The U.S. government, in partnership with Gilead Sciences, has initiated distribution of lenacapavir, a long-acting injectable drug that provides near-complete protection against HIV infection with just two doses per year. The rollout, announced on November 18, 2025, delivered the first 1,000 doses to Zambia and Eswatini, with plans to expand to 10 other African countries in the coming months Business Insider Africa STAT Kansas Public Radio.
Lenacapavir has been hailed as a “breakthrough” in HIV prevention, offering a simpler and more effective alternative to daily oral pre-exposure prophylaxis (PrEP). Global health experts describe the rollout as “unprecedented,” noting how quickly the drug has moved from approval in wealthy countries to distribution in low- and middle-income nations Kansas Public Radio.
However, the program has drawn criticism for excluding South Africa, which has the largest HIV epidemic in the world, with over 7.8 million people living with HIV. Despite being the hardest-hit country, South Africa is expected to self-finance its access to lenacapavir, rather than benefit from U.S.-funded distributions Business Insider Africa STAT.
This decision has sparked debate among health advocates and policymakers. Critics argue that leaving South Africa out undermines global HIV prevention efforts, given its central role in the epidemic. Others suggest the exclusion reflects political and financial tensions, as South Africa has historically pursued independent health policies and negotiated directly with pharmaceutical companies.
The U.S. State Department defended the rollout, emphasizing that the initial focus is on countries with smaller populations and weaker health systems, where external support is most urgently needed. Gilead Sciences, which manufactures lenacapavir, has pledged to provide the drug “at cost” to ensure affordability STAT.
