The lenacapavir effect and the limits of biomedical HIV prevention: Biomedical triumphalism, social science, and re-grounding HIV prevention within sovereign and Indigenous responses

Lenacapavir, a twice-yearly injectable pre-exposure prophylaxis medication, was hailed in 2024 as a game-changing breakthrough after randomized controlled trials reported exceptionally high efficacy in preventing HIV. This working paper does not argue against lenacapavir as a biomedical technology. Rather, it uses the rhetoric surrounding lenacapavir as an entry point to examine a longer-standing political economy of HIV prevention in which scientific efficacy is repeatedly converted into claims of epidemic transformation before real-world effectiveness, affordability, sustainability, opportunity cost, or country-level prioritization have been established.

The paper argues that biomedical HIV prevention has been shaped by biomedicalization, commodification, and biomedical triumphalism. It examines how pharmaceutical companies, research networks, donors, multilateral agencies, philanthropic foundations, advocacy coalitions, media platforms, and country implementation systems organize evidence, funding, policy authority, and public discourse around product-centered HIV prevention. Drawing on critical social science and cultural studies, the paper argues for re-grounding HIV prevention in country-led, community-driven, structurally informed, and socially grounded approaches.