Eswatini has begun scaling up the use of a new long-acting HIV prevention injection, with authorities confirming that around 2,000 people have already received the treatment since its introduction in December.
The southern African kingdom joins a small but growing group of countries deploying lenacapavir, a breakthrough drug designed to reduce HIV transmission through a twice-yearly injection.
The rollout marks a significant shift in HIV prevention efforts in one of the world’s most affected countries. By moving away from daily pills to long-acting injections, health officials aim to improve adherence, reduce new infections, and sustain gains made over the past decade — building on broader health system investments such as recent US-backed HIV and healthcare funding initiatives in Eswatini.
Health officials say the response from the public has been overwhelmingly positive, with early demand rapidly depleting available stock.
‘People have responded very well to the new option,’ Sindy Matse, programme manager for Eswatini’s National AIDS Programme, told Reuters, noting that initial supplies are already close to being exhausted.
Authorities now plan to expand availability of the injection across all 206 health facilities currently offering pre-exposure prophylaxis (PrEP), signalling an ambitious nationwide scale-up.
A new approach to prevention
Developed by US-based Gilead Sciences, lenacapavir is administered as a subcutaneous injection every six months. It is designed to address persistent challenges linked to daily oral PrEP, including missed doses and inconsistent access to medication.
Health experts have long identified adherence as a key barrier in HIV prevention programmes, a challenge increasingly being addressed through emerging health innovations across Africa.
Eswatini’s HIV burden remains high
Despite progress, Eswatini continues to face one of the highest HIV prevalence rates globally. According to 2023 data from the US Centres for Disease Control and Prevention (CDC), roughly one in four people aged 15 to 49 is living with HIV.
However, the country has recorded significant progress in reducing new infections. Annual cases have dropped sharply from around 14,000 in 2010 to approximately 4,000 in 2024, reflecting sustained investment in prevention, testing, and treatment programmes.
Eswatini is among a select group of African nations introducing lenacapavir, alongside several other high-prevalence countries. The United States, where the drug was developed, has also begun deploying it as part of its HIV prevention strategy, reflecting a wider shift towards sustainable, investment-driven health programmes across the continent.
With demand already outpacing supply, Eswatini’s next challenge will be ensuring consistent availability while expanding access nationwide. If successfully scaled, lenacapavir could play a pivotal role in further reducing new infections and strengthening long-term public health resilience across Africa.
