A new report by the Gates Foundation has revealed that long-acting HIV prevention tools, such as lenacapavir, the twice-yearly HIV-prevention injection, offer some of the strongest opportunities to drive infections and deaths towards zero in high-burden countries.
The 2025 Goalkeepers Report, released on Thursday, highlights lenacapavir’s potential as a transformative HIV prevention option, particularly for women and adolescent girls who face barriers to using existing daily oral Pre-Exposure Prophylaxis (prep) due to stigma, adherence challenges, or inconsistent access to medication.
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Recently, South Africa, Eswatini, and Zambia commenced the first rollout of the twice-yearly HIV-prevention injection, marking the initial public use of the drug in Africa.
Lenacapavir, developed by Gilead Sciences, costs approximately $28,000 per person per year in the United States. However, through partnerships with Unitaid and the Gates Foundation, generic versions are expected to be available by 2027 at a cost of roughly $40 per year in low- and middle-income countries.
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Life-saving potential
Although antiretroviral therapy continues to save lives, only a small proportion of people who could benefit from preventive medication currently have access, leaving millions vulnerable.
Despite global progress in reducing HIV infections since 2000, 1.3 million people acquired HIV in 2024, while only 18 per cent of those who could benefit from PrEP are currently receiving it.
Modelling in the Goalkeepers Report shows that scaling up access to affordable lenacapavir to just four per cent of people in high-incidence settings could prevent up to 20 per cent of new infections.
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With a generic version expected within the next few years, advocates believe the twice-yearly injection could rapidly expand protection for those at the highest risk of infection.
The report argues that the drug’s impact would extend well beyond adults.
With fewer women contracting HIV, the number of babies born with the virus would fall significantly, especially as mother-to-child transmission can already be reduced to less than one per cent when pregnant and breastfeeding women receive appropriate antiretroviral treatment.
Innovation needed
The Gates Foundation warned that, for the first time this century, child mortality is projected to rise, driven by stagnating health investments, widening inequities, and slow uptake of proven innovations.
It identifies a set of interventions capable of reversing this trend, including strengthened primary health care, routine immunisation, and the development of new vaccines and medicines.
The report highlighted how sustained investment has already transformed global health outcomes.
The work of Gavi has enabled more than one billion children to receive lifesaving vaccines since 2000, delivering enormous health and economic returns.
Similarly, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved an estimated 70 million lives since 2002, reducing deaths associated with those diseases by more than 60 per cent.
The fund’s recent replenishment, with leaders pledging more than $11 billion, signals continued commitment but also highlights the risks of retreating from health financing at a critical moment.
Modelling in the Goalkeepers Report projects that continued investment in next-generation innovations could save millions of children by 2045.
It points to promising developments such as new vaccines for respiratory syncytial virus and pneumonia, improved malaria tools, and long-acting HIV prevention options like lenacapavir, which could substantially reduce infections and HIV-related deaths in high-burden countries.
Sustained investments
The report notes that although lenacapavir currently requires two injections per year, a once-a-year version could be available by 2028.
Even at present, the shift from daily medication to twice-yearly dosing represents a substantial improvement for people facing stigma, limited access, or difficulty with adherence.
In an era of scarce resources, the report notes, this kind of innovation has never been more important.
It warns that stepping back from global health commitments now would put millions of children at risk, particularly in Africa, where gains against pneumonia, malaria, and HIV remain fragile.
The foundation called for sustained investment to ensure new tools reach the people who need them most and to prevent the projected rise in child deaths from becoming a reality.
Nigeria’s commitment
For Nigeria, where adolescent girls and young women remain among the most affected by the epidemic, access to long-acting HIV prevention has become a national priority.
The Director General of the National Agency for the Control of AIDS (NACA), Temitope Ilori, said the country is committed to ensuring that Nigerians can access the new $40, twice-yearly HIV prevention injections.
Ms Ilori, while speaking during the 2025 World AIDS Day commemoration in Abuja, highlighted progress, emerging challenges, and Nigeria’s efforts to build a more self-reliant national HIV programme.
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She described the injection as part of a “remarkable scientific evolution” in HIV prevention and treatment, noting how the field has advanced from multiple daily pills to long-acting injectable options.
She also recalled being on stage with former United States President Bill Clinton at the United Nations General Assembly when the $40 pricing announcement was made, describing it as a pivotal moment for global access.
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