Demand for the twice-yearly HIV prevention injection lenacapavir is outpacing supply in parts of Africa, with distribution covering a fraction of estimated need and leaving behind vulnerable slum communities, health charities have told SciDev.Net.
LEN, the long-acting injectable form of pre-exposure prophylaxis (PrEP) made by Gilead Sciences, has seen rapid uptake in eSwatini, the first country to receive the rollout.
Despite progress in fighting the disease, this small country has the highest HIV prevalence in the world with around 220 000 people – 23.4% of the population – affected by the disease, according to UN figures.
After a pilot rollout at five sites from December 2025 to February this year, distribution was expanded to 27 sites, reaching an estimated 3 000 people to date, Nsindiso Tsabedze, communications officer at eSwatini’s Ministry of Health told SciDev.Net.
“We expect an increase as more stocks become available,” Tsabedze said, without elaborating on when that might be. He added that around two thirds of recipients of the drug were women, with strong uptake by youth and young adults.
However, the spokesman told SciDev.Net that the initial stock was nearly depleted because of high demand.
Médecins Sans Frontières (MSF/Doctors Without Borders) said it had only received 70 doses at its clinic in eSwatini and these were gone within weeks, while one of its clinics in Kenya was working with fewer than 40 doses.
eSwatini and Kenya are among nine African countries to have received initial doses of the HIV drug, the others being: South Africa, Lesotho, Mozambique, Nigeria, Uganda, Zambia and Zimbabwe.
In April, Gilead and its distribution partners, the US President’s Emergency Plan for Aids Relief (Pepfar) and the Global Fund to Fight Aids, TB and Malaria, pledged to extend supplies to an additional 1m people in low- and middle-income countries. This brings the total commitment to 3m people over a period of three years.
Daniel O’Day, chief executive of Gilead, said the company was supplying LEN at no profit to Pepfar and the Global Fund in countries with the most urgent need, with large-scale rollout of generic versions of the drug by other manufacturers expected from 2027.
Tom Ellman, director of MSF’s South African Medical Unit, said the extra 1m was “a tiny fraction of what’s needed to make a real dent in the HIV epidemic”.
The organisation highlighted the exclusion of countries like Argentina, Brazil, Mexico and Peru – where some of the drug trials were conducted – from Gilead’s generic licensing deal, noting that the excluded countries account for a quarter of new HIV infections.
Ellman said MSF had been seeking to buy LEN directly from Gilead for a year but had been directed to procure it through the Global Fund instead.
According to the charity, the drug sells for around $28 000 per patient per year in the United States.
“It is not enough for this ground-breaking medicine to only be available to people living in wealthy countries who can pay $28 000 per year, or to be drip fed to certain LMICs through the Global Fund,” Ellman added.
Reaching Kenya’s slums
Kenya received an initial consignment of 21 000 starter doses of LEN in February, delivered in partnership with the Global Fund, according to a statement from Kenya’s Ministry of Health.
A further 12 000 continuation doses were expected by April, with an additional 25 000 doses pledged by the US government to support early implementation, the Ministry said.
The first phase of the rollout began in March across 15 high-burden counties, to be followed by two further phases. The Ministry said the drug would be offered at an estimated annual cost of 7 800 Kenyan shillings (US$60) per patient.
Charity workers say this cost is locking out the poorest communities.
In Nairobi’s Kibera slum, Kenya’s largest informal settlement, leaders at CFK Africa, a community health organisation that has worked there for more than 25 years, said the way Kenya’s phased rollout is implemented will determine whether the drug narrows or widens existing inequalities.
Jeffrey Okoro, chief executive of CFK Africa, told SciDev.Net the national rollout was an “important advancement” but said the practical benefits of a twice-yearly injectable would only be realised if delivery models accounted for poverty, stigma and how residents access care.
CFK sites were not included in phase one of Kenya’s rollout, Okoro added, and the organisation is now positioning itself as a “community access bridge”, strengthening drug referral pathways, training staff in counselling and follow-up, and pressing for the inclusion of informal settlements in subsequent phases.
It is also advocating for adolescent girls and young women to be prioritised.
“Slums like Kibera are home to populations that face the highest HIV risk yet also the greatest barriers to consistent prevention,” Okoro pointed out.
“Prioritising these communities is not only a matter of equity but also essential for achieving national impact, because prevention efforts are most effective when they reach those most vulnerable.”
He stressed the importance of investing in community-based delivery, trusted local partners, and context-appropriate distribution models to close access gaps to lenacapavir and other innovations.
Investment in last-mile delivery and community health systems is needed to avoid a repeat of the Covid-19 pandemic, when lifesaving interventions reached informal settlements months after better-served areas, he added.
Dennis Kinoti, CFK Africa’s clinical services lead, said transport costs, lost wages, long clinic waits and low awareness were keeping many Kibera residents from reaching facilities to access the new HIV drug.
“For some community members, the choice becomes food for the family versus paying for travel and medication,” Kinoti said.
He pointed to three immediate fixes: deeper subsidies or targeted waivers to allow the poorest to get treatment; small transport stipends to cover travel and offset lost earnings, and fast data-sharing agreements between community clinics and referral sites so that community health promoters can confirm referrals, follow up missed visits and report adverse effects.
The charity says it is also working to build surveillance networks through Kenya’s Population-Based Integrated Disease Surveillance programme to support equitable uptake and monitor safety.
SciDev.Net article – HIV jab demand outstrips supply in African rollout (Creative Commons Licence)
See more from MedicalBrief archives:
Lenacapavir to be rolled out via Pepfar to selected countries
Eswatini on track to end Aids by 2030
Twice-yearly anti-HIV jab shows total protection – African study
Lenacapavir demonstrates efficacy in people with highly resistant HIV
Africa’s HIV response must pivot from aid dependency to ownership