A medicine injected just twice a year could transform the fight against HIV. In a 2024 clinical trial involving more than 2,000 young women in South Africa and Uganda, no participants who received lenacapavir contracted HIV. Developed by United States pharmaceutical company Gilead Sciences, the injectable drug can be used to prevent HIV.
The World Health Organization has recommended the long-acting injectable as an additional form of pre-exposure prophylaxis, or PrEP – medicine to reduce the risk of getting HIV. But the arrival of the drug comes at a challenging juncture in the global fight against HIV. International funding for HIV fell 18 percent in 2025, to $7.3bn, its lowest level in nearly two decades, according to the United Nations programme on HIV/AIDS (UNAIDS).
The squeeze has already hit prevention programmes: The number of people receiving medicine to reduce risk fell from 1.4 million in 2024 to 1.1 million in 2025. That makes the arrival of a highly effective, twice-yearly prevention option significant. The question of who can access it is now more urgent.
For MSF, the scientific question has largely been answered: lenacapavir can prevent HIV with remarkable efficacy. The fight now is whether the rules governing manufacture, price and supply will allow that scientific breakthrough to reach the people who need it. In the United States, lenacapavir costs about $28,000 per person annually.
Generic versions are expected to cost about $40 a year. A generic version is a copy of the original drug made by another manufacturer after the patent holder licenses the technology. It contains the same active ingredient, but it can be produced and sold at a much lower price.
In June 2025, the US Food and Drug Administration (FDA) approved lenacapavir for HIV prevention, giving people the option of an injection twice a year. But in several low- and middle-income countries, access to cheaper versions is not expected at scale until 2027. Gilead is supplying its own version of lenacapavir at no profit for programmes supported by the Global Fund and the US President’s Emergency Plan for AIDS Relief (PEPFAR), with rollouts under way in countries including South Africa, Kenya, Zambia, Nigeria and Eswatini.
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