Eswatini, a small landlocked nation in southern Africa, is facing a critical shortage of a groundbreaking HIV prevention drug known as Last. The medication, which has the potential to end new HIV infections, is being undermined by insufficient supply, leaving thousands of citizens at risk. Despite its global significance, the drug’s availability in Eswatini remains inconsistent, raising urgent concerns among health officials and local communities.
The drug, developed by pharmaceutical giant Gilead Sciences, is a long-acting injectable form of pre-exposure prophylaxis (PrEP), known as cabotegravir. Unlike daily pills, it requires only two injections per month and has shown near-complete effectiveness in preventing HIV transmission. However, Eswatini, one of the hardest-hit countries in the HIV/AIDS epidemic, is struggling to secure enough doses to meet demand.
Why Last Matters in Eswatini
Last is not just a medical breakthrough — it is a lifeline for Eswatini’s most vulnerable populations. The country has one of the highest HIV prevalence rates in the world, with nearly 27% of adults living with the virus. For many, the daily pill regimen is difficult to maintain due to stigma, lack of access, or forgetfulness. Last offers a more reliable and discreet alternative, making it a game-changer in the fight against the epidemic.
Health workers in Eswatini have praised the drug’s potential, but they are also frustrated by the supply shortages. “Last could be the key to ending new infections, but we can’t protect people if we don’t have the medicine,” said Dr. Mthandeni Dlamini, a public health official in the capital, Mbabane. “It’s like having a cure but not being able to give it to the patients who need it most.”
Supply Chain Challenges and Global Inequity
Despite its potential, Last remains out of reach for many in Eswatini due to global supply chain constraints and high costs. Gilead has faced criticism for its pricing model, which makes the drug unaffordable for many low-income countries. While the company has pledged to increase production, the rollout has been slow, and Eswatini is among the many nations struggling to get the medication.
Local advocates argue that the lack of access to Last highlights broader issues in global health equity. “This isn’t just about a drug — it’s about who gets priority in the global health system,” said Precious, a community health worker in Eswatini. “If we don’t get Last, we’re stuck with outdated methods that aren’t working as well.”
Impact on Daily Life and Local Economy
The shortage of Last is having a ripple effect on Eswatini’s communities. Many individuals, especially women and young people, are turning to less effective prevention methods, increasing their risk of infection. This has led to a rise in HIV cases in some areas, straining an already overburdened healthcare system.
The economic impact is also significant. HIV-related illnesses place a heavy burden on families, reducing productivity and increasing healthcare costs. Without access to Last, the cycle of poverty and disease continues, making it harder for communities to recover and thrive.
What’s Next for Eswatini?
Health officials in Eswatini are calling for urgent action, including increased funding and international support to secure more doses of Last. They are also pushing for local production of the drug to reduce dependence on global suppliers. Meanwhile, community leaders are organizing awareness campaigns to educate people about alternative prevention methods while advocating for better access to Last.
As the global health community watches, the situation in Eswatini serves as a stark reminder of the challenges facing Africa in the fight against HIV. “We need to do better,” said If Precious, a local activist. “Last is a breakthrough, but without access, it’s just a promise.”
