专家表示，一种能够提供抗艾滋病毒完全保护且每年只需注射两次的有前景的药物，并未能惠及足够多的民众。
Experts say that a promising drug that offers complete protection against HIV and requires only two shots a year isn't getting to enough people.
乌干达姆巴拉拉——在以性旅游闻名的乌干达西部城市姆巴拉拉的红灯区，一名名叫莉萨·穆托尼的性工作者坚持在男士进入她的房间时使用安全套，以保护自己免受艾滋病毒和其他感染。问题在于：有些人会在性交时试图取下或撕破安全套。
MBARARA, Uganda — In the red light district in Mbarara, a city in western Uganda known in part for sex tourism, a sex worker named Lisa Mutoni insists on using condoms when men enter her room, to protect her against HIV and other infections. The problem: Some try to remove or tear the condom while having sex.
她服用名为PrEP（即暴露前预防）的艾滋病毒预防药物，这种药物可以是以每日药片或定期注射的形式出现。但对于她和数百万像她一样的人来说，有一个新选择——如果他们能够获得的话。这是一种名为来那卡帕韦（lenacapavir）的药物，研究表明，该药物每年只需注射两次，就能提供几乎完全的艾滋病毒保护。
She takes HIV-prevention medication called PrEP, or preexposure prophylaxis, which can come in the form of daily pills or periodic injections. But there’s a new option for her and millions like her —if they could only get it It’s a drug called lenacapavir that studies have shown can offer nearly complete protection from HIV with just two shots a year.
穆托尼表示，获得来那卡帕韦将有利于那些有时会外地转移数月的性工作者。
Mutoni said access to lenacapavir would benefit sex workers who sometimes shift elsewhere for months at a time.
“如果你知道自己打了那针可以维持六个月，你会觉得很安全，”她说。“而且这非常好，很棒，因为有时你也会忘记，如果是药片，你可能会忘记吞服。”来那卡帕韦带来的希望与挫折 但穆托尼表示，每次她试图获取这种通常被称为“lena”的药物时，它都买不到。“他们告诉我，已经卖完了，”她说。
“If you know that you have that injection for six months, you feel like you are safe,” she said. “And then it is very good, nice because sometimes you can also forget, if it is the pill, you can forget to swallow.”Promise and frustration with lenacapavir But Mutoni says every time she tries to get what is commonly referred to as “lena,” it’s not available. “They tell me that it is finished,” she said.
这就是由吉利德科学公司开发的一种名为来那卡帕韦的药物所带来的希望与挫折。其他PrEP选择（包括药片和每两个月注射一次的卡博特韦）也非常有效且广泛可用。但卫生专家表示，来那卡帕韦不仅能够保护个人，由于其持久的效果，甚至有可能扭转全球艾滋病毒疫情的局势。
Such is the promise and the frustration with lenacapavir, a drug developed by Gilead Sciences. Other PrEP options, including pills and an every-other-month shot of the drug cabotegravir, are very effective and widely available. But health experts say lenacapavir has the power not just to protect individuals but potentially even turn the tide of the HIV epidemic globally because of its long-lasting effects.
“（来那卡帕韦推广的）增长速度还不够快。我们很快就需要让数百万人用上它，”位于英格兰西北部的利物浦大学高级客座研究员、艾滋病毒治疗专家安德鲁·希尔说。
“The rate of growth (of lenacapavir rollout) isn’t fast enough. We need to be getting to the millions pretty soon,” said Andrew Hill, an expert in HIV treatment who is a senior visiting research fellow at the University of Liverpool in northwest England.
FDA批准了一种仿制版，未来几个月可能会开始改变这一局面。美国食品药品监督管理局刚刚暂时批准了仿制版的伦卡帕韦，这可能有助于加快该药物向120个低收入国家的生产和分销，每年价格约为40美元，远低于美国的标价28,218美元。该批准周一宣布。
FDA approves a generic version That may start to change in the coming months. The U.S. Food and Drug Administration has just tentatively of lenacapavir that could help speed the production and distribution of the drug to 120 low-income countries at a price of roughly $40 a year, far below the U.S. list price of $28,218. The approval was announced Monday.
据全球基金称，目标是在2028年底前将该药物提供给300万人。
The hope, according to the Global Fund, is to get it to 3 million people by the end of 2028.
