Lenacapavir for HIV Prevention in Africa: Opportunities, Barriers, and Policy Priorities.

Despite global progress in HIV prevention, Africa continues to carry a disproportionate share of the epidemic and its related inequalities. Daily oral pre-exposure prophylaxis (PrEP) has been limited by adherence and accessibility challenges. Lenacapavir, a long-acting injectable PrEP administered every six months, has shown efficacy in clinical trials among high-risk populations in sub-Saharan Africa and offers new promise for prevention efforts. This Policy Perspective examines the opportunities and barriers to equitable access and rollout of lenacapavir in African settings. Key challenges include high implementation costs, limited health infrastructure, regulatory delays, supply chain constraints, and social barriers such as stigma, misinformation, and mistrust. We argue that the promise of lenacapavir will only be realized if its introduction is accompanied by policies and programs that address these systemic obstacles. Ensuring equitable access will require robust stakeholder collaboration, meaningful community engagement, and deliberate efforts to strengthen health systems.