U.S. and company officials confirmed that about 1,000 doses of Gilead Sciences’ HIV prevention drug, lenacapavir, reached Zambia and Eswatini last Thursday. Each country received nearly 500 doses under a new U.S. initiative designed to supply the long-acting injectable to nations with high HIV prevalence. The African region continues to remain the epicenter of the global AIDS pandemic.
Expansion to Other High-Burden Countries
Gilead is now pursuing regulatory approvals to distribute lenacapavir across additional high-burden sub-Saharan African countries. The company aims to broaden access as quickly as possible, particularly in regions where HIV transmission remains widespread.
U.S. Excludes South Africa From Funded Supply
However, the United States clarified that it will not supply U.S.-funded doses to South Africa, despite the country having the world’s highest HIV burden—nearly 8 million people, or one in five adults. Senior U.S. State Department official Jeremy Lewin said that countries with substantial financial capacity, including South Africa, must fund their own supplies. He emphasized that the U.S. reserves its funded doses for nations with fewer domestic resources.
Political Tensions Influence Assistance
As reported by Reuters, relations between the U.S. and South Africa have been strained. Former President Donald Trump confronted South African President Cyril Ramaphosa over false claims related to land seizures and white genocide. Additionally, the U.S. halted key aid, expelled South Africa’s ambassador, and criticized its stance on international legal matters. These tensions have contributed to the withdrawal of certain forms of American support.
A Game-Changer for HIV Prevention
In September, the U.S. State Department unveiled a plan to provide lenacapavir at cost to high-burden HIV countries, aiming to reach two million people within three years. Under this plan, Gilead agreed to supply the drug without profit to the Global Fund and the President’s Emergency Plan for AIDS Relief (PEPFAR).
Gilead CEO Daniel O’Day noted that Rwanda, Tanzania, Botswana, and several other countries have submitted marketing authorization applications. Global Fund Executive Director Peter Sands described lenacapavir as a game-changing tool that can accelerate efforts to end HIV as a public health threat—provided stakeholders deploy it widely and quickly.
Impact of U.S. Aid Cuts on HIV Prevention
After taking office, Trump ordered a 90-day halt to foreign aid and suspended USAID grants, which previously handled much of PEPFAR’s work. According to earlier Reuters reports, these cuts severely limited access to critical HIV prevention drugs for millions of Africans, including vulnerable populations such as gay men and sex workers. As a result, health systems and community groups across Africa faced new challenges in maintaining progress against HIV transmission.