At the ART clinic of Mbarara City Council Health Center IV, patients line up for care while a nurse prepares a syringe containing lenacapavir. The injection, approved for pre-exposure prophylaxis (PrEP), promises protection with just two doses a year. Yet on Aug. 21 and Aug. 22 2026, women like sex worker Lisa Mutoni reported that the drug was unavailable, the clinic’s stock reportedly “finished.” Mutoni, who already takes daily PrEP pills, explained that a six-month shot would give her “a feeling of safety” she cannot always achieve with pills that can be forgotten.
Promising science meets a stark supply gap
Developed by Gilead Sciences, lenacapavir showed near-complete efficacy in clinical trials, positioning it as a potential game-changer against HIV in sub-Saharan Africa. The drug’s long half-life means patients need only two injections per year, a stark contrast to daily tablet regimens or the every-other-month shot of cabotegravir. However, the rollout is hampered by limited doses. Andrew Hill, a senior visiting research fellow at the University of Liverpool, warned that “the rate of growth isn’t fast enough” and that millions must receive the medication soon.
Regulatory breakthrough and price disparity
In a recent development, the U.S. Food and Drug Administration gave tentative approval to a generic version of lenacapavir. The approval could enable production for roughly $40 a year—a dramatic reduction from the U.S. list price of $28,218. The generic is slated for distribution across 120 low-income nations, with the Global Fund targeting 3 million beneficiaries by the end of 2028. Yet critics argue the plan is insufficient. Melissa Barber, MSF USA’s global health advocacy adviser, said, “Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise.”
Local impact: doses vanish within days
In Mbarara, where an estimated 10 % of adults live with HIV—double the national average—health workers describe a revolving door of supply. In April, the clinic received a batch of 40 doses, earmarked initially for pregnant women at risk. Guidelines were later broadened to include couples like Julius Bampe, a builder whose younger wife tested positive earlier this year, as well as sex workers and other high-risk groups. By June, a shipment of 70 doses was administered within ten days, according to nursing officer Tarsisio Biryeija. The rapid depletion leaves many patients, including Mutoni, without access to the protective injection.
Community advocates such as Immaculate Nyamwija, founder of Action for Improved Health and Wealth, provide counseling, condoms and moral support, but they cannot solve the supply bottleneck. “It is a challenge, because the demand is high and the doses are few,” Nyamwija said. “Who would not wish to take (lenacapavir) for six months? Who would wish to be on drugs every day?”
The situation underscores a broader tension between pharmaceutical innovation and equitable distribution. While the generic approval promises a cheaper product, the logistics of manufacturing, allocation and delivery to remote clinics remain uncertain. If the intended 3 million-person target by 2028 is to be met, coordination between Gilead, the FDA, the Global Fund and on-the-ground NGOs will need to accelerate dramatically.
For now, the residents of Mbarara must navigate an imperfect landscape: some rely on daily oral PrEP, others wait for the scarce injection, and a few, like Bampe, are left without any preventive option at all. The disparity highlights how a breakthrough medical technology can still falter without the supply chains and pricing structures needed to reach the most vulnerable.
