.

The earlier announcement of royalty-free licensing agreements with six generic manufacturers aims to accelerate production and reduce the price dramatically by 2027. Modeling studies suggest that, in regions such as Western Kenya, a cost of roughly $16–$20 per dose would be highly cost-effective.

Ambassador Dr. John Nkengasong, the U.S. Global AIDS Coordinator, emphasized that innovations like lenacapavir are essential to “turn the tide against HIV” and reach the goal of ending the epidemic by 2030. PEPFAR, which has invested more than $8 billion in Kenya since 2003, will play a central role in supporting the country’s eventual rollout.

Priority populations for early access will include:

• Adolescent girls and young women

• Pregnant and breastfeeding women

• People in high-incidence counties

• Key populations at elevated risk

These groups account for a significant proportion of new infections in East Africa.

Financing and Future Challenges

In a notable policy stance, U.S. officials confirmed that PEPFAR-funded doses would not be supplied to South Africa, despite it being home to the world’s largest HIV epidemic, with nearly eight million people living with the virus. South Africa was encouraged to fund its own procurement — a position that reflects a broader shift toward shared responsibility in global health financing.

For Kenya, Zambia, and Eswatini, the real test will lie in the implementation phase. Successful rollout will require:

• Rapid regulatory approval

• Strengthening supply chains

• Training healthcare workers

• Building public awareness and demand

• Addressing stigma and misinformation

• Ensuring seamless integration into existing PrEP programs

The experiences of Zambia and Eswatini will provide valuable lessons for Kenya’s 2026 launch.

As scientists have noted, increasing access to lenacapavir to just 4% of a population could prevent up to 20% of new HIV infections. If implemented effectively, the drug could become the most significant HIV prevention tool since the introduction of antiretroviral therapy (ART) more than two decades ago.

A Critical Moment for the Continent

Lenacapavir arrives at a time when global health funding has been under pressure — including cuts to USAID programs — but the scientific promise remains undeniable. With more than 40 million people living with HIV worldwide, and the highest burdens in Eastern and Southern Africa, this new injection offers a renewed chance to change the trajectory of the epidemic.

For Kenya and its neighbors, the next 18–24 months will determine whether this groundbreaking scientific achievement translates into real-world impact — saving lives, preventing infections, and pushing the continent closer to the dream of an HIV-free generation.