The HIV drug arriving this month is free everywhere except America

This is not a typo.

Lenacapavir is arriving in Nigeria in March. It's a twice-yearly HIV prevention injection. Clinical trials showed it provides near-total protection against HIV infection. The National Agency for the Control of AIDS confirmed the shipment is coming.

In the United States, this drug costs about $28,000 per person per year. Through partnerships involving Unitaid and the Gates Foundation, generic versions are coming to Nigeria and other low-income countries at around $40 annually.

That price gap isn't generosity. It's the global pharmaceutical pricing system doing exactly what it was designed to do: charge what markets can bear. Americans pay $28,000 because the system allows it. Nigerians pay $40 because donors subsidised it down to something survivable.

Nigeria has approximately 1.9 million people living with HIV. 74,000 new infections were recorded in 2021. The South-South zone has the highest prevalence. Women aged 15 to 49 are more than twice as likely to be living with HIV as men.

The drug matters because daily pills have real adherence problems. People forget. People hide their status. People have jobs and routines that don't accommodate daily medication. Twice a year, by injection, administered by a health worker, changes that equation.

Readiness assessments have been completed in 10 states. Healthcare workers have been trained. The rollout starts phased, not national.

Here's what to watch. Nigeria's healthcare delivery system has consistently struggled to get drugs that exist on paper to the patients who need them. The question is not whether Lenacapavir works. Clinical trials answered that. The question is whether the last mile of Nigeria's health infrastructure, the nurse at the primary health centre, the motorcycle that should carry the cold-chain supply, the record-keeping system that should track who was injected and when, is actually ready.

This month, we find out.