A groundbreaking HIV prevention drug, lenacapavir, which offers nearly complete protection with just two shots per year, is facing significant access challenges worldwide, despite its potential to alter the course of the global HIV epidemic. Developed by Gilead Sciences, lenacapavir represents a promising alternative to daily pills and existing every-other-month injections.
In Mbarara, a city in western Uganda with an estimated 10% adult HIV rate, individuals like Lisa Mutoni, a sex worker, are struggling to obtain the drug. "If you know that you have that injection for six months, you feel like you are safe," Mutoni said, highlighting the convenience and efficacy compared to daily medication, which can be forgotten. However, she reports frequent unavailability, with facilities often stating the doses are finished.
Health experts emphasize the drug's potential impact but point to insufficient production and distribution. "The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon," said Andrew Hill, an expert in HIV treatment at the University of Liverpool.
While the U.S. Food and Drug Administration has tentatively approved a generic version of lenacapavir, potentially making it available to 120 low-income countries for approximately $40 per year, widespread access remains a concern. The Global Fund aims to supply the drug to 3 million people by the end of 2028. However, organizations like Doctors Without Borders (MSF) argue this is insufficient and urge Gilead to increase availability and supply directly to aid groups for faster distribution.
"Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise," stated Melissa Barber, MSF USA global health advocacy and policy adviser.
The demand for lenacapavir is high, particularly in regions like Mbarara. Tarsisio Biryeija, a nursing officer at Mbarara Health Centre IV, noted that initial batches of 40 doses were quickly administered, and a subsequent shipment of 70 doses was used within 10 days. Initial guidelines restricted its use to pregnant mothers at risk, but were later expanded to include couples, sex workers, and others facing higher risks.
Despite Uganda's success in reducing its HIV rate over the past three decades, infections continue to be driven by transactional sexual encounters, the very type of transmission lenacapavir is designed to prevent. Immaculate Nyamwija, founder of the Mbarara-based organization Action for Improved Health and Wealth, offers support services and highlights the challenge: "It is a challenge, because the demand is high and the doses are few. Who would not wish to take (lenacapavir) for six months?"