The lenacapavir paradox: why a promising prevention tool raises difficult questions about African HIV response priorities

Lenacapavir is widely recognised as a major scientific advance in HIV prevention. Lenacapavir is a twice-yearly injectable prophylaxis that addresses barriers to daily oral medication and has shown high efficacy in clinical trials. Enthusiasm regarding lenacapavir within global policy discussions reflects genuine scientific progress and a commitment to developing effective prevention beyond treatment. This excitement is understandable. However, African countries are facing a lenacapavir roll-out, while HIV epidemics remain incompletely controlled, with approximately 5·8 million people living with HIV not virally suppressed and health systems facing increasing fiscal and operational pressure.