For 27 years, Esther Shiyayo and her husband have managed life in a discordant relationship.
She is HIV-positive, while he is negative.
To stay safe, her husband takes a daily dose of pre-exposure prophylaxis (PrEP) pills.
“It hasn’t been easy. There are days he feels tired and wants to stop, but I keep encouraging him,” says Esther.
The couple, married for 27 years, has managed to raise six HIV-negative children, thanks to strict PrEP use and Esther’s suppressed viral load. Still, the daily pill routine has taken a toll on her husband.
“When I first introduced him to PrEP, he had so many questions. He didn’t like the idea of taking pills every day for the rest of his life. But with time, he accepted it was the only way to protect himself,” she says.
Now, Esther is among the many in discordant relationships who are celebrating the introduction of Lenacapavir, an injectable HIV prevention drug taken just twice a year.
“The injectable will ease the stress of taking pills every day and reduce the pressure of monthly clinic visits. It’s a huge relief for couples like us,” she told The Standard.
Thousands of Kenyans are set to benefit from the roll-out of Lenacapavir injectable HIV preventive drug.
The drug is the first long-acting injectable form of PrEP, offering an alternative to the daily oral pills currently used for HIV prevention.
Ministry of Health, through the National AIDS and STI Control Programme (NASCOP), announced the approval of the injectable on Monday.
The country will begin receiving the drugs by January 2026.
Clinical data shows the drug has up to 99 per cent efficacy in preventing HIV transmission.
The injection is administered under the skin in the abdominal area (stomach) by a healthcare provider and is designed to be discreet, convenient, and stigma-free.
Trials found little to no differences in rates of adverse events,, apart mild and moderate severity at injection site.
Also, it has no adverse side effects in pregnancy and birth outcome as compared to oral PrEP.
Kenya is expected to receive the drug with procurement supported by the Global Fund and other partners.
The rollout will be coordinated by the Ministry of Health through NASCOP, in collaboration with partner organisations.
NASCOP Chief Executive Dr Andrew Mulwa said approval of the medicine for use is a big milestone in prevention of HIV infections.
It will also be easy to monitor uptake and adherence.
“Approval of the injectable means we are making a leap in prevention services with the long acting pre-exposure prophylaxis medicine which will be easy to administer and monitor adherence,” said Mulwa.
On who will be eligible for the drug, he said NASCOP, Ministry of Health and partners are working on the details before rollout.
But on principle, he said, Lenacapavir should be available first to every sexually active person who needs the service.
Prof Omu Anzala, a virologist at the University of Nairobi, explained that Lenacapavir is an antiviral drug that directly targets the HIV virus, similar to other antiretroviral medications currently in use.
“It is purely antiviral—it’s not a vaccine. It’s a drug that targets the virus itself,” said Anzala.
He note that Lenacapavir serves both as a treatment and a preventive measure, and is considered revolutionary because it is administered only twice a year.
“This PrEP is safe, highly effective, and has been in use in the United States for the past two years,” he added.
However, despite its benefits, the drug remains prohibitively expensive.
“The injectable itself is not a problem. The real issue is the cost—it’s extremely expensive,” said Anzala. “Saying it will be rolled out is one thing, but ensuring consistent access for those who need it is another.”
Anzala, who has been at the forefront of HIV research, believes the long-acting injectable could help address challenges around medication adherence.
“If someone is asked to take a pill every day versus an injection every six months, adherence becomes much easier with the injectable,” he said.
But in a quick rejoinder, Mulwa said the drug shall be available through the government programme or private sector "covered by the Government of Kenya, partners including global fund, insurance including Social Health authority (SHA) and out of pocket for those who can afford”.
Additionally, he said, “We are working on the procurement modalities, but the public and private sector will have a role,” said the NASCOP boss.
