A new long-acting HIV-prevention drug called lenacapavir is facing significant supply challenges in Uganda, despite its potential to provide nearly complete protection.
In Mbarara, a city in western Uganda known in part for sex tourism, the demand for new HIV-prevention medication is outstripping available supply. In the city's red light district, sex worker Lisa Mutoni reports that while she uses condoms to protect against HIV and other infections, she also relies on PrEP (preexposure prophylaxis), which can be administered as daily pills or periodic injections.
A new option for HIV prevention is a drug called lenacapavir, developed by Gilead Sciences. According to studies, the drug can offer "nearly complete protection from HIV with just two shots a year." This long-acting nature offers specific benefits for certain populations; Mutoni stated that access to the drug would benefit sex workers who sometimes shift locations for months at a time. "If you know that you have that injection for six months, you feel like you are safe," Mutoni said. She added, "And then it is very good, nice because sometimes you can also forget, if it is the pill, you can forget to swallow."
Despite these benefits, health experts note that lenacapavir is not yet widely available. Andrew Hill, a senior visiting research fellow at the University of Liverpool, said, "The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon."
In Mbarara, where an estimated 10% of the adult population has HIV—a rate double that of Uganda as a whole—residents are often unable to access the new drug. Julius Bampe, an itinerant builder, reported that when he sought the injection after his wife tested positive for HIV, he was told there were not enough doses for everyone.
At the Mbarara City Council Health Center IV, supply has been limited. Tarsisio Biryeija, a nursing officer working as a counselor, stated that a batch of 40 lenacapavir doses received in April was quickly administered following instructions to focus on pregnant mothers at risk. A subsequent batch of 70 doses sent in June was used up within 10 days.
Immaculate Nyamwija, founder of the Mbarara-based organization Action for Improved Health and Wealth, noted the difficulty of the situation. "It is a challenge, because the demand is high and the doses are few," Nyamwija said.
There may be shifts in availability in the coming months. The U.S. Food and Drug Administration recently announced the tentative approval of a generic version of lenacapavir. This generic version could potentially speed up production and distribution to 120 low-income countries at a price of roughly $40 a year, which is significantly lower than the U.S. list price of $28,218. The Global Fund stated its hope is to get the drug to 3 million people by the end of 2028.
However, some organizations argue this is insufficient. Doctors Without Borders (MSF) has called on Gilead to make cheap doses available to more countries and to sell the drug directly to MSF to increase the speed of protection. Melissa Barber, an MSF USA global health advocacy and policy adviser, stated, "Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise."
Sources
This article was drafted with AI assistance and checked against the sources above. Company claims are reported as claims. Cover image is AI-generated.
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