By Chantelle Muzanenhamo
The World Health Organization (WHO) has endorsed injectable lenacapavir (LEN) as a twice-yearly pre-exposure prophylaxis (PrEP) option to prevent HIV a decision being hailed as a breakthrough in science, but one that raises urgent questions about affordability, access, and rollout capacity across lower-income countries.
Unveiled at the 13th International AIDS Society Conference (IAS 2025) in Kigali, Rwanda, WHO’s new guidelines promote lenacapavir as a game-changing HIV prevention method.
Lenacapavir, approved earlier this year by the U.S. Food and Drug Administration, is the first PrEP product requiring just two injections per year, offering a powerful alternative to daily oral pills especially for people facing stigma or access barriers.
WHO says the long-acting formula could reshape HIV prevention for key populations such as sex workers, men who have sex with men, transgender individuals, and adolescents.
However, access remains limited outside clinical trials, and pricing details for lower-income countries remain unclear. Advocates fear that without a rapid and well-funded global rollout, LEN could become a niche option for the privileged few, rather than a scalable solution.
WHO also announced a series of updates to its HIV treatment and service delivery guidelines including recommendations to integrate HIV care with services for mental health, noncommunicable diseases (NCDs), and substance use.
Additionally, new guidance urges rapid initiation of ART for people with HIV who contract mpox, and calls for routine testing for STIs like gonorrhoea and chlamydia in high-risk groups.
But public health officials warn that these recommendations while critical risk being buried by chronic underfunding, donor fatigue, and shifting global health priorities.
“We are fighting 21st-century epidemics with 20th-century systems and 19th-century budgets,” one panelist said during a WHO session at IAS 2025.
WHO’s call for bold implementation comes at a time when global HIV funding is in decline, and many national programmes are struggling to maintain even basic services, let alone integrate costly innovations.
“This is not just about guidelines it’s about political will, resources, and justice,” Dr. Doherty emphasized.
As policymakers digest WHO’s latest recommendations, the challenge is clear: scientific breakthroughs must not become luxury goods.
Without urgent action to ensure equity in delivery, the promise of lenacapavir may remain out of reach for the very communities it was meant to protect.