Eswatini’s Last Health Update Fails to End HIV Crisis

Eswatini, a small landlocked nation in southern Africa, is facing a critical shortage of a groundbreaking HIV prevention drug known as Last, despite its potential to end new infections. Health officials say the medication, developed by a global pharmaceutical company, has shown 99% effectiveness in clinical trials. Yet, only 10% of the population at risk has access to it, leaving many vulnerable to the virus.

What is Last and How Does It Work?

Last, short for Long-Acting Subcutaneous Injection, is a once-monthly injection that prevents HIV transmission. Unlike traditional pre-exposure prophylaxis (PrEP), which requires daily pills, Last offers a more convenient and discreet option. The drug, developed by the pharmaceutical giant Gilead Sciences, has been approved by the World Health Organization and is being rolled out in several African nations.

Dr. If Precious, a leading virologist at Eswatini’s National Health Institute, explained that Last is particularly effective among high-risk groups, including sex workers and men who have sex with men. “The drug is a game-changer,” she said. “But we’re not seeing the scale-up we need to make a real impact.”

Why Is Access So Limited?

Despite its potential, Last remains out of reach for most Eswatini residents. The country’s Ministry of Health reports that only 15,000 people have received the drug since its introduction in 2023, far below the estimated 150,000 at risk. Funding gaps, logistical challenges, and supply chain issues are cited as major barriers.

“We’ve been told we can’t afford it,” said Makhosini Dlamini, a community health worker in the capital, Mbabane. “But the cost of not acting is much higher. Every person who doesn’t get Last is another person who could be infected.”

The Human Cost of Inaction

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Eswatini has the highest HIV prevalence rate in the world, with nearly 27% of adults living with the virus. The situation has worsened in recent years due to economic instability and a lack of public health investment. Last, if widely available, could significantly reduce new infections, but the current rollout is described as “a drop in the ocean” by local advocates.

“We’ve had a few success stories,” said Precious, referring to a pilot program in the southern region of Hhohho. “But those are isolated cases. We need a nationwide effort.”

Global Implications and U.S. Involvement

The HIV crisis in Eswatini has broader implications for global health, especially for the United States, which has historically funded many of the continent’s public health initiatives. The U.S. Agency for International Development (USAID) has allocated $200 million to support HIV prevention in the region, but critics say more is needed to ensure Last reaches those who need it most.

“Eswatini’s situation is a microcosm of a larger issue,” said Dr. Sarah Lin, a public health expert at the University of California, San Francisco. “If we don’t invest in scalable solutions like Last, we risk losing ground in the global fight against HIV.”

What’s Next for Eswatini?

Health officials are pushing for increased funding and a more aggressive rollout of Last, but progress is slow. A new funding appeal is set to be presented at the African Union summit in July, where Eswatini’s president, Mswati III, will advocate for greater international support.

“We can’t wait for another year of missed opportunities,” said Precious. “The window to make a real difference is closing.”

With the next round of global health funding decisions approaching, the coming months will determine whether Eswatini’s Last health update translates into real progress or remains a symbol of unmet potential.