The Lenacapavir effect: Triumphalist rhetoric and the displacement of social and structural responses to HIV prevention.

Abstract

Lenacapavir, a long-acting injectable pre-exposure prophylaxis (PrEP) medication for HIV prevention with proven high efficacy in randomised controlled trials, has been widely positioned as a "game-changing" technology capable of ending the AIDS epidemic. Despite the withdrawal of major donor funding that necessitates a critical reappraisal of HIV prevention priorities, lenacapavir has been rapidly embedded within global policy discourse through claims of exceptional efficacy, anticipated cost-efficiency, and potential epidemiological impact. These narratives reflect a long-standing pattern of biomedical triumphalism, the rhetorical apparatus through which a political economy of biomedical HIV prevention reproduces itself. This rhetoric emanates collectively from a network of institutions, including pharmaceutical companies, research institutions, multilateral agencies, donors, and advocacy coalitions. This article traces how the rhetorical construction of lenacapavir promotes technological salvation while diverting attention from the structural and social conditions that shape HIV vulnerability. Drawing on critical social science frameworks to show the social construction of biomedical prevention, the synthesis demonstrates how triumphalist rhetoric directs resources toward biomedical approaches and products in the absence of implementation science or a robust prioritisation rationale, while marginalising other approaches of known impact, including community- centred approaches that moderate the drivers of HIV vulnerability. Billions of dollars in public funding have been directed toward biomedical HIV prevention research and development over the previous decades on microbicides and PrEP products. These investments mainly benefited research institutions in the North and select Southern partners, without contributing to epidemiological gains against HIV in eastern and Southern Africa. At a moment of constrained resources and fragile health systems, the rhetorical urgency surrounding lenacapavir limits substantive debate and is unwarranted, given that prioritisation and sustainability analyses are vital for country HIV responses in the region. Ethical, accountable discourse and the remobilisation of critical social science are needed to guide the next phase of the global HIV response.