“I feel lucky, empowered and safe”, says Samson Mutua, 27, shortly after becoming one of the first people in Kenya to receive lenacapavir, a twice-yearly jab that offers near-total protection against HIV. Mutua has taken daily pre-exposure prophylaxis (PrEP) pills since 2017, part of Kenya's earlier prevention strategy. But the shift to a twice-yearly jab, he says, feels transformative.
Last month, Kenya became one of the first countries in the world to begin distributing lenacapavir. Described by scientists as the closest thing yet to a HIV vaccine, it has been heralded as a turning point in the global fight against the virus, including the 1.4 million Kenyans living with HIV, and the many more at risk.
For the government, the rollout is intended to mark a decisive step towards substantially reducing new HIV infections by 2030. But just a few miles away, in the dense sprawl of Kibera – one of Africa's largest informal settlements – that future still feels distant.
Kibera has not been included among the priority areas selected for the first phase of the rollout. The omission is striking. HIV prevalence in Nairobi's informal settlements is estimated at around 12 per cent, more than double the roughly five percent recorded in non-slum urban areas. The initial rollout will see 21,000 doses distributed across 152 health facilities in 15 high-burden counties. But the Tabitha Medical Clinic – the main health facility operated by CFK Africa, a long-standing community organisation in Kibera – is not among them.
Jeffrey Okoro, the organisation's chief executive, grew up in the settlement. He says they have received no explanation for the exclusion and no indication of when that might change.
“I've seen firsthand how devastating HIV and AIDS can be. As an organisation, we welcome the national rollout. But in communities like Kibera, lenacapavir could be a game-changer. Right now, it's not reaching the people who would benefit most”, he tells The Independent.
In theory, residents can travel to designated facilities elsewhere in Nairobi. In practice, that presents a barrier that is easy to underestimate. The nearest approved sites are between roughly 1.5 and 3.5 miles away. A one-way journey costs between 220 and 380 Kenyan shillings - the equivalent of £1.30 to £2.20. For residents living on less than £1.50 a day, that can be a choice between transport and food.
“People prefer to go to clinics they know and trust,” Okoro says. “If you push everything into national hospitals, you exclude the very people you say you are targeting.”
For now, the drug is being offered free during the initial rollout, but there are concerns about what comes next. Officials have indicated that, if scaled up, lenacapavir could cost around 7,800 Kenyan shillings per year – heavily subsidised, but still a significant outlay in low-income communities. Agreements announced last year involving the Clinton Health Access Initiative and the Gates Foundation aim to reduce the price to around £30 per patient annually across more than 120 low and middle-income countries. But that price depends on generic versions expected from 2027. Until then, supply remains limited.
For some, this raises a broader concern that scientific breakthroughs are outpacing the systems needed to deliver them equitably. Antonio Flores, a senior HIV adviser at Médecins Sans Frontières, has warned: “Without deliberate policy choices, access will remain uneven.”
Kenya's health authorities insist this stag of the rollout is only the beginning, but access, rather than efficacy, may prove the decisive factor. In Kibera, past efforts to improve retention on HIV treatment have shown how persistent the barriers can be. A recent trial offering small non-cash incentives such as football shirts alongside psychosocial support found no meaningful improvement in keeping patients on treatment during the first six months. Structural challenges like transport costs and time spent travelling to clinics remain the major issues.
Okoro says: “The issue isn't motivation, people want to stay healthy. But the system doesn't meet them where they are.”
He argues that a community-rooted approach is needed: using existing networks of health promoters, youth centres and local organisations to deliver the drug and ensure patients return for their second injection six months later. Lenacapavir's dosing schedule makes such a model feasible. He saus: “You could attach someone to a youth centre, follow up with them, remind them when their next injection is due. That's how you build something that actually works.”
At Riruta Health Centre, one of the sites included in the rollout, patients like Teresia Wanjiku describe the injection as long overdue. She ays: “I have been waiting for this for many years. It is much easier than taking pills every day.”
For those who can access it, lenacapavir represents a profound shift – a glimpse of a future in which HIV is no longer a constant threat. But in places like Kibera, it remains – for the moment – a breakthrough just out of reach.
This article has been produced as part of The Independent’s Rethinking Global Aid project
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