MBARARA – In the red light district of Mbarara, a city in western Uganda renowned for its sex tourism, a sex worker named Lisa Mutoni insists on the use of condoms during encounters with clients to safeguard herself against HIV and other sexually transmitted infections (STIs). Despite her precautions, she faces a significant challenge: some clients attempt to remove or tear the condom during intercourse, jeopardizing her safety.
Mutoni is proactive about her health; she takes HIV-prevention medication known as PrEP, or pre-exposure prophylaxis, which is available in the form of daily pills or periodic injections. However, there is a promising new option available for her and millions of others: a drug called lenacapavir, which studies have indicated could provide nearly complete protection from HIV with just two injections per year.
“If you know that you have that injection for six months, you feel like you are safe,” Mutoni remarked. “And then it is very good, nice because sometimes you can also forget; if it is the pill, you can forget to swallow it.”
However, she expresses frustration at the lack of availability. “Every time I try to get what is commonly referred to as ‘lena,’ it’s not available. They tell me that it is finished,” she said. This reflects the broader challenge surrounding lenacapavir, a drug developed by Gilead Sciences. While other PrEP options, including pills and an every-other-month injection of the drug cabotegravir, are effective and more widely available, health experts believe lenacapavir could be a game-changer in the global fight against HIV due to its long-lasting effects.
Despite its potential, the supply of lenacapavir is critically low, both in Uganda and globally. “The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon,” stated Andrew Hill, a senior visiting research fellow at the University of Liverpool and an expert in HIV treatment.
In a recent development, the U.S. Food and Drug Administration (FDA) has tentatively approved a generic version of lenacapavir, which could significantly accelerate production and distribution to 120 low-income countries at an estimated price of about $40 per year. In stark contrast, the U.S. list price is $28,218. The hope is to reach 3 million individuals with this treatment by the end of 2028, according to the Global Fund.
However, organizations such as Doctors Without Borders (MSF) argue that this initiative is insufficient. They have urged Gilead to expand access to affordable doses and consider direct sales to MSF to enhance protection efforts. “Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise,” remarked Melissa Barber, a global health advocacy and policy adviser for MSF USA.
Currently, residents of Mbarara, where approximately 10% of the adult population is living with HIV — double the national average in Uganda — must rely on less effective options. The demand for lenacapavir is high, yet the availability of doses is alarmingly low.
One local man, Julius Bampe, was taken aback when tests revealed that his younger wife had HIV. She began treatment immediately, prompting Bampe to seek lenacapavir for himself. Unfortunately, upon visiting a local clinic, he discovered that the anticipated doses were unavailable. “When I got here, they said that is what they would have given me, but they didn’t have enough doses for everyone,” he explained.
The facility where Bampe sought treatment received a limited supply of lenacapavir, initially designated for pregnant women at risk of HIV. Subsequent guidelines expanded eligibility to include couples like Bampe and his wife, sex workers, and other high-risk groups. Nonetheless, the available doses were quickly exhausted, indicative of the overwhelming need for better access.
Despite Uganda’s significant progress in reducing its HIV rate over the past three decades, the country still faces challenges. Health authorities point to transactional sexual encounters, common in places like Mbarara, as primary drivers of new infections — precisely the type of transmission that lenacapavir could effectively prevent.
To support individuals like Mutoni, organizations such as Action for Improved Health and Wealth, founded by Immaculate Nyamwija, provide crucial resources like counseling, condoms, and other HIV support services to women facing discrimination. “It is a challenge, because the demand is high and the doses are few,” Nyamwija noted. “Who would not wish to take (lenacapavir) for six months? Who would wish to be on drugs every day?”
___
Gerald Imray in Cape Town, South Africa, and Laura Ungar in Louisville, Kentucky, contributed to this report.
___
For more on Africa and development: https://apnews.com/hub/africa-pulse
___
The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.
