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Funding Shortfalls Threaten Global Rollout of Twice-Yearly HIV Prevention Injection

Recent U.S. prevention funding cuts risk derailing access to the drug in the world’s poorest regions.

Gilead Sciences in Oceanside, California, U.S., April 29, 2020. REUTERS/Mike Blake/File Photo
Martin Agunda (left), a lab technician at Kuoyo Sub-county Hospital, once supported by USAID, in Kisumu, prepares to test a viral load sample from Ruth Gweyi (right), a mother living with HIV on April 24, 2025, in Kisumu, Kenya. Kisumu has one of the highest HIV rates in Kenya, with around 17.6% of the adult population are living with the virus, nearly five times the national average of 4.5%. In 2025, Kisumu has beco
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Overview

  • The U.S. FDA last month approved Gilead Sciences’ twice-yearly injectable lenacapavir for HIV prevention after trials showed near-perfect efficacy in adults and adolescents.
  • Gilead and the Global Fund have finalized an at-cost supply agreement to deliver the drug to 2 million people in low-income countries by 2028, with first doses expected in sub-Saharan Africa before year-end.
  • Royalty-free licenses with six generic manufacturers will enable low-cost production in 120 low- and middle-income countries, but generic supplies are not projected until around 2027.
  • Cuts to PEPFAR and USAID funding under the U.S. administration have eroded testing, counseling and distribution networks, leading to the loss of 8,000 HIV health-worker jobs in South Africa.
  • Public health models project that reduced prevention funding could result in at least 70,000 additional HIV infections and 5,000 more deaths over the next five years.