Mbarara’s 70 June doses were used within 10 days
In Mbarara, a city in western Uganda known in part for sex tourism, Julius Bampe, an itinerant builder and polygamous man, sought a lenacapavir injection earlier this year after testing confirmed that his younger wife had HIV. She was immediately given drugs to suppress the infection, while Bampe sought protection for himself. When he went to the facility for the injection, he found that no doses were left. “When I got here, they said that is what they would have given me, but they said they didn’t have enough doses for everyone,” he said.
The facility Bampe uses received 40 lenacapavir doses in April with instructions to focus only on pregnant mothers at risk of acquiring HIV. The guidelines were later changed to include couples such as Bampe and his wife, sex workers and others. The April batch was quickly administered. Tarsisio Biryeija, a nursing officer working as a counselor at Mbarara Health Centre IV, said another 70 doses sent in June were used up within 10 days.
Lisa Mutoni, a sex worker in Mbarara’s red light district, said she insists that men use condoms when they enter her room because some try to remove or tear the condom during sex. She uses the protection against HIV and other infections. She takes HIV-prevention medication called PrEP, or preexposure prophylaxis, which can come as daily pills or periodic injections, and wants a longer-lasting option. Lenacapavir was a new option for Mutoni and millions of people like her if they could obtain it. Studies have shown it can offer nearly complete protection from HIV with two shots a year.
Mutoni said access to lenacapavir would benefit sex workers who sometimes shift elsewhere for months at a time. “If you know that you have that injection for six months, you feel like you are safe,” she said. “And then it is very good, nice because sometimes you can also forget, if it is the pill, you can forget to swallow.”
Mutoni said every time she tries to get what is commonly referred to as “lena,” it is not available. “They tell me that it is finished,” she said.
Mutoni receives counseling and other support, including condoms, from Immaculate Nyamwija, founder of the Mbarara-based organization Action for Improved Health and Wealth. Nyamwija said the organization offers HIV support services to women who would face discrimination elsewhere. “It is a challenge, because the demand is high and the doses are few,” she said. “Who would not wish to take (lenacapavir) for six months? Who would wish to be on drugs every day?”
There are not nearly enough doses in Uganda or the rest of the world. Other PrEP options, including daily pills and an every-other-month shot of cabotegravir, are very effective and widely available. Health experts said lenacapavir’s long-lasting effects could protect individuals and potentially even turn the tide of the HIV epidemic globally. Andrew Hill, an expert in HIV treatment who is a senior visiting research fellow at the University of Liverpool in northwest England, said the rollout needs to accelerate. “The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon,” he said.
The Global Fund said it hopes to deliver generic lenacapavir to 3 million people by the end of 2028. Doctors Without Borders, known by its French initials MSF, said the target was not nearly enough. The group called on Gilead Sciences, which developed lenacapavir, to make cheap doses available to more countries and to sell the drug directly to MSF so it could help protect more people faster. “Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise,” said Melissa Barber, MSF USA global health advocacy and policy adviser, in a recent statement.
Regulatory context. The U.S. Food and Drug Administration tentatively approved a generic version of lenacapavir in an announcement Monday. The approval could help speed production and distribution of the drug to 120 low-income countries at roughly $40 a year, far below the U.S. list price of $28,218. Associated Press said the situation may start to change in the coming months.
Local epidemiology. Uganda has slashed its HIV rate over the past three decades, and its rate remains far below that of some southern African countries. Health authorities in Uganda say infections are driven largely by transactional sexual encounters like those in Mbarara. Transactional sexual encounters represent a type of transmission lenacapavir could be effective at stopping. An estimated 10% of Mbarara’s adult population has HIV, double Uganda’s rate overall. Associated Press reported that, for now, people in Mbarara “have to settle for inferior choices.”
Gerald Imray in Cape Town, South Africa, and Laura Ungar in Louisville, Kentucky, contributed to the Associated Press report. Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation and is solely responsible for all content.