Twice-yearly HIV injection moves from trial success to rollout

Lenacapavir, an HIV prevention medicine given by injection twice a year, is being rolled out in countries including South Africa, Kenya and Zambia. In a 2024 trial involving more than 2,000 young women in South Africa and Uganda, none of those who received the drug contracted HIV.

Developed by Gilead Sciences, the medicine won US approval for HIV prevention in June 2025 and has been recommended by the World Health Organization as an additional prevention option.

Daily prevention pills already work when taken consistently. Six months of protection between injections could make prevention easier for people who struggle to take a pill every day, including those displaced by conflict or disaster.

Gilead is supplying its own version at no profit through programmes supported by the Global Fund and the US government. It has also licensed six manufacturers to make lower-cost generic versions, expected to cost about US$40 per person annually, with large-scale rollout anticipated in 2027.

Access remains uneven. Doctors Without Borders says at least 26 middle-income countries are excluded from the generic licensing agreement. A separate Gilead agreement creates an access pathway for 14 Latin American and Caribbean countries outside that territory, although the medical charity says this leaves them dependent on Gilead rather than automatically able to buy cheaper generics.