Lenacapavir is a newly approved injectable medication designed to prevent HIV infection in HIV-negative individuals, a category of prevention known as pre-exposure prophylaxis or PrEP. The drug is administered into the abdomen twice per year, with each injection providing six months of protection. Unlike daily oral PrEP medications, lenacapavir addresses two significant barriers in HIV prevention: adherence and efficacy.
Clinical trials examining the drug, designated PURPOSE 1 and 2, produced notable results. PURPOSE 1, conducted in Uganda among nearly 4,200 women, demonstrated that none of the participants acquired HIV after the drug became available to all trial participants. Adherence rates exceeded 96% of women receiving the drug on schedule. PURPOSE 2, which enrolled men and gender-diverse individuals, showed slightly lower adherence with one participant acquiring HIV. Researchers attribute the drug’s effectiveness partly to its mechanism of action, which targets multiple stages of the HIV lifecycle rather than a single point of intervention.
However, the initial rollout has encountered significant obstacles. Uganda received its first batch of approximately 20,000 doses in February and began distribution in April. The rollout has been characterized as a “drip feed” approach, with limited doses reaching communities. Kasensero, a town of approximately 15,000 people with one of Uganda’s highest HIV rates, received only enough doses to cover 60 people before supplies were exhausted. Some districts identified as having high HIV burden were excluded from initial distribution plans, with additional sites scheduled for inclusion in November 2026. Concerns about long-term funding stability and supply chain uncertainties have created skepticism among healthcare workers.
Pricing presents another barrier to broader access. The current list price for two doses is approximately $28,000, substantially higher than the roughly $45 annual cost of daily oral PrEP. Manufacturer Gilead has announced plans to allow generic production beginning in 2027 and committed to selling the drug at no profit until generics become available. A United Nations agency negotiated an agreement for generic production at $40 per patient per twice-yearly injection. According to the company, lenacapavir is currently available in 10 countries with expected expansion to 24 low- and middle-income countries by year-end.
The drug’s rollout occurs amid broader challenges to HIV prevention infrastructure. Following reduced U.S. foreign aid funding in 2025, Uganda experienced staff reductions across its HIV treatment and prevention system, including counselors, data specialists, and contact tracing workers. An estimated 980 Ugandans have started lenacapavir since April. Meanwhile, initiation of oral PrEP declined 42% across 10 countries in 2025 compared with the previous year. Health workers emphasize that comprehensive HIV prevention requires multiple tools working in concert, with both injectable and oral options playing important roles in the overall strategy.
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