Context:

The rollout of a revolutionary HIV preventive drug, lenacapavir, which promised significant progress against the epidemic, faces severe setbacks as the U.S. withdraws critical funding. This decision by the Trump administration disrupts efforts across Africa, particularly impacting young women who are most affected by new infections. Key HIV programs and clinical trials are halted, clinics are closing, and essential staff are laid off, leading to fears of rising infection rates and undermining years of progress. The potential support from the Gates Foundation and negotiations for generic versions offer some hope, but challenges remain in ensuring affordable and widespread access. The situation highlights the vulnerability of global health initiatives to political shifts and funding changes, risking the resurgence of the virus in heavily impacted regions like South Africa and Eswatini.

Dive Deeper:

• Lenacapavir, a promising new HIV preventative drug, was set for rapid deployment in Africa, targeting young women who make up half of all new infections globally, but U.S. funding cuts have derailed these plans.

• The Trump administration's decision to slash foreign aid has forced HIV programs to scramble for resources, leading to the closure of clinics, layoffs of healthcare workers, and halted vaccine trials across the continent.

• U.S. support for lenacapavir's rollout was initially planned through PEPFAR and the Global Fund, but funding cuts have left a significant gap in the projected distribution and administration of the drug.

• Gilead Sciences, the drug's manufacturer, faces uncertainty over funding for lenacapavir, as the Gates Foundation hesitates to purchase from large pharmaceutical companies, complicating negotiations for affordable pricing.

• In countries like South Africa and Eswatini, the withdrawal of U.S. support has resulted in decreased HIV testing, interruptions in treatment, and fears of increased drug resistance and new infections.

• Efforts to encourage generic production of lenacapavir are underway, with hopes that affordable versions will be available by 2027, but there are concerns about the willingness of generic manufacturers to scale up without proven demand.

• The situation underscores the dependency of global health efforts on consistent international support and the risks posed by sudden policy changes, potentially reversing hard-won gains against the HIV epidemic.