In the red light district in Mbarara, a city in western Uganda known in part for sex tourism, a sex worker named Lisa Mutoni insists on using condoms when men enter her room, to protect her against HIV and other infections.
asserted
men → know → HIV
The problem: Some try to remove or tear the condom while having sex.
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Some → try → sex
She takes HIV-prevention medication called PrEP, or preexposure prophylaxis, which can come in the form of daily pills or periodic injections.
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which → take → pills
But there’s a new option for her and millions like her — if they could only get it.
uncertain
they → ’ → it
It’s a drug called lenacapavir that studies have shown can offer nearly complete protection from HIV with just two shots a year.
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studies → ’ → shots
Mutoni said access to lenacapavir would benefit sex workers who sometimes shift elsewhere for months at a time.
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who → say → time
“If you know that you have that injection for six months, you feel like you are safe,” she said.
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she → know → months
“And then it is very good, nice because sometimes you can also forget, if it is the pill, you can forget to swallow.”
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you → forget → ?
Promise and frustration with lenacapavir
But Mutoni says every time she tries to get what is commonly referred to as “lena,” it’s not available.
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it → say → lena
“They tell me that it is finished,” she said.
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she → tell → me
Such is the promise and the frustration with lenacapavir, a drug developed by Gilead Sciences.
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promise → develop → Sciences
Other PrEP options, including pills and an every-other-month shot of the drug cabotegravir, are very effective and widely available.
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options → include → drug
But health experts say lenacapavir has the power not just to protect individuals but potentially even turn the tide of the HIV epidemic globally because of its long-lasting effects.
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lenacapavir → say → effects
We need to be getting to the millions pretty soon,” said Andrew Hill, an expert in HIV treatment who is a senior visiting research fellow at the University of Liverpool in northwest England.
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who → need → England
FDA approves a generic version
That may start to change in the coming months.
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That → approve → months
The U.S. Food and Drug Administration has just tentatively approved a generic version of lenacapavir that could help speed the production and distribution of the drug to 120 low-income countries at a price of roughly $40 a year, far below the U.S. list price of $28,218.
uncertain
that → approve → 28,218
The approval was announced Monday.
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approval → announce → ?
The hope, according to the Global Fund, is to get it to 3 million people by the end of 2028.
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hope → accord → 2028
Some, including Doctors Without Borders, known by its French initials MSF, say this isn’t nearly enough.
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this → include → initials
The group is calling on Gilead to make cheap doses available to more countries and to sell it directly to MSF so it can help protect more people faster.
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it → call → people
“Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise,” said Melissa Barber, MSF USA global health advocacy and policy adviser, in a recent statement.
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Barber → say → statement
For now, people in Mbarara, where an estimated 10% of the adult population has HIV — double the rate of Uganda as a whole — have to settle for inferior choices.
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% → estimate → choices
Demand is high and doses aren’t enough
Julius Bampe, a polygamous man, was alarmed earlier this year when testing confirmed his younger wife had HIV.
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wife → alarm → HIV
She was immediately given drugs to suppress her infection, while Bampe sought lenacapavir.
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Bampe → give → lenacapavir
But when Bampe, an itinerant builder, went to get his injection, he found that there were no doses left.
“When I got here, they said that is what they would have given me, but they said they didn’t have enough doses for everyone,” he said.
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he → go → everyone
The facility that Bampe goes to received 40 lenacapavir doses in April, with instructions to focus only on pregnant mothers at risk of acquiring HIV.
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Bampe → go → HIV
The guidelines were later changed to include couples like Bampe and his wife, sex workers and others.
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guidelines → change → Bampe
That batch was quickly administered and another 70 doses sent in June were used up within 10 days, said Tarsisio Biryeija, a nursing officer working as a counselor at Mbarara Health Centre IV.
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Biryeija → administer → IV
Uganda has slashed its HIV rate over the past three decades, and it’s far below that of some southern African countries.
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it → slash → countries
But like in many nations, health authorities in Uganda say infections are driven largely by transactional sexual encounters like those in Mbarara — and the type of transmission that lenacapavir could be so effective at stopping.
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lenacapavir → say → transmission
Mutoni, the sex worker in Mbarara, gets counseling and other support, including condoms, from Immaculate Nyamwija, founder of a Mbarara-based organization known as Action for Improved Health and Wealth.
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Mutoni → get → Health
Nyamwija offers HIV support services to women who would face discrimination elsewhere.
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who → offer → discrimination
“It is a challenge, because the demand is high and the doses are few,” she said.
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she → say → ?
“Who would not wish to take (lenacapavir) for six months?
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Who → wish → months
Who would wish to be on drugs every day?”
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Who → wish → drugs
Gerald Imray in Cape Town, South Africa, and Laura Ungar in Louisville, Kentucky, contributed to this report.
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Imray → contribute → report
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The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation.
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Press → receive → Foundation
The Aporia
