HARARE – In a landmark moment for the African continent, Eswatini has emerged as the pioneering country to welcome lenacapavir, a revolutionary HIV prevention injection administered biannually. This medical breakthrough is celebrated by global health leaders as a significant step forward in controlling a virus that has claimed countless lives across Africa.

Crafted by Gilead Sciences, lenacapavir has shown near-complete efficacy in clinical trials, offering a promising new tool in the fight against HIV. The introduction of this drug in Africa is part of a broader initiative under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), in collaboration with the Global Fund. By 2027, this initiative hopes to reach at least 2 million individuals across 10 high-risk African nations.

Daniel O’Day, the chair and CEO of Gilead Sciences, lauded the distribution in Eswatini as “extraordinary.” He emphasized that this marks the first instance of a new HIV medication being introduced in a sub-Saharan African country within the same year as its U.S. approval. This is particularly significant as Eswatini faces the highest HIV incidence globally. The drug received U.S. approval in June.

Meanwhile, the United States, despite facing significant reductions in foreign aid under the administration of President Donald Trump, initially aimed to allocate 250,000 doses to the identified countries this year. On the same day as Eswatini, Zambia received its first batch, while Gilead works towards gaining regulatory approval in Botswana, Kenya, Malawi, Namibia, Rwanda, Tanzania, Uganda, and Zimbabwe.

Due to “early demand signs,” the initial allocation was increased to 325,000 doses, as reported by Brad Smith, a senior advisor for the Bureau of Global Health Security and Diplomacy, during a press briefing.

The U.S. government has noted that over 25 million people across Africa are living with HIV.

In Eswatini, a tiny kingdom in southern Africa, about 6,000 high-risk people are set to benefit from the drug’s initial rollout, primarily to prevent HIV transmission from mothers to newborns. Home to roughly 1.2 million people, Eswatini currently has over 200,000 people living with HIV, with most receiving treatment funded by PEPFAR, Smith said.

Eswatini, the world’s last absolute monarchy with a documented record of human rights violations, is also among the African countries participating in Trump’s third-country deportation program, which has faced protests from rights groups.

In July, the World Health Organization approved lenacapavir as an additional HIV prevention option. UNAIDS has called long-acting injectables a “fresh option” amid concerns that foreign funding cuts could worsen infections.

South Africa’s health minister, Aaron Motsoaledi, recently called lenacapavir “groundbreaking” but raised concerns over limited supplies when South Africa begins its own rollout in April 2026.

Motsoaledi also welcomed Gilead’s steep price reduction from over $28,000 per person annually in the U.S. to approximately $40 for lower-income countries.

The rollout has fueled 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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