When I walked into Eswatini’s Central Medical Stores that morning, the first thing I saw were the boxes.
They were stacked neatly in tall, orderly columns on pallet racks in the middle of the warehouse — plain cardboard, carefully labelled, indistinguishable from any other medical shipment. Warehouse staff moved around them with quiet purpose, entering data, conducting routine checks, doing the work that keeps a health system running. Nothing suggested these boxes held something historic and that they were the first of their kind in Africa.
But inside those unremarkable boxes was something extraordinary: the first delivery of lenacapavir to reach the continent — a twice-yearly HIV prevention injection, developed by Gilead Sciences, which could redefine how people protect themselves from infection. I arrived just days after the team had finished receiving it.
The excitement among the warehouse staff was subdued but unmistakable. Teams from the Ministry of Health, the National Emergency Response Council on HIV and AIDS (NERCHA), AIDS Healthcare Foundation Eswatini (AHF Eswatini), the Global Fund and the Children’s Investment Fund Foundation (CIFF), alongside Gilead, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and other partners, had spent years preparing for this moment — strengthening systems, developing implementation plans, aligning protocols, ensuring supply chains were ready. Eswatini, a country with one of the highest HIV prevalence rates in the world has long embraced leadership in the HIV response and that spirit was palpable in the warehouse.
These boxes were more than a delivery. They represent a turning point in a country that has known the very worst of the epidemic and has fought tirelessly to reverse it.
Later that day in Manzini, I saw what this milestone means up close.
The LaMvelase Clinic, operated by AHF Eswatini, is the country’s biggest treatment center and one of the busiest hubs for HIV testing, treatment and prevention. By mid-morning, its courtyard was full: adolescent girls in school uniforms, young men in work boots, mothers balancing toddlers, members of key populations who often face stigma elsewhere. The clinic has become a trusted place — a rare space where people can seek care without judgement.
In one consultation room, a nurse described her typical day. She sees dozens of clients with very different needs: HIV tests, STI screenings, family planning, counselling. Many arrive because they have heard that the clinic offers compassionate, confidential care — and that it provides real options for prevention.
What struck me most was how deeply the staff understood the realities shaping people’s choices. In Eswatini, as in many places, daily oral prevention pills can be difficult to hide. For individuals experiencing gender-based violence or power imbalances in relationships, asking a partner to use a condom can be dangerous or simply impossible. Stigma can be enough to keep someone from carrying medication at all.
In this context, a long-acting injectable taken twice a year is not simply convenient — it is liberating. It gives people, especially young women, a discreet, private way to protect themselves.
Upstairs, Dr. Nkululeko Dube reflected on how far the country has come. He remembers the days when antiretrovirals were scarce, when hospital wards were filled with people dying from treatable infections, when families sold livestock and furniture for medicines that arrived too late. Today, Eswatini has surpassed the UNAIDS 95-95-95 targets and built one of the strongest HIV treatment programs anywhere.
Yet he also reminded me how fragile progress can be. A small number of people still do not know their HIV status or are not yet on treatment. Without strong prevention efforts, this remaining gap could drive new infections and threaten the gains of the past decade.
That is why the boxes I saw in the warehouse matter so deeply.
As I left AHF’s clinic, I thought about the journey those vials will take: from the Central Medical Stores to facilities across the country; from trained hands to people making choices about their futures; from a scientific innovation to a lived reality.
Eswatini is not alone in this moment. Across sub-Saharan Africa, momentum is building. Zambia had also just received first shipments and seven other countries are preparing to receive their first deliveries of lenacapavir between now and early next year — a powerful demonstration of regional leadership and a dramatic shift from the historical pattern in which the world’s most affected countries received innovations last, not first.
For the first time, a cutting-edge HIV prevention tool is being introduced in low- and middle-income countries nearly simultaneously with high-income countries. That alone is a breakthrough as previous drugs for HIV prevention have taken an average of five years to become available in these settings after evidence of their efficacy is first known.
As these first doses arrive, a new possibility is taking shape: a future where scientific advances reach people everywhere — not years later, but now.
Yet this moment is also a test. Together with PEPFAR, we have set a bold goal: to reach up to two million people with long-acting pre-exposure prophylaxis (PrEP) in the next three years. Achieving it would significantly reduce new infections in countries with the highest burden. But without sustained investment — from donors, governments and partners — this momentum could stall just as we approach what could be a decisive step toward ending AIDS.
Preventing infections today is far more cost-effective than treating them for life. It strengthens health systems, accelerates the path to sustainable domestic financing, and protects the extraordinary progress countries like Eswatini have achieved. But success depends not only on funding — it depends on trust. Trust in clinics to provide stigma-free care. Trust in health workers to keep medicines available. Trust in global partners to stay the course.
What I carry from Eswatini is the memory of those plain boxes in the warehouse — outwardly ordinary, inwardly full of possibility. I carry the dedication of the nurse in Manzini, the resolve of Dr. Dube, the professionalism of the warehouse team, and the leadership of the Ministry of Health and NERCHA.
If we act now — boldly, collaboratively and with communities at the center — the moment I witnessed in Eswatini may one day be remembered as the point when the world began to finish the job: the moment when ending AIDS shifted from aspiration to achievable reality.
