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A twice-yearly HIV shot arrives as funding to deliver it shrinks

A twice-yearly HIV shot arrives as funding to deliver it shrinks

New Capabilities

Lenacapavir can nearly stop new HIV infections. AIDS 2026 in Rio is where access gets decided.

Today: AIDS 2026 opens in Rio de Janeiro

Overview

A single shot, twice a year, prevented HIV in nearly everyone who received it in late-stage trials. The question at AIDS 2026, which opened in Rio de Janeiro on July 26, is whether that shot reaches the people who need it.

The drug, lenacapavir, works. It arrives as U.S. foreign-aid cuts have closed thousands of HIV clinics across Africa. The conference is where scientists, drugmakers, and funders decide whether a near-perfect prevention tool scales up or stalls.

Why it matters

A twice-yearly injection can nearly stop HIV transmission. Whether millions get it now turns on money and delivery, not the science.

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Key Indicators

100%
Efficacy in PURPOSE 1 trial
Twice-yearly lenacapavir prevented every HIV infection among cisgender women in the trial.
3 million
People targeted by 2028
Combined PEPFAR and Global Fund purchase commitment for lenacapavir prevention.
$40
Generic price per person per year
Planned cost of generic lenacapavir in up to 120 lower-income countries from 2027.
2×/year
Dosing frequency
Two injections a year replace a daily prevention pill.

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People Involved

Beatriz Grinsztejn
Beatriz Grinsztejn
Hosting AIDS 2026 in her home country
 Daniel O'Day
Daniel O'Day
Steering lenacapavir pricing and supply deals

Organizations Involved

International AIDS Society
International AIDS Society
Scientific membership organization
Organizer of AIDS 2026

The world's largest association of HIV professionals, which runs the biennial International AIDS Conference.
President's Emergency Plan for AIDS Relief (PEPFAR)
President's Emergency Plan for AIDS Relief (PEPFAR)
U.S. government program
Major funder facing disruption

The U.S. President's Emergency Plan for AIDS Relief, the largest bilateral funder of the global HIV response.
The Global Fund
The Global Fund
International financing partnership
Co-funder and first deliverer of lenacapavir

A multilateral fund that finances HIV, tuberculosis, and malaria programs across low- and middle-income countries.

Timeline

June 2024 July 2026

9 events Latest: Today
Tap a bar to jump to that date

  1. AIDS 2026 opens in Rio de Janeiro

    Today Conference

    The 26th International AIDS Conference convenes, centered on scaling long-acting prevention amid disrupted global HIV funding.

  2. Once-weekly oral pill posts positive Phase 3 results

    Clinical Trial

    Gilead and Merck report that a weekly islatravir/lenacapavir pill held HIV suppressed in switch trials, matching daily regimens.

  3. Purchase commitment rises to 3 million people

    Funding

    PEPFAR and the Global Fund add a million more people to the lenacapavir prevention target, with Gilead supplying at cost.

  4. Kenya begins national rollout

    Delivery

    Kenya starts offering long-acting injectable lenacapavir for HIV prevention through its public health system.

  5. First shipments reach Eswatini and Zambia

    Delivery

    The Global Fund delivers lenacapavir for prevention to two African countries, the first new HIV drug to arrive there in its approval year.

  6. Funders commit to 2 million people; generic deal set at $40

    Funding

    PEPFAR and the Global Fund pledge lenacapavir for up to 2 million by 2028. Gates Foundation and Unitaid target a $40 generic price from 2027.

  7. WHO recommends injectable lenacapavir

    Guidance

    The World Health Organization endorses twice-yearly lenacapavir as a prevention option at its Kigali conference.

  8. FDA approves lenacapavir for prevention

    Regulatory

    The U.S. Food and Drug Administration approves lenacapavir, sold as Yeztugo, as twice-yearly pre-exposure prophylaxis.

  9. PURPOSE 1 trial shows 100% prevention in women

    Clinical Trial

    Gilead reports that twice-yearly lenacapavir prevented every HIV infection among cisgender women in a large African trial.

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

2000–2004

Antiretroviral price collapse (2000–2004)

HIV treatment cost about $10,000 per patient a year, out of reach for most of Africa. Generic competition from Indian manufacturers and pressure campaigns cut the price to under $350, then lower. PEPFAR launched in 2003 to fund mass treatment.

Then

Millions in poor countries began antiretroviral therapy for the first time within a few years.

Now

The episode set the template: a working drug matters less than the price and financing that decide who gets it.

Why this matters now

Lenacapavir faces the same split today, cheap generics abroad against a high branded price, and the same question of whether funding closes the gap.

July 2012

Truvada approved for prevention (2012)

The FDA approved the daily pill Truvada as the first pre-exposure prophylaxis for HIV. It was highly effective when taken consistently. Uptake stayed low for years because of cost, stigma, and the difficulty of a daily regimen.

Then

Prevention prescriptions grew slowly and unevenly, concentrated in wealthier countries and populations.

Now

A decade passed before oral PrEP reached meaningful scale, showing that daily adherence is a real barrier.

Why this matters now

A twice-yearly shot removes the daily-pill problem that held back Truvada, which is why lenacapavir is treated as a chance to break that pattern.

December 2021

Cabotegravir long-acting PrEP approved (2021)

The FDA approved cabotegravir, an injectable given every two months, as long-acting HIV prevention. It outperformed daily pills in trials. Price and limited supply slowed its arrival in the countries with the highest HIV burden.

Then

Rollout in Africa lagged years behind approval as access deals were negotiated.

Now

It became a cautionary case for how a better tool can still stall on cost and supply.

Why this matters now

Lenacapavir's backers built early at-cost and generic deals specifically to avoid repeating cabotegravir's slow, uneven launch.

Sources

(8)
+2
International AIDS Society European AIDS Treatment Group Gilead Sciences World Health Organization Gates Foundation Merck AllAfrica Gilead Sciences