People hesitate most at clinics closest to where they live. That hesitation is rarely about distance or time, it is about being seen. In my journey through community development and health advocacy, I have watched people walk past facilities meant to save their lives because they fear the look that seems to measure you. Fear the silent calculations neighbours make when someone enters a clinic known in the community as an HIV point, whether clearly branded or simply recognized locally. For years, HIV drug points marked with PEPFAR, USAID, or familiar donor logos have told a story before a word is spoken. Separated from other services, they invite judgement and connect dots.

To cope, patients travel. Someone living in Homa Bay town collects ARVs in Oyugis, Ndhiwa, or wherever anonymity feels safer. It helps, yes, but it does not heal the fear. It only relocates it. Treatment becomes a journey of avoidance rather than access. And it raises the question, “should life-saving care require disappearance?” Until HIV services are fully integrated, until seeking treatment looks no different from visiting any other clinic, stigma will continue to do its damage through the systems meant to defeat it.

HIV survives in systems that expose, in routines that punish the ordinary act of seeking care, in the invisible calculations people make every day to remain unseen. And it is within this reality, where access still demands courage, that breakthroughs like Lenacapavir become not just medicine, but possibility.

For decades, the United Nations’ goal of zero new HIV infections by 2030 has felt distant. Roughly 1.3 million people are diagnosed with HIV each year, and the 2025 target, fewer than half a million new infections annually, was missed. As the finish line drifted, global funding tightened. Cuts to PEPFAR and USAID transformed what once felt inevitable into a whisper of hope. Then came Lenacapavir.

Lenacapavir is neither a vaccine nor a cure. It is a long-acting capsid inhibitor, a drug that targets HIV-1’s protective shell and disrupts the virus’s replication at multiple stages. For decades, prevention relied on daily discipline. One missed pill could open a window for infection. Lenacapavir changes that equation. Administered just twice a year, it works like pre-exposure prophylaxis (PrEP) without the daily burden. It offers a six-month shield protection that slips seamlessly into life as it is actually lived.

The trial results were extraordinary. In sub-Saharan Africa, the PURPOSE trials reported zero new infections among women using Lenacapavir. Among gay and bisexual men and transgender women, protection reached 96%. In a field long accustomed to incremental gains, these numbers feel historic.

Breakthrough, though, means little without access. Gilead Sciences, which manufactures Lenacapavir under the brand name Yeztugo, could have confined it to wealthy markets. Instead, it signed royalty-free licensing agreements with six generic manufacturers, opening the door for affordable versions in 120 or thereabout low- and middle-income countries.

In Kenya, the National AIDS and STI Control Programme (NASCOP) is preparing for a nationwide rollout beginning January 2026. Lenacapavir will not replace condoms, daily PrEP, or other prevention tools. It will expand choice. And in high-burden settings, choice is power. Protection without disclosure. Prevention without permission. Safety without explanation.

Can a twice-yearly injection help the world reach the UN’s 2030 target? Possibly. Lenacapavir directly confronts three long-standing gaps in the HIV response:

1. Adherence: No daily pill. No constant reminders. No fear of discovery.

2. Biology: Clinical trials leave the virus with almost no room to replicate.

3. Access: Generic production makes scale realistic, not rhetorical.

Lenacapavir will not end HIV on its own. But it may mark a turning point.

@doddyokelo