“For the early adopter countries, Global Fund is negotiating with Gilead to have it at lower than the US price of $28 so that in Kenya it is free for those who will enrol,” said Nelson Otwoma, Executive Director of the National Empowerment Network of People Living with HIV/Aids in Kenya (NEPHAK). “But if you need it in private sector, you pay $60”
According to the drug guideline, dubbed “Guidelines on lenacapavir for HIV prevention and testing strategies for long-acting injectable pre-exposure prophylaxis”, in Kenya, cost of the drugs would range from $10 to $33.
“In lower-prevalence settings, such as western Kenya and Zimbabwe, the maximum feasible per person per year cost of lenacapavir was much lower, ranging between US$ 10–33 in western Kenya and US$ 16–42 in Zimbabwe, even when focusing on key populations” reads a section of the guidelines.
Meanwhile, key population, among them sex workers, have welcomed the approval of the drug, saying it will significantly reduce the burden of daily pill-taking associated with current PrEP (pre-exposure prophylaxis) options.
Everly Nabwire, who leads the key population program at NKOKOIJU, a sex worker-led organisation, said sex workers face a high risk of HIV due to the nature of their work, making the availability of a more convenient prevention method crucial.
“Sex work comes with risk, including condom bursts during engagements, which exposes us to HIV,” she explained.
Nabwire noted that daily oral PrEP is often a challenge for many of her peers, who sometimes forget to take their medication, especially after late-night work or emergencies.
“It’s stigmatising to take pills every single day. Daily medication is stressful—and if you miss a dose, you’re at risk. Some of the women even confuse PrEP with ARVs and ask what the difference is,” she told The Standard.
She said the introduction of an injectable taken only twice a year will ease adherence, reduce stigma, and eliminate the pressure of remembering to take pills daily.
“An injectable PrEP will be a game changer,” she said. “It will boost adherence and improve health outcomes for sex workers.”
The NKOKOIJU initiative, supported by USAID through the Stawisha project, works with 1,080 sex workers across Mombasa’s Bamburi, Kisauni, and Nyali areas. Of these, 580 are currently on oral PrEP, while 100 are living with HIV and on treatment. The group collects PrEP and condoms from the Bamburi Dispensary.
However, Nabwire said inconsistent supply due to foreign aid cuts has made it difficult to maintain access to PrEP.
“We often experience stock-outs. That’s why we do community outreach every three months to remind sex workers about PrEP and safe sex,” she said.
She added that sex workers also rely on free condoms distributed at hotspots to prevent infection and transmission to the general population.
But the cost of the new injectable drug is a major concern.
“Most sex workers cannot afford PrEP if they are required to pay for it,” she said. “Sometimes they can't even afford Sh100 for oral PrEP at pharmacies—what about a drug that might cost thousands?”
In Nakuru, Daisy Achieng, Chair lady of the Smart Ladies sex worker outfit, also expressed support for the injectable form of PrEP, saying it will ease their daily struggles and make their work safer and more manageable.
“Injectables will make our work smooth and less stressful, unlike pills that must be taken every day,” she said.
Achieng noted that oral PrEP comes with side effects such as drowsiness, vomiting, and diarrhoea, which discourage many from continuing its use.
“Imagine you have a client, and because you want to stay safe, you take PrEP—but then you start vomiting and get diarrhoea. You end up losing the client—it is a financial loss,” she said.
She added that injectable PrEP will also reduce the stigma often associated with taking pills in front of clients.
“When you take pills, some clients assume you are HIV positive. But with an injectable, no one needs to know you are on medication,” Achieng explained.
Smart Ladies has 17,000 registered sex workers in Nakuru County, of whom 4,900 are currently using oral PrEP.
However, Achieng noted that access has become more limited due to reduced donor funding-priority is given to pregnant and breastfeeding mothers.
At a glance
99 percent - Efficacy of injectable HIV PrEP
$10 to $ 33 - Cost of injectable HIV PrEP, per person per year
Side effects of oral PrEP - Nausea, Vomiting, dizziness, fatigue, high appetite.
