The World Health Organization (WHO) updated its HIV prevention guidelines in 2025. It strongly recommends lenacapavir, a long-acting antiretroviral drug, for high-risk populations and areas with high HIV prevalence. This announcement was made at the 13th International AIDS Society Conference in Kigali, Rwanda. Lenacapavir has recently been approved by the US Food and Drug Administration (FDA) as a twice-yearly injectable pre-exposure prophylaxis (PrEP) treatment. This marks advancement in HIV prevention efforts worldwide.
Lenacapavir – A New Era in HIV Prevention
Lenacapavir is a long-acting injectable drug developed by Gilead Sciences in New Delhi. It belongs to a novel class called capsid inhibitors. These drugs disrupt several stages of the HIV replication cycle. Initially approved in 2022 for HIV treatment, lenacapavir’s prevention use was approved in 2024. It requires only two injections per year. This reduces the need for daily pills and improves adherence, especially for people facing stigma or limited healthcare access.
WHO’s Strategic Shift in HIV Prevention
The WHO’s endorsement of lenacapavir signals a move towards diversifying HIV prevention methods. The organisation aims to provide individuals with more effective and convenient options. WHO Director-General Dr Tedros Adhanom Ghebreyesus called lenacapavir the next best thing to an HIV vaccine. The new guidelines also promote simplified HIV testing using rapid diagnostic kits. This supports wider access to injectable PrEP through pharmacies, clinics, and telehealth services.
Challenges in Global HIV Prevention
Despite advances, global HIV prevention has stalled. Approximately 1.3 million new infections were recorded in 2024. High-risk groups include sex workers, men who have sex with men, transgender individuals, injecting drug users, prisoners, children, and adolescents. Funding cuts, particularly by the United States, threaten progress. US reductions in aid to programmes like PEPFAR have led to sharp declines in PrEP access in countries such as Nigeria. The United Nations warns that without restored funding, millions could die from HIV-related causes by 2029.
Funding and Access – The Road Ahead
International aid accounts for around 80% of HIV prevention funding in low- and middle-income countries. Although some countries plan to increase domestic HIV budgets, these may not fully replace lost foreign aid. In a positive development, Gilead Sciences agreed to supply lenacapavir at cost through the Global Fund to Fight AIDS, Tuberculosis and Malaria. This pricing model aims to improve affordability and access in affected regions. However, in the US, lenacapavir remains expensive, with an annual list price exceeding $28,000.
Questions for UPSC:
- Critically discuss the role of long-acting antiretroviral drugs in transforming HIV prevention strategies globally.
- Examine the impact of international funding cuts on public health programmes in low- and middle-income countries with reference to HIV/AIDS management.
- Analyse the challenges faced by high-risk populations in accessing HIV prevention tools and the measures to address these barriers.
- Point out the significance of rapid diagnostic testing in enhancing healthcare delivery and disease control in resource-limited settings.
