New HIV Injection Works for 6 Months, Reaches 2M People

For millions of women in South Africa, protecting themselves from HIV has meant taking a daily pill they might forget, hide from partners, or simply give up on. Now a single injection every six months could change everything.

Lenacapavir, the most potent HIV prevention drug ever developed, requires just two shots per year instead of 365 pills. Studies show that by month three, about half of people taking daily prevention medication have stopped. By year's end, only a handful remain consistent.

"You're asking people who are healthy, who don't have any illness, to take a tablet every day," said Salim Abdool Karim, director of South Africa's Centre for the AIDS Programme of Research. "That's a high bar."

The new drug works completely differently from existing prevention pills. Instead of blocking enzymes the virus uses to copy itself, lenacapavir targets the capsid, a cone shaped shell surrounding HIV's genetic material. This shell is essential for the virus to replicate and spread.

"It's the most potent molecule we know of against HIV," said Wesley Sundquist, a University of Utah biochemist specializing in the HIV capsid. The drug creates a small deposit under the skin that slowly dissolves, staying effective even at very low concentrations.

South Africa launched its rollout in June 2024 after drugmaker Gilead agreed to supply lenacapavir at no profit to up to 2 million people over three years. The deal came through the Global Fund, a public private financing organization. Gilead also agreed to allow cheaper generic versions in 120 resource-limited countries with high infection rates.

The drug targets three groups where HIV rates remain stubbornly high: adolescent girls and young women in parts of Africa, younger gay men in Western countries, and vulnerable communities in Eastern Europe and Central Asia.

The Ripple Effect

When people can actually stick with their HIV prevention plan, entire communities benefit. Every person protected means the virus has fewer chances to spread to partners, reducing infection rates across neighborhoods and countries.

The twice yearly schedule removes the daily burden of remembering pills, hiding medication from partners who might react badly, or dealing with side effects. For women who couldn't always insist partners use condoms or didn't know their partner's HIV status, lenacapavir offers protection they control completely.

Generic versions will make the drug affordable in the countries that need it most. Doctors Without Borders is pushing for even wider access, calling on Gilead to supply the drug at around $40 per shot to reach excluded regions like Brazil, Mexico, Peru and Argentina.

The deciding factor in stopping HIV's spread is whether lenacapavir reaches the people and places where infections happen fastest, but the infrastructure is finally falling into place to make that possible.

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