Eswatini Leads Africa's HIV Breakthrough With New Drug

Sandra didn't hesitate when she heard about a new HIV prevention drug that required just two shots per year instead of daily pills. The 24-year-old salon owner in Mbabane, Eswatini, was among the first people in all of Africa to receive lenacapavir, a breakthrough injectable that's nearly 100% effective at preventing HIV.

"I know a lot of people with HIV. Young people, old people, people even born with HIV, so I wanted to protect myself," Sandra says. She immediately told her friends, and four of them came to get the shot too.

In Eswatini, where one in nine young women is HIV positive, this matters enormously. Nurse Phumlile Ndlow at the AIDS Healthcare Foundation clinic in Manzini has personally given over 540 doses since November 2025. "The uptake has been amazing," she says. "People are now informed, they are telling each other and they are coming."

The transformation feels especially remarkable to Dr. Nkululeko Dube, who remembers when things looked very different. As a young medical student during the height of the AIDS epidemic, nearly everyone in the hospital wards was being treated for HIV-related conditions. "Every family had one or two people who were sick," he recalls.

Back then, Eswatini faced one of the world's most severe health crises, with 25% of adults living with HIV. While wealthy countries got lifesaving treatments in the late 1990s, Africa waited nearly a decade. Millions died not because medicine didn't exist, but because they couldn't afford it.

Today, Eswatini has completely turned that story around. Now 98% of people living with HIV know their status, 98% of those diagnosed receive treatment, and 98% of those on treatment have achieved viral suppression. "It has been nothing short of a revolution," says Dr. Dube, now Country Director for AHF Eswatini.

The Ripple Effect

This time, Africa isn't waiting. Lenacapavir's arrival in Eswatini and Zambia last year marked the first time an HIV prevention tool became available in both wealthy and developing countries in the same year. That's a fundamental break from the delays that defined earlier treatments.

The swift rollout happened through coordinated efforts between Eswatini's Ministry of Health, the Global Fund, and multiple partners who took early action to get ahead of manufacturing challenges. Four more African countries have already started administering the drug, and by year's end, lenacapavir will reach 21 countries across Asia, Africa, Eastern Europe, Latin America, and the Caribbean.

The numbers tell a hopeful story. In four months, approximately 2,750 people in Eswatini have received lenacapavir, with plans to expand access to 204 health facilities nationwide by the end of 2027. Research suggests that if scaled across Eastern and Southern Africa, the drug could prevent one in three new HIV infections over the next decade.

"We have done so well with treatment. Now we want to achieve zero new infections," says Sindy Matse, Director of the Eswatini National AIDS Program.

For Sandra and thousands like her, that future is already beginning.