Lenacapavir is a scientific breakthrough. Africa must now make it an access breakthrough 

Prof Vinodh Aroon Edward, Group Chief Operating Officer at the Aurum Institute 

A twice-yearly injection that can prevent HIV infection is not just another biomedical advance. Lenacapavir is the kind of breakthrough that forces us to ask a larger question: when science finally delivers something this powerful, will the people and countries that carry the greatest HIV burden be first in line, or last once again? 

The science is compelling. In the PURPOSE 1 trial among cisgender adolescent girls and young women in South Africa and Uganda, twice-yearly lenacapavir was associated with zero HIV infections in the lenacapavir group during the trial period, outperforming daily oral PrEP options in a population for whom adherence, stigma and unequal power in relationships have long constrained prevention choices. PURPOSE 2 extended the evidence to cisgender men, transgender women, transgender men and gender-diverse people who have sex with partners assigned male at birth. 

For communities, this matters because HIV prevention is not only a question of efficacy. It is a question of whether an option fits into real lives. Daily tablets work well for many people, but daily adherence can be difficult when people face stigma, privacy concerns, unstable relationships, transport costs, school or work pressures, or the simple fatigue of taking medication every day while healthy. A discreet injection every six months may offer more autonomy, especially for adolescent girls and young women, sex workers, men who have sex with men, transgender people, mobile workers and others who need prevention options that respect their circumstances. 

The World Health Organization’s recommendation of injectable lenacapavir as an additional HIV prevention choice confirms that this is no longer only a trial result; it is now part of the global policy conversation. South Africa’s registration of lenacapavir for PrEP is equally important, because regulatory approval creates a pathway from evidence to implementation in one of the countries at the center of both the HIV epidemic and the lenacapavir evidence base. 

But registration is not the same as access. A medicine that exists on paper but is unavailable in public programs, unaffordable to governments, poorly understood by providers, or inaccessible to communities will not change the trajectory of HIV. The history of HIV has taught Africa that innovation without equity can widen gaps before closing them. Antiretroviral treatment transformed the epidemic only after advocacy, financing, generic competition, procurement systems and community mobilization turned scientific possibility into public health reality. 

That lesson should guide how we approach lenacapavir. The Global Fund’s agreement to procure lenacapavir for low- and middle-income countries is a major equity signal, particularly because it aims to avoid the familiar delay between high-income-country access and African access. Yet the real test will be whether countries can move from announcements to delivery: forecasting demand, financing procurement, training providers, building pharmacovigilance systems, adapting HIV testing algorithms, protecting informed choice, and ensuring that community voices shape rollout from the beginning. 

This is where Africa must not be treated only as a market or implementation site. Africa was central to generating evidence. South African and Ugandan participants, communities, investigators and research teams helped produce the knowledge that the world is now celebrating. That contribution should translate into a stronger role for African scientists, policymakers, manufacturers and communities in deciding how lenacapavir is prioritized, priced, procured, studied and delivered. 

We also need a more serious conversation about manufacturing and regional security of supply. In South Africa, that conversation is already underway: the South African National AIDS Council’s March 2026 call for local manufacturers is moving through licence negotiations with Gilead, with final regulatory sign-off resting on the South African Health Products Regulatory Authority. And there is a strong economic case for this — branded lenacapavir costs over $28,000 per person per year in the United States, while early generic licensing deals have already set a price of around $40 per person per year, a gap of more than 700-fold. Local and regional manufacturing will not happen through aspirations alone. It requires policy commitment, predictable demand, technology transfer, regulatory strengthening, pooled procurement, and financing that recognizes health R&D as infrastructure. If Africa is expected to help end HIV as a public health threat by 2030, then Africa must also be enabled to produce, adapt and govern the tools required to get there. 

Lenacapavir should therefore be seen as both a prevention option and a policy test. Will we invest early enough to reach those who would most benefit? Will we protect people’s right to choice? Will donors, governments and industry be transparent about price, supply, licensing and timelines? Will African research institutions be resourced to evaluate real-world delivery and equity, not only to recruit participants for pivotal trials? 

For South Africa, the opportunity is immediate. The country has world-class HIV researchers, a strong clinical trial history, regulatory experience, public health infrastructure, civil society capacity and urgent prevention needs. The missing link is a coordinated ambition: domestic resource mobilization, donor alignment, evidence from local implementation, and a policy environment that treats HIV prevention innovation as a national development priority. 

Lenacapavir gives us a rare moment of hope for HIV prevention. But hope is not a strategy. The strategy must be equitable access, African scientific leadership, sustainable financing, community accountability and stronger regional manufacturing capacity. If we get this right, lenacapavir will not only prevent infections. It will show that Africa can help shape the future of HIV science and policy on its own terms. 

About the Author: 

Prof. Vinodh Edward is Group Chief Operating Officer at the Aurum Institute, where he plays a key role in advancing clinical research and health innovation across Africa. With more than 20 years of experience in biotechnology and clinical research, he has led major international trials and helped strengthen research infrastructure across the continent. He is also a champion in the African Voices of Science (AvoS) initiative that aims to amplify the voices of African health research specialists to drive continental policy and financing goals for research, development and Innovation (RD&I) in Africa.