Nigerians weigh hopes and concerns over affordable HIV prevention injection

A new twice-yearly HIV prevention injection, expected to be rolled out at about $40 (less than ₦70,000) per patient annually in Nigeria, has sparked both optimism and scepticism among health workers, patients, and advocates.

The drug, called lenacapavir, offers six months of protection with a single dose, making it one of the most anticipated advances in HIV prevention in decades. Unlike daily pre-exposure prophylaxis (PrEP) pills, which many users struggle to take consistently, lenacapavir promises convenience and durability.

Currently marketed as Yeztugo by American biotech company Gilead Sciences at over $28,000 per year in the United States, the injection is being made affordable through a partnership with Indian pharmaceutical manufacturers Hetero Labs Ltd.. Reddy’s Laboratories. Backing from global health partners, including the Gates Foundation, Unitaid, the Clinton Health Access Initiative, and South Africa’s Wits RHI, is expected to make generic versions available in Africa and other resource-limited regions within weeks.

Read also: Lagos targets 11,354 residents in HIV impact survey across 20 LGAs

For many Nigerian public health experts, lenacapavir could dramatically reshape HIV prevention strategies. With Nigeria still accounting for one of the highest burdens of HIV infections globally, any tool that reduces reliance on daily pills is viewed as a breakthrough.

Dr Funmi Adeyemi, an Abuja-based infectious disease specialist, said the injection’s twice-yearly dosing removes one of the biggest barriers to HIV prevention adherence. “Most patients find it difficult to keep up with daily pills, whether due to stigma, forgetfulness, or lifestyle challenges. An injection that lasts six months could help us close the gap between those at risk and those actually protected,” she explained.

This is especially crucial for women and young people who often face difficulties negotiating condom use or may be unable to disclose their PrEP use to partners. Health advocates believe the discreet nature of an injection could give vulnerable groups more autonomy over their health.

Despite the excitement, not all Nigerians are celebrating. While $40 a year seems affordable compared to international prices, critics argue that it remains costly for low-income populations in a country where millions survive on less than $2 a day.

“This is not cheap when you put it in the context of Nigeria’s economic reality,” said Chidi Nwankwo, a Lagos-based HIV activist. “For someone struggling to feed daily, ₦70,000 a year on prevention alone is out of reach. We need the government and donors to subsidize or provide it free, just like condoms and some PrEP pills.”

Others worry about equitable access. In rural areas where healthcare infrastructure is weak, distributing and storing injectable medication may be more challenging than handing out pills. Without careful planning, critics say the innovation could deepen the urban-rural gap in healthcare delivery.

Read also: Aid cuts stalls HIV vaccine research in Nigeria

Some Nigerians have also expressed caution due to mistrust of new medical products. Memories of controversies around past vaccination campaigns, coupled with misinformation on social media, fuel scepticism.

“People will ask: What are the side effects? Is it really safe? Why is it cheap here but expensive abroad?” noted health communication expert Dr Ifeanyi Okoro. “Unless there is strong public education, uptake may not be as high as expected.”

Studies show lenacapavir is well-tolerated, but widespread awareness campaigns are expected to be critical in building trust.

Globally, lenacapavir is being hailed as the most important HIV prevention tool since the introduction of antiretroviral therapy. Former US President Bill Clinton described the breakthrough as one that could “change lives,” stressing its potential to protect someone for half a year at the same cost as daily PrEP pills.

The drug is also being seen as a critical step toward UNAIDS’ target of ending HIV as a public health threat by 2030. According to the World Health Organisation, consistent and accessible prevention tools are essential to reducing new infections, especially in sub-Saharan Africa, which carries two-thirds of the global HIV burden.

Health experts say Nigeria’s readiness to embrace lenacapavir will depend on government policy, donor support, and the country’s ability to integrate the injection into existing HIV prevention programs.

Read also: HIV Care in Nigeria strained as donor funds skip key diagnostic tests

Dr Adeyemi emphasised that prevention cannot succeed without political will. “Affordability is one thing, accessibility is another. If the government can partner with global health agencies to subsidise the injection and train healthcare workers, Nigeria could be one of the biggest beneficiaries of this breakthrough,” she said.

For now, Nigerians living with or at risk of HIV remain watchful. For some, the injection represents hope for a healthier, stigma-free life. For others, it raises concerns about inequality, affordability, and trust.

As rollout plans progress, the debate underscores a familiar Nigerian reality: scientific breakthroughs are only as impactful as the systems in place to deliver them.