US ignores South Africa as it rolls out HIV-Prevention drug to 12 African countries

A new U.S.-led initiative to expand access to HIV-prevention medication in high-burden African countries began last week with the delivery of about 1,000 doses of Gilead Sciences Inc.’s long-acting drug, lenacapavir, to Zambia and Eswatini, with 12 other African countries also designated to receive the drug.

The shipment marks the first stage of a broader effort to curb HIV transmission across sub-Saharan Africa, the region most affected by the AIDS pandemic.

Zambia and Eswatini each received approximately 500 doses, U.S. and company officials confirmed, according to Reuters.

However, the programme notably excludes South Africa, which has the world’s largest population of people living with HIV, estimated at around 8 million, or one in five adults.

The country continues to bear the highest HIV burden globally, with 7.7 million infections recorded in 2023. In 2024, South Africa received $250 million in support, the largest share of global HIV/AIDS funding.

Jeremy Lewin, senior U.S. State Department official for foreign assistance, said Washington expects capable countries to finance their own supplies.

“Obviously we encourage every country, including countries like South Africa that have significant means of their own, to fund doses for their own population … U.S.-funded doses will not be going to South Africa,” Lewin told reporters.

The move comes against a backdrop of strained relations between Washington and Pretoria. President Donald Trump ordered a 90-day pause on foreign aid after taking office in January and halted grants by the U.S. Agency for International Development (USAID), which had previously implemented much of the assistance under the President’s Emergency Plan for AIDS Relief (PEPFAR).

Business Insider Africa reported in May that Trump’s cuts had reduced access to HIV‑prevention drugs relied upon by millions across the continent, particularly within vulnerable groups.

At the time, Deputy President Paul Mashatile said the government was exploring more affordable antiretroviral options, and assured that its HIV/AIDS treatment programme remains fully funded for the current financial year.

In September, the U.S. State Department announced a plan to provide lenacapavir “at cost” in high-burden HIV countries, aiming to reach two million people over three years.

Under the arrangement, Gilead will supply the long-acting drug without profit to both the Global Fund and PEPFAR, the world’s largest HIV/AIDS initiative.

Lewin has said agreements are already in place with 12 African countries designated to receive the drug, though their names have not been disclosed.

Gilead CEO Daniel O’Day said the company is working with several African governments through partnerships with the Global Fund and PEPFAR and has submitted marketing applications in Rwanda, Tanzania, Botswana and other countries.

Peter Sands, executive director of the Global Fund, described lenacapavir as a major advancement. “Lenacapavir is a game-changer … it brings forth the promise of ending HIV as a public health threat in a very, very short time if we deploy at scale and at speed,” he said.

The initial deliveries highlight a significant step in advancing HIV prevention across Africa, though South Africa’s exclusion underscores deep political tensions and raises questions about equitable access.