The Global Fund for HIV, TB, and Malaria has committed to funding the rollout of the twice-yearly anti-HIV jab, lenacapavir, in low-income countries, including South Africa, regardless of support from the US government’s AIDS fund, Pepfar.

Studies have shown lenacapavir is 100% effective for young women and 96% for gay and bisexual men. In December, Pepfar and the Global Fund announced plans to fund the rollout of the jab once regulatory approval was granted. However, concerns have risen over Pepfar’s continued participation, especially following the Trump administration’s termination of USAID-funded projects.

Peter Sands, executive director of the Global Fund, reaffirmed their commitment: “We see lenacapavir as a game-changer in HIV prevention. Even if the rollout is on a smaller scale, we cannot afford to miss this opportunity.”

Uncertain Future for US Support

Pepfar has historically funded HIV programs in 28 developing countries, while the Global Fund supports over 100 nations, including South Africa. Initially, both entities, along with the Gates Foundation and the Children’s Investment Fund Foundation, pledged to provide two million people with access to lenacapavir over three years.

The US government has not clarified whether it will honor its December commitment. Experts fear the Trump administration’s hostility towards HIV prevention projects signals Pepfar’s withdrawal from the deal.

The Economic Case for HIV Investment

The Global Fund argues that investing in health yields economic benefits. Research from Imperial College London found that every dollar spent on effective health interventions results in a $19 return. The Global Fund has invested $26.6 billion in HIV programs since its inception, with the US contributing $26.31 billion.

This year, the Global Fund is seeking $18 billion in donor contributions to prevent 400 million infections and save 23 million lives by 2029. If US funding decreases or disappears, the scale of the lenacapavir rollout could be severely impacted.

The Challenge of Affordability

Lenacapavir, developed by Gilead Sciences, is still awaiting regulatory approval in various regions, including the US, EU, and South Africa. Gilead has licensed six companies to produce generic versions, but these are not expected to be available before 2027.

To ensure widespread availability, cost is a crucial factor. Gilead has promised to sell the branded version at a no-profit rate, but its price remains unknown. A cost model suggests that for the South African government to afford lenacapavir, the price per shot should not exceed R629.40. However, advocacy group Avac estimates the initial price will be about $100 (R1,870), significantly higher than South Africa’s affordability threshold.

The Path Forward

Health experts stress the need for strategic planning in deploying the limited supply of lenacapavir. Dr. Linda-Gail Bekker, head of the Desmond Tutu Health Foundation, suggests assembling experts to determine the most equitable and cost-effective distribution strategy.

Investment in HIV prevention has proven long-term benefits. A 2023 South African HIV investment case found that prevention strategies significantly boost productivity and economic growth. However, failure to sustain investments could lead to a resurgence of diseases, as seen with rising TB and measles cases in the US.

Sands emphasized that the Global Fund’s broader mission extends beyond HIV, TB, and malaria, focusing on strengthening global health systems. “Diseases don’t respect borders. While we have made progress, the fight isn’t over. If we let up, these diseases will come back.”

With or without US support, the Global Fund remains determined to push forward with lenacapavir, ensuring that HIV prevention remains a global priority.