"When is the HIV vaccine getting here?"

A patient recently asked me this during his visit to an HIV clinic in the Dominican Republic. He was there to refill his monthly prescription for pre-exposure prophylaxis (PrEP), a daily pill that reduces the risk of HIV infection. While PrEP pills have been an important tool in HIV prevention, we now have something potentially far more transformative: lenacapavir, recently named Science Magazine's 2024 "Drug of the Year."

Lenacapavir, developed by Gilead Sciences, represents a groundbreaking leap in HIV prevention. Unlike daily PrEP pills, it requires only two injections per year, dramatically improving adherence. In clinical trials, it demonstrated a 96 percent reduction in HIV incidence and was 89 percent more effective at preventing HIV acquisition compared to daily PrEP pills.

Yet weeks after discussing this promising innovation with my patient, I witnessed how quickly political decisions can derail progress in HIV care.

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