THE KEY TO STOPPING HIV TRANSMISSION IN AFRICA IS, GUESS WHAT?, MONEY. Devex newsletter.
Gilead knew it had a blockbuster on its hands as soon as the results came back in 2024, showing that lenacapavir, a twice-yearly injectable, had been 100% effective in preventing HIV infections during a study among thousands of women in Uganda and South Africa.
The pharmaceutical company also “knew it would put on everyone responsibility, including politically, massive calls for access in the countries where you have high incidence,” Michel Joly, Gilead’s vice-president of global patient solutions, explained at a Devex Impact House panel this week.
After an unprecedented push by communities, governments, activists, and Gilead, lenacapavir is now available in 10 African countries. And Dr. Neil Buddy Shah, the CEO of Clinton Health Access Initiative, says the demand has been as high as everyone anticipated.
“We’re seeing oversubscription from key populations and more generally,” he tells me on the sidelines of WHA. “All of this is very, very promising in terms of, we’ve got the product, we’ve got the demand, and we’re figuring out the delivery channels.”
According to a CHAI flash market report out last week, in the eight countries that had introduced lenacapavir by April, more than 11,000 people had been initiated on the drug.
That’s still far short of the kinds of numbers everyone involved in the rollout hopes to reach. But ongoing hurdles, including funding and building program infrastructure to ensure people will continue to receive injections, could limit its uptake, Mitchell Warren, AVAC’s executive director, said.
Rhoda Igweta of the Elizabeth Glaser Pediatric AIDS Foundation raised another challenge during the Devex Impact House session: Cuts in U.S. funding for the global AIDS response led to the firing of thousands of health workers. But those health workers are crucial to providing lenacapavir, which must be administered in a clinical setting.
“We need to make good on the promise of a product that can prevent infections in everyone at risk everywhere in the world,” Warren said during the same session. “That will require us to dig deep financially, dig deep programmatically.”
For Shah, “the question now really is mobilizing the resources to scale it up.” Despite this initial success and efforts by CHAI and others to bring generic versions of lenacapavir online by early 2027, there’s no guarantee the funds will be there to ensure the drug reaches everyone who could benefit from it. But with actual subscriber numbers now available, Shah said it’s time “to start to have that conversation about the whole next phase and what it will look like to fully close the gap in terms of funding.”