Eswatini, a small African kingdom, has become the first nation on the continent to deploy a groundbreaking twice-yearly HIV prevention injection called lenacapavir. This move marks a significant shift in how the world’s most affected countries access cutting-edge medical innovations, traditionally lagging years behind wealthier nations. The first shipments arrived at Eswatini’s Central Medical Stores, initiating a program expected to redefine HIV prevention efforts across sub-Saharan Africa.
A Turning Point in the Epidemic
For decades, Eswatini has grappled with one of the highest HIV prevalence rates globally. However, the country has consistently demonstrated leadership in its HIV response, and the arrival of lenacapavir is a testament to that commitment. The injection, developed by Gilead Sciences, offers a discreet and private prevention method, particularly crucial in contexts where daily oral pills are difficult to conceal or access.
The significance of this step extends beyond mere convenience. In environments where gender-based violence and power imbalances exist, negotiating condom use can be dangerous. Similarly, stigma can prevent individuals from carrying medication openly. Lenacapavir bypasses these obstacles, offering a long-acting, confidential solution.
Strengthening Systems for Sustainable Progress
The deployment of lenacapavir did not happen overnight. Years of preparation involving the Ministry of Health, the National Emergency Response Council on HIV and AIDS (NERCHA), AIDS Healthcare Foundation Eswatini (AHF Eswatini), the Global Fund, and other partners were essential. These efforts focused on strengthening healthcare systems, aligning protocols, and ensuring robust supply chains.
Dr. Nkululeko Dube, a physician in Manzini, reflects on this transformation. He recalls the days when antiretrovirals were scarce, and patients died from treatable infections. Today, Eswatini has exceeded the UNAIDS 95-95-95 targets, establishing one of the strongest HIV treatment programs worldwide. Despite this progress, gaps remain; without continued prevention efforts, hard-won gains could be reversed.
Regional Momentum and Global Implications
Eswatini is not an outlier. Zambia has also received initial shipments of lenacapavir, and seven other African countries are scheduled to follow suit in the coming months. This represents a dramatic departure from the historical pattern where high-income nations received innovations first, while low- and middle-income countries waited years for access.
The speed of this rollout is unprecedented. Previous HIV prevention drugs took an average of five years to reach affected countries after their efficacy was proven. This shift demonstrates regional leadership and underscores the urgent need for equitable access to life-saving technologies.
The Path Forward: Sustained Investment and Trust
To maximize the impact of lenacapavir, PEPFAR and its partners aim to reach up to two million people with long-acting PrEP in the next three years. Achieving this goal would significantly reduce new infections in high-burden countries. However, sustained investment from donors, governments, and other stakeholders is critical to prevent momentum from stalling.
Preventing infections is demonstrably more cost-effective than treating them long-term. It strengthens health systems, accelerates domestic financing, and protects the progress made by countries like Eswatini. The key lies in fostering trust: trust in clinics to provide confidential care, in health workers to maintain medicine availability, and in global partners to remain committed.
The arrival of these seemingly ordinary boxes in Eswatini holds extraordinary promise. If bold action, collaboration, and community-centered approaches prevail, this moment may be remembered as the turning point when ending AIDS shifted from an aspiration to an achievable reality.
