How often, on average, do you forget to take your daily meds?

For me, it’s about twice a week. And that’s for something as low stakes as a vitamin D supplement; it’s not the end of the world if I’m a little deficient. But when it comes to HIV prevention, missing a dose of your prescribed daily prevention pills could mean the difference between protection and new infection.

A new drug called lenacapavir might entirely change the game, though.

Right now, our most widely used tool to stave off HIV — which killed an estimated 630,000 people last year — is through prevention pills, called pre-exposure prophylaxis. PrEP works extremely well and has prevented millions of HIV infections in the 13 years it’s been around. But the catch is that it needs to be taken every single day. In much of the Global South, having consistent access to it remains a big hurdle, on top of issues with adherence and stigma.

That’s the reason why, by 2023, only about 6 million people worldwide were on PrEP, a fraction of the tens of millions who could benefit. Each year, another 1.3 million people still acquire HIV.

But a discreet shot taken just twice a year, like the newly approved lenacapavir, takes forgetfulness — and some stigma — out of the equation. For a field where breakthroughs have been rare, lenacapavir has almost vaccine-like efficacy (even though it’s not one). In clinical trials, the drug showed 100 percent protection in women and approximately 96 percent in men, transgender and nonbinary people. Those are the kind of numbers policymakers can’t ignore.

The US Food and Drug Administration approved it in June, the World Health Organization endorsed it in July, and the European Union followed in August. And the Trump administration — which grounded its live-saving global health work to a complete stop eight months ago — has recently made lenacapavir the center of its “America First” global health strategy. The administration plans to roll out the drug in about a dozen low-income countries by early 2026.

That’s all remarkable news. Low-income countries typically have had to wait decades, if not more, before newer, better drugs trickled down. This time, at least in theory, access could come almost simultaneously.

But whether lenacapavir actually makes a dent in the HIV epidemic will depend less on science than on politics.

What is lenacapavir?

Four decades ago, an HIV infection was a near-death sentence. But since then, we’ve marched toward progress — making better drugs with simpler regimens and widening access.

But even after all that work, we still don’t have a cure or a true vaccine. That’s why an innovation like lenacapavir feels notable.

For years, HIV drugs targeted the virus’s enzymes, and it wasn’t obvious that targeting anything else would work. Then in the 1990s, researchers backed by the National Institutes of Health began studying how the virus builds its cone-shaped shell, called the capsid. Most

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