Suazilândia, All Africa Eswatini, Inglês

At 24, Sandra is building her future.

She owns two small beauty salons in and around Mbabane, Eswatini, and is saving up to pursue a degree in computer science.

Taking control of her health is part of her plan, in a country where 1 in every 9 young women is HIV positive.

When Sandra learned about lenacapavir – a twice-yearly injectable form of pre-exposure prophylaxis (PrEP) that is nearly 100% effective at preventing HIV – she didn’t hesitate.

Daily pills were difficult to maintain, and this long-acting injectable option offered a simpler way to stay protected.

“I know a lot of people with HIV. Young people, old people, people even born with HIV, so I wanted to protect myself,” she says. “I told all of my friends about it, four of them also came to get it.”

Sandra received her first dose from Nurse Phumlile Ndlow at the AIDS Healthcare Foundation (AHF) Eswatini, LaMvelase Clinic in Manzini – one of the very first health institutions in all of Africa to receive lenacapavir in November 2025.

In less than four months, Nurse Phumlile has personally administered more than 540 doses.

“The uptake has been amazing,” she says. “People are now informed, they are telling each other and they are coming.”

Nurse Phumlile Ndlow administers lenacapavir, one of the approximately 540 doses she has given. At the height of the AIDS epidemic, the small Southern African Kingdom of Eswatini faced one of the most severe public health crises in the world. Approximately 25% of the adult population was living with HIV – the highest prevalence rate globally at the time.

The epidemic devastated families, reduced life expectancy, and placed enormous strain on the country’s health care system and economy.

Dr. Nkululeko Dube, now Country Director for AHF Eswatini, was a young doctor at the time.

“In my early days as a medical student, almost everyone in the medical wards would be treating HIV-related conditions,” he says. “Every family had one or two people who were sick.”

While people in high-income countries gained access to lifesaving antiretroviral therapy in the late 1990s, most of sub-Saharan Africa – including Eswatini – was left behind. For nearly a decade, treatment remained out of reach for the majority, and millions died not because medicine didn’t exist, but because they couldn’t afford it.

But out of this crisis rose a determined response.

Two decades later, Eswatini stands as a global leader, having transformed one of the world’s most severe HIV epidemics into one of the strongest national AIDS responses.

Today, 98% of people living with HIV in the country know their status, 98% of those diagnosed are on treatment, and 98% of those on treatment have achieved viral suppression.

“It has been nothing short of a revolution,” says Dr. Dube.

Eswatini is now helping to shape the next chapter of the global HIV response.

Last year, together with Zambia, it became one of the first two countries on the continent to introduce lenacapavir – a breakthrough from Gilead Sciences that could dramatically accelerate the end of AIDS.

Despite decades of progress against HIV and AIDS, more than 40 million people globally live with HIV today, and over 600,000 die from AIDS-related illnesses every year.

Lenacapavir has the potential to drastically reduce new infections. It also represents a massive shift in global health equity.

Its arrival in southern Africa in 2025 marked the first time an HIV prevention tool was made available in both high- and low-income countries in the same year – a fundamental break from the years-long delays that characterized the early rollout of antiretroviral therapy.

To make this possible, the Global Fund, working closely with key partners, took early action, including early, at-risk procurement commitments to get ahead of long manufacturing lead times. Demand for long-acting PrEP is still evolving, yet countries are showing strong early interest.

The Global Fund is working with Gilead and upcoming generic manufacturers to expand supply quickly and sustainably, with generics anticipated as early as 2026, which will help meet increased demand.

The swift and effective rollout of lenacapavir in Eswatini is the result of a highly coordinated effort led by the Ministry of Health with support from the Global Fund, bringing together Eswatini’s National Emergency Response Council on HIV/AIDS (NERCHA), the Coordinating Assembly of Non-Governmental Organizations (CANGO), Gilead Sciences, the United States, the Children’s Investment Fund Foundation (CIFF), and others.

“We have done so well with treatment. Now we want to achieve zero new infections,” says Sindy Matse, Director of the Eswatini National AIDS Program. “As soon as the technology was approved, it was embraced for introduction across the country.”

In less than four months, approximately 2,750 people in Eswatini have received lenacapavir. The goal is to expand access to 204 health facilities, covering every region of the country by the end of 2027.

Four additional African countries – Kenya, Lesotho, Nigeria and Zimbabwe – have also started administering the drug. By the end of this year, lenacapavir will be available in 21 countries across Asia, Africa, Eastern Europe, Latin America, and the Caribbean supported through Global Fund investments.

This expansion also signals a profound shift in what is possible for global HIV prevention.

According to a recent study, if scaled, lenacapavir could prevent 1 in 3 new HIV infections across parts of Eastern and Southern Africa over the next decade. Not only would this spare millions of people the burden of lifelong HIV therapy, but it would also significantly reduce the financial cost of lifelong treatments.

Suazilândia, All Africa Eswatini, Inglês

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