Long-acting HIV injection at $40 could reshape prevention — if the world can deliver it
A potentially seismic shift in HIV prevention is quietly taking shape: a twice-yearly injectable drug, lenacapavir, has won backing from global health partners and is slated to be available to more than 100 low- and middle-income countries within the next two years — at a price that would make it accessible to millions.
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Under an agreement brokered by the Clinton Health Access Initiative with support from the Bill & Melinda Gates Foundation and research partners including Wits RHI in South Africa, lenacapavir — previously priced in the tens of thousands of dollars — will be offered in a low-cost formulation at roughly $40 per person for six months of protection. An initial rollout could begin by the end of this year, with the lower-cost version due across some 120 countries in 2027.
Why this matters
For decades the backbone of HIV prevention has been oral pre-exposure prophylaxis (PrEP) — typically a once-daily pill. While highly effective when taken as directed, daily PrEP has been hard to scale among key groups most at risk: young women in southern Africa, sex workers, transgender people and men who have sex with men often contend with stigma, privacy concerns, and inconsistent access to medication.
Lenacapavir, administered as an injection every six months, removes the burden of daily adherence. Early trials and the World Health Organization’s endorsement suggest it provides robust protection during those intervals. Public health specialists say that for people who struggle with daily pills, a biannual clinic visit for an injection could be transformative.
“Long-acting options change the conversation from ‘Can you remember a pill every day?’ to ‘Can you get to a clinic twice a year?’” said a senior clinician working in Johannesburg who has treated people living with HIV for more than two decades. “That’s a very different problem — and one we have a better chance of solving.”
From price shock to price hope
The headline number is striking. Lenacapavir had been listed at prices that put it beyond reach for most people in low-income settings. The negotiated figure — around $40 per six-month injection — is a dramatic reduction that mirrors other global health efforts to widen access through pooled procurement, licensing arrangements, and philanthropic financing.
If the price holds, it would follow the pattern set by earlier treatments and preventives: when manufacturers, global health groups and donors cooperate, drugs can move from boutique products for wealthy markets to mass tools for public health. Yet the arithmetic of global rollouts is rarely that simple — production, regulatory approvals, supply chains, and local health systems must all be aligned.
Practical hurdles on the path to impact
Even with a low unit cost, delivering lenacapavir to the people who need it most will require sustained effort.
- Regulatory and clinical pathways: Countries must register the product, update guidelines, and train clinicians on administration and monitoring. Some governments move quickly; others are slowed by bureaucracy or competing priorities.
- Supply chains and manufacturing: Producing injections at scale and transporting them with the necessary cold-chain protections will test existing systems, especially in rural areas.
- Human resources and clinics: Twice-yearly injections may still be a barrier if clinics are distant, overcrowded, or under-staffed. Community-based delivery and task-shifting to nurses or trained lay providers will be part of the conversation.
- Uptake and trust: Communities that have experienced broken promises from health systems may be cautious. Clear communication, involvement of community leaders, and protections against stigma are essential.
- Resistance and long-term safety: As with any antiretroviral, surveillance for drug resistance and longer-term effects will be needed as use expands beyond clinical trials.
South Africa and the political stakes
South Africa — home to nearly 8 million people living with HIV — is slated to be among the early beneficiaries. The national health department has welcomed efforts to make long-acting prevention affordable, and clinicians here say the country’s vast HIV programs could provide a blueprint for scale-up across the continent.
Yet South Africa’s public health system also shows why low price alone is not enough. Clinics are chronically overstretched, and adding a new service requires money for training, cold storage, data systems and outreach. The question is whether donors and governments will match the one-time price concession with the downstream funding that turns promise into protection.
Where this fits in the global trend
Lenacapavir’s emergence is part of a broader shift toward long-acting HIV tools. In recent years, long-acting cabotegravir injections have been rolled out in some settings, and researchers are pursuing vaccines and other sustained-delivery technologies. The logic is the same: interventions that reduce the need for daily behaviour change have a better chance of reaching people who face social and structural barriers to prevention.
For advocates, the deal is proof that price is negotiable and that public-private partnerships can produce victories for equity. For policy-makers, it is a reminder of the work still to be done to turn biomedical breakthroughs into population-level declines in new infections.
Questions that remain
Will manufacturers be able to scale production fast enough to meet demand without compromising quality? Can health systems — many still strained by COVID-19 and other pressures — absorb another major prevention tool? And crucially, will communities be engaged in ways that build trust and address the social drivers of HIV, from gender-based violence to economic insecurity?
As the world marks decades of effort against HIV/AIDS, the lenacapavir deal offers both hope and a reality check: biomedical innovation can open new doors, but unlocking them requires finance, politics, and relentless attention to the people these interventions are meant to protect.
If the global community gets the delivery right, lenacapavir could become one more weapon in the long fight to end AIDS. If it stops at procurement, it will be another missed opportunity.
By News-room
Axadle Times international–Monitoring.
