HIV prevention: lenacapavir rollout prompts access gaps

What's happened

Uganda reports HIV prevalence stable at 5.9% with 1.496 million adults living with HIV; 85.3% know their status, 99.1% on treatment, 96.5% virally suppressed. In MENA, lenacapavir's global rollout shows affordability gaps and uneven access; six generic manufacturers will produce cheaper versions, but many countries remain excluded, raising concerns over reach of the prevention option.

What's behind the headline?

Context and implications

• Lenacapavir offers a twice-yearly PrEP option that could boost adherence vs daily pills. In the MENA region, access hinges on licensing and price, with exclusions in Lebanon and Iraq limiting reach.
• The pricing gap between the US ($28,218/year) and generics (about $40/year) highlights global inequities in HIV prevention access.
• Funding shortfalls and stockouts across IPPF, IP and other NGOs threaten continuity of prevention, testing, and treatment services in multiple regions.
• The mix of progress and gaps underscores a need for targeted funding and expanded licensing to meet UNAIDS targets and regional health goals.

Forecast: Wider generic availability by 2027 could substantially broaden coverage, but political and funding hurdles will shape rollout speed and equity.

How we got here

Uganda's UPHIA 2025 shows a shift from earlier declines, keeping prevalence around 5.9% while treatment outcomes improve. Gilead's lenacapavir rollout, announced after US FDA approval, is licensed to six manufacturers for low- and middle-income countries, with price and access gaps in the Middle East and North Africa.

Our analysis

All Africa: Uganda UPHIA 2025 results. The New Arab: Lenacapavir licensing and regional access in MENA. Bloomberg: NGO stockouts in HIV prevention. The Guardian/IPPF: stockouts and testing shortages. Al Jazeera: lenacapavir context and funding shifts.

Go deeper

• How might Uganda accelerate undiagnosed testing to close the status gap?
• Which MENA countries are outside the generics licensing and how might policy shifts address that?
• What funding changes are anticipated to stabilize PrEP supply globally?

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