Inside the ‘miracle’ drug rollout that could end Aids

Lianne was just 13 when she lost her parents to Aids. Newly orphaned, she had to find a way to keep herself and her younger sister alive. With no money to finish school, unable to find a job and struggling to put food on the table, there was only one option – sex work.

Now 24, she knows the dangers in Eswatini, a kingdom in southern Africa once described as the epicentre of the HIV epidemic and a country still struggling with some of the highest infection rates in the world.

“Both my parents passed away. Hunger led me to join this work although I know it’s risky,” Lianne says, explaining that she earns under £25 a week. She is unable to acquire HIV preventative medication – known as PrEP – on her own.

But there is now hope in the form of lenacapavir – dubbed the “miracle” drug – which the United Nations hopes can protect millions of people like Lianne and even end the Aids epidemic altogether.

The twice-yearly injection – described by the head of the UN Aids agency as “the closest thing we have to a vaccine” – provides near complete protection against infection.

Lenacapavir is being introduced for the first time in nine of the most at-risk countries, including Eswatini, meaning Lianne was among the first people in the world to get the injection.

While it is a big step forward in HIV care, concerns have been raised about the extent of the rollout and fears it will be ineffective if it is not introduced on a global scale.

The positive news about lenacapavir comes after last year’s devastating cuts to foreign aid spending by US president Donald Trump, which had previously funded around half of Estwatini’s HIV response.

For Lianne, it meant the abrupt closure of the mobile clinics that gave her access to potentially life-saving HIV prevention therapy for free.

The closures have had a deadly effect: a friend and fellow sex worker recently died after contracting HIV and losing access to life-sustaining medication.

“That is why I am so happy today, it’s protection,” she continues with relief, as she receives the brightly coloured yellow injection.

At the beginning of 2025, the world was on track to end the Aids pandemic by 2030.

But that was upended by unprecedented foreign aid cuts from the US, the UK and other European countries, which have created the biggest ever disruptions to HIV response, from testing to treatment and prevention.

If these aid cuts continue, there could be millions more deaths and infections, as well as double the number of medication-resistant strains, according to The Independent’s own modelling of data.

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