In Mbarara, a western Uganda city known in part for sex tourism, sex worker Lisa Mutoni insists on condoms to protect against HIV, but she says some clients try to tamper with them. She takes PrEP, or preexposure prophylaxis, and has her eye on a newer option, lenacapavir HIV prevention, that promises protection with just two injections a year.
Mutoni says lenacapavir would help people who travel for months at a time. “If you know that you have that injection for six months, you feel like you are safe,” she said, adding that daily pills are easy to forget. Yet when she asks for the shot, she is told it is out of stock.
That mix of promise and frustration surrounds lenacapavir, developed by Gilead Sciences. Other PrEP options, including daily pills and a bimonthly cabotegravir injection, are effective and more widely available. But health experts say lenacapavir’s long-acting profile could not only protect individuals, it could help shift the trajectory of the global epidemic if enough people can get it.
Lenacapavir HIV prevention faces supply and cost hurdles
There are far too few doses available in Uganda and around the world, according to researchers and public health officials. “The rate of growth isn’t fast enough. We need to be getting to the millions pretty soon,” said Andrew Hill, a senior visiting research fellow at the University of Liverpool who studies HIV treatment.
Momentum may build in the coming months. The U.S. Food and Drug Administration recently granted tentative approval for a generic version of lenacapavir that could be supplied to 120 low-income countries for about 40 dollars per year. That is far below the U.S. list price of 28,218 dollars, and global health partners hope the move will speed manufacturing and distribution.
The Global Fund aims to reach 3 million people with the drug by the end of 2028. Doctors Without Borders, known as MSF, says that goal falls short and is urging Gilead to expand low-cost access to more countries and sell directly to MSF to accelerate protection for those at highest risk. “Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise,” said Melissa Barber, MSF USA global health advocacy and policy adviser.
In Mbarara, where an estimated 10% of adults live with HIV, double Uganda’s national rate, people are still relying on other methods. Julius Bampe, a builder with multiple partners, sought lenacapavir after his younger wife tested positive and began treatment to suppress her infection. When he arrived for his shot, he was told supplies had run out.
A local facility received 40 lenacapavir doses in April and initially prioritized pregnant women at risk. Guidance later expanded to include serodifferent couples, sex workers and others, but the stock vanished quickly. Another 70 doses arrived in June and were used within 10 days, said Tarsisio Biryeija, a counselor at Mbarara Health Centre IV.
Uganda has sharply reduced HIV prevalence over three decades, and rates are lower than in several southern African countries. Still, health officials say new infections are often driven by transactional sex, the kind of transmission that lenacapavir could help prevent with its twice-yearly schedule.
Mutoni receives counseling and condoms from Action for Improved Health and Wealth, a Mbarara nonprofit founded by Immaculate Nyamwija that supports women who might face discrimination elsewhere. “It is a challenge, because the demand is high and the doses are few,” Nyamwija said. “Who would not wish to take lenacapavir for six months? Who would wish to be on drugs every day?”
Reporting support was contributed from Cape Town, South Africa, and Louisville, Kentucky. For more coverage of how policy decisions affect access to medicine, see our report on DEA medical marijuana registrations.
