Uganda: Mbarara residents wait for HIV shots despite generic lenacapavir approval

Gilead Sciences developed a drug called lenacapavir that provides nearly complete protection against HIV with only two injections per year. Health experts describe the medication as a potential turning point for global HIV prevention. However, the supply has not kept pace with demand, leaving many people in high-risk areas without access to the treatment.

The U.S. Food and Drug Administration tentatively approved a generic version of the drug on Monday. This move aims to lower costs and speed up distribution to 120 low-income countries. The generic version is priced at roughly $40 per year. This figure is far below the U.S. list price of $28,218. The Global Fund hopes to reach 3 million people with the medication by the end of 2028.

In Mbarara, a city in western Uganda, residents face daily challenges with HIV prevention. Lisa Mutoni, a sex worker in the local red light district, relies on condoms and daily pills for protection. She notes that some partners attempt to remove or tear the condom during intercourse. Mutoni said the injection offers a sense of security that daily pills do not. "If you know that you have that injection for six months, you feel like you are safe," she said. She added that the pill requires daily attention, which can be difficult to maintain.

Despite the benefits, Mutoni often finds the drug unavailable. "They tell me that it is finished," she said. Julius Bampe, a builder in Mbarara, faced a similar situation earlier this year. After his younger wife tested positive for HIV, he sought the injection for himself. His facility had no doses remaining. "When I got here, they said that is what they would have given me, but they said they didn't have enough doses for everyone," Bampe said.

Tarsisio Biryeija, a nursing officer at Mbarara Health Centre IV, reported that the facility received 40 doses in April. Initial guidelines restricted use to pregnant mothers at risk of infection. The rules later expanded to include couples, sex workers, and other groups. The first batch was used quickly. A subsequent shipment of 70 doses arrived in June and was administered within 10 days.

Andrew Hill, a senior visiting research fellow at the University of Liverpool, said the current rollout speed is insufficient. "The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon," Hill said. He noted that other prevention options, such as daily pills or monthly injections of cabotegravir, are effective and widely available. Lenacapavir is distinguished by its long-lasting effects.

Doctors Without Borders, known as MSF, argued that the planned distribution is not enough. The organization asked Gilead to make cheaper doses available to more countries and to sell directly to MSF. Melissa Barber, an MSF USA global health advocacy and policy adviser, stated that Gilead's actions do not match its stated goal of ending the HIV epidemic for everyone, everywhere.

Immaculate Nyamwija, founder of the Mbarara-based organization Action for Improved Health and Wealth, provides support to women facing discrimination. She noted that the demand for lenacapavir is high while doses remain few. "Who would not wish to take (lenacapavir) for six months? Who would wish to be on drugs every day?" she said. Mbarara has an estimated HIV rate of 10% among adults, which is double the national average in Uganda.

Health authorities in Uganda attribute many infections to transactional sexual encounters. The region has seen a decline in HIV rates over the past three decades. The current shortage leaves many residents relying on alternative prevention methods while awaiting more supplies.