The promise of lenacapavir crackled through the halls in Kigali: two injections a year, near-total protection, and overwhelming demand from those too often left out of prevention trials. For a moment, it felt like history bending toward possibility. But outside the euphoria lies the harder question — whether health systems, governments, and Big Pharma can move fast enough to turn a scientific breakthrough into protection in the real world.
At IAS 2025, the 13th IAS Conference on HIV Science, in Kigali, PURPOSE researchers showcased lenacapavir, the twice-yearly injectable HIV prevention already approved by the U.S. Food and Drug Administration. It delivered near-total protection across groups such as adolescents, pregnant women, and gender-diverse populations. Trial participants overwhelmingly favoured the injections over daily pills. But experts warned the next test lies not in the data but in the ability of health systems to turn science into access.
Unlike oral pre-exposure prophylaxis, or PrEP, options, which could be picked up in pharmacies or community spaces, injectables demand nurses, testing, reliable supply chains, and repeated clinic visits — conditions many health systems, and the people most at risk, struggle to meet. The PURPOSE trials showed that with resources and support, the regimen can work. But outside those environments, experts fear that stigma, cost, and weak infrastructure could limit access.