A twice-yearly injection is being hailed as a major advance in HIV prevention, but concerns over price, patents and supply are raising questions about who will actually benefit from it. Developed by US pharmaceutical company Gilead Sciences, lenacapavir is a long-acting injectable used as pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection. In a 2024 clinical trial involving more than 2,000 young women in South Africa and Uganda, none of the participants who received lenacapavir contracted HIV. The World Health Organization has since recommended the medicine as an additional

A twice-yearly injection is being hailed as a major advance in HIV prevention, but concerns over price, patents and supply are raising questions about who will actually benefit from it. Developed by US pharmaceutical company Gilead Sciences, lenacapavir is a long-acting injectable used as pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection. In a 2024 clinical trial involving more than 2,000 young women in South Africa and Uganda, none of the participants who received lenacapavir contracted HIV. The World Health Organization has since recommended the medicine as an additional PrEP option. Doctors Without Borders (MSF) describes lenacapavir as one of the most significant innovations in HIV prevention in recent years, particularly because a single injection can provide protection for six months. But access remains a major concern. International HIV funding fell 18 percent in 2025 to $7.3bn, according to UNAIDS, while the number of people receiving preventive medicines dropped from 1.4 million to 1.1 million. In the United States, lenacapavir costs about $28,000 per person annually. Generic versions are expected to cost around $40 a year, but large-scale production is not expected until 2027. Gilead has licensed six manufacturers to produce generic versions and is supplying its own medicine at no profit through programmes supported by the Global Fund and PEPFAR in countries including South Africa, Kenya, Zambia, Nigeria and Eswatini. However, MSF says at least 26 middle-income countries are excluded from the generic licensing agreement, including Brazil, Mexico, Argentina and Peru. The organisation also says it has spent more than a year seeking permission to purchase lenacapavir directly from Gilead for humanitarian programmes but has been unable to do so. For countries facing patent barriers, World Trade Organization rules allow governments, under certain conditions, to authorise cheaper generic production or imports. The debate over lenacapavir now goes beyond its effectiveness. Its impact on the global HIV response may ultimately depend on whether affordable access reaches people based on need rather than geography or purchasing power.

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