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Eswatini became the first on Tuesday African First country to get lencapavir twice a year hiv The preventive injection has been hailed by global health officials as a game-changer in the fight against the virus that has killed millions across the continent.
Developed by gilead scienceLencapavir has demonstrated almost complete safety in clinical studies. It was initially planned for 10 high-risk African countries, part of the US President’s Emergency Plan for AIDS Relief, or PEPFAR, in partnership with the Global Fund. By 2027, the initiative aims to benefit at least 2 million people in those countries.
Gilead Sciences Chairman and CEO Daniel O’Day described the Eswatini rollout as “extraordinary” because “it is the first time in history that a new HIV drug is reaching a country in sub-Saharan Africa in the same year as it has United States approval” and because Eswatini is “the country with the highest incidence of HIV in the world.” America had approved this medicine in June.
The United States, whose deep cuts in foreign aid this year under President Donald Trump have severely hit health programs in Africa, had initially planned to distribute 250,000 doses to 10 countries this year. Zambia also received its first shipment on Tuesday, while Gilead seeks regulatory authorization in Botswana, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda and Zimbabwe.
That was increased to 325,000 due to “early demand signals,” Brad Smith, a senior adviser at the Bureau of Global Health Security and Diplomacy, told reporters.
The US government has noted that more than 25 million people are living with HIV across Africa.
In Eswatini, a small state in southern Africa, about 6,000 high-risk people will benefit from the early rollout of the drug, primarily to prevent HIV transmission from mothers to newborns. Home to about 1.2 million people, Eswatini currently has more than 200,000 people living with HIV, the majority of whose treatment is funded by PEPFAR, Smith said.
Eswatini, the world’s last absolute monarchy with a documented record of human rights violations, is also one of the African countries participating in Trump’s third-country deportation program, which has faced opposition from rights groups.
In July, the World Health Organization approved lencapavir as an additional HIV prevention option. UNAIDS has called long-acting injections a “fresh option” amid concerns that cuts in foreign funding could worsen the infection situation.
South Africa’s health minister, Aaron Motsoaledi, recently called lencapavir “phenomenal” but raised concerns over limited supplies when South Africa Its own rollout will begin in April 2026.
Motsoaledi also welcomed Gilead’s sharp reduction in the US price to around $40 for countries with per capita income below $28,000 a year.
The rollout has sparked debate over access and manufacturing rights. Civil society groups in South Africa, sub-Saharan Africa’s most advanced economy, have criticized Gilead for excluding local manufacturers from voluntary licensing agreements despite the country’s role in clinical trials.
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