Twice-Yearly HIV Prevention Drug Remains Scarce in Uganda

In Mbarara, western Uganda, sex worker Lisa Mutoni uses condoms and takes HIV-prevention medicine, but says she has been unable to obtain lenacapavir. The injection can provide nearly complete protection against HIV with two doses a year, a schedule that could help people who find daily pills difficult to maintain or travel for work.

Health workers say supplies are far below demand in Uganda and elsewhere. Mbarara Health Centre IV received 40 doses in April, initially reserved for pregnant women at risk of HIV. Later, eligibility expanded to include couples affected by HIV and sex workers. A further 70 doses sent in June were used within 10 days.

The shortage has affected Julius Bampe, who sought the drug after his wife tested positive for HIV. He was told the clinic had run out. In Mbarara, an estimated 10% of adults have HIV, about twice Uganda’s national rate. Health officials say transactional sex contributes significantly to new infections.

The U.S. medicines regulator has tentatively approved a generic version that could be distributed in 120 low-income countries for about $40 per year, compared with a U.S. list price of $28,218. The Global Fund’s stated goal is to reach 3 million people by the end of 2028.

Doctors Without Borders says that target and current access are insufficient, and is urging Gilead Sciences to provide lower-cost doses to more countries and sell directly to the organization. Meanwhile, people seeking prevention in Mbarara continue to rely on other PrEP options, including daily pills and an injection given every other month.

HIV Prevention Breakthrough Is Out of Reach for Those Who Need It

A promising HIV-prevention injection is in short supply where the need is acute. In Mbarara, Uganda, sex worker Lisa Mutoni says she cannot get lenacapavir, even though two doses a year can provide nearly complete protection and may be easier to manage than daily pills.

The scarcity is stark at Mbarara Health Centre IV: 40 doses arrived in April, followed by 70 in June, and the later shipment was gone in 10 days. The initial allocation was limited to pregnant women at risk; eligibility later widened to include couples affected by HIV and sex workers. Julius Bampe, whose wife tested positive, was unable to get a dose because the clinic had run out.

The FDA has tentatively approved a generic intended for 120 low-income countries at roughly $40 per year. But the Global Fund’s aim of reaching 3 million people by the end of 2028 does not meet Doctors Without Borders’ demand for more rapid, widespread access. The group wants Gilead Sciences to make affordable doses available in more countries and sell them directly to MSF.

In a city where an estimated one in 10 adults has HIV, the gap between the drug’s potential and the doses people can actually obtain leaves those at risk relying on other PrEP choices. A lower-cost version offers a path forward, but the shortage and the limited scale of planned access remain pressing concerns.

Generic HIV Prevention Drug Offers Path to Wider Access

Lenacapavir offers a potent new option in the fight against HIV: two injections a year can provide nearly complete protection. But in Mbarara, Uganda, demand has outrun supply, and people seeking the drug have been turned away. The question now is how quickly production and distribution can grow.

The FDA has tentatively approved a generic version for potential distribution in 120 low-income countries at roughly $40 annually, while the American price is $28,218. The Global Fund hopes to reach 3 million people by the end of 2028. That is a concrete route toward expanding access, though Doctors Without Borders argues the scale is not enough and wants Gilead to provide low-cost doses to more countries and sell directly to MSF.

The need is visible at Mbarara Health Centre IV, which received 40 doses in April and another 70 in June. The June supply was used in 10 days after eligibility widened beyond pregnant women at risk to include couples affected by HIV and sex workers. Julius Bampe sought a dose after his wife tested positive but found none available.

Lenacapavir’s long-lasting protection could make prevention easier for people who struggle with daily pills or move between locations. The immediate task is getting more doses to clinics: people in Mbarara still depend on other PrEP options while the generic rollout is prepared.