More than two thousand teen girls and young women had been injected with the drug, which stays in the body for an astonishing six months. In the first year of the trial, each received two shots, and none of them became infected with H.I.V. “It was phenomenal,” Das told me. “We thought it was going to work, but none of us thought it was going to be one hundred per cent.” Three months later, the drug demonstrated ninety-six-per-cent efficacy in a similar trial that had enrolled more than three thousand men, transgender men and women, and nonbinary people who have sex with men.
For nearly twelve years, Gilead had been selling a pill named Truvada as a preventive treatment called pre-exposure prophylaxis, or PrEP. The drug worked remarkably well in clinical trials, but many healthy people had difficulty taking a daily pill, and others faced stigma and discrimination from sexual partners. Another company, ViiV Healthcare, brought a PrEP injection to market in 2021, but it only lasts two months, and remains little used. If two shots a year offered the same protection, Das knew, it could revolutionize H.I.V. prevention. On June 18th, the F.D.A. approved lenacapavir for PrEP. A stunning new era is upon us. But, as world leaders dismantle global health programs and cut back foreign aid, will this extraordinary new technology be able to change the world?
...
The fate of the rollout of lenacapavir PrEP remains murky. Although neither the Gates Foundation nor the Global Fund has committed to honoring their original pledge, both have indicated that they still plan to support “equitable access” to lenacapavir PrEP. (What this means, in practice, is difficult to say.) The White House, earlier this month, released its Congressional Budget Justification for fiscal year 2026 that calls for continued support for PEPFAR, with a budget cut of thirty per cent and a desire to speed its elimination; it specifically mentions funding for “high cost-efficiency biomedical tools, such as a twice-a-year HIV prevention injection.”
Injectable lenacapavir, despite its clear benefits, faces several other financial, political, and cultural challenges that have dogged PrEP from the outset. Will insurance companies reimburse for it in full? How aggressively will health officials promote its use? Will communities embrace it? “We have not seen evidence of the bigger resources being devoted and the political will to do what needs to be done to get any of these PrEP options into the populations that need it the most,” says Raphael Landovitz, an H.I.V./AIDS researcher at the University of California, Los Angeles, who has helped run other PrEP studies. “Everything we have seen is incremental. And so I fear that this is going to be yet another incremental improvement.”
https://archive.is/OF0OT
From the article:
...