包括无国界医生（其法语缩写为MSF）在内的一些人表示，这远远不够。该组织呼吁吉利德科学公司向更多国家提供廉价剂量，并直接向MSF销售，以便更快地保护更多人。
Some, including Doctors Without Borders, known by its French initials MSF, say this isn’t nearly enough. The group is calling on Gilead to make cheap doses available to more countries and to sell it directly to MSF so it can help protect more people faster.
“吉利德说它希望‘为所有人、在任何地方’终止艾滋病疫情，但它的行动却表明并非如此，”无国界医生美国分会全球健康倡导与政策顾问梅丽莎·巴伯在最近的一份声明中表示。
“Gilead says it wants to end the HIV epidemic ‘for everyone, everywhere,’ but its actions say otherwise,” said Melissa Barber, MSF USA global health advocacy and policy adviser, in a recent statement.
目前，在恩巴拉拉，那里估计有10%的成年人感染艾滋病病毒——是乌干达全国感染率的两倍——人们只能将就于次要选择。
For now, people in Mbarara, where an estimated 10% of the adult population has HIV — double the rate of Uganda as a whole — have to settle for inferior choices.
需求量大，剂量不足。朱利叶斯·巴姆佩是一名一夫多妻制的男子，今年早些时候，检测确认他较年轻的妻子感染了艾滋病病毒，他感到惊慌。她立即被给予抑制感染的药物，而巴姆佩则寻求伦卡帕韦。但当这名流动建筑工人去打针时，发现没有剂量了。
Demand is high and doses aren’t enough Julius Bampe, a polygamous man, was alarmed earlier this year when testing confirmed his younger wife had HIV. She was immediately given drugs to suppress her infection, while Bampe sought lenacapavir. But when Bampe, an itinerant builder, went to get his injection, he found that there were no doses left.
“我到那里时，他们说本该给我这个，但他们说没有足够的剂量供所有人使用，”他说。
“When I got here, they said that is what they would have given me, but they said they didn’t have enough doses for everyone,” he said.
巴姆佩就诊的医疗机构四月份收到了40剂伦卡帕韦，指示只关注面临感染艾滋病病毒风险的孕妇。后来指南被修改，将巴姆佩和他的妻子这样的夫妇、性工作者等纳入其中。
The facility that Bampe goes to received 40 lenacapavir doses in April, with instructions to focus only on pregnant mothers at risk of acquiring HIV. The guidelines were later changed to include couples like Bampe and his wife, sex workers and others.
姆巴拉拉IV号卫生中心的一名担任辅导员的护理官员塔尔西西奥·比尔耶伊贾（Tarsisio Biryeija）表示，那批药物很快就被用完，6月份送来的另外70剂药物也在10天内用尽。
That batch was quickly administered and another 70 doses sent in June were used up within 10 days, said Tarsisio Biryeija, a nursing officer working as a counselor at Mbarara Health Centre IV.
在过去的三十年里，乌干达大幅降低了艾滋病毒感染率，远低于一些南部非洲国家。但与其他许多国家一样，乌干达卫生官员表示，感染主要由姆巴拉拉等地那样的性交易行为驱动——而这正是来那卡帕韦（lenacapavir）在阻止此类传播方面能发挥巨大效用的地方。
Uganda has slashed its HIV rate over the past three decades, and it’s far below that of some southern African countries. But like in many nations, health authorities in Uganda say infections are driven largely by transactional sexual encounters like those in Mbarara — and the type of transmission that lenacapavir could be so effective at stopping.
穆托尼是姆巴拉拉的一名性工作者，她从总部位于姆巴拉拉的“争取改善健康与财富行动”（Action for Improved Health and Wealth）组织创始人伊马克拉特·尼亚姆维哈（Immaculate Nyamwija）那里获得辅导和其他支持，包括避孕套。尼亚姆维哈为那些在其他地方会面临歧视的女性提供艾滋病毒支持服务。
Mutoni, the sex worker in Mbarara, gets counseling and other support, including condoms, from Immaculate Nyamwija, founder of a Mbarara-based organization known as Action for Improved Health and Wealth. Nyamwija offers HIV support services to women who would face discrimination elsewhere.
她说：“这是一个挑战，因为需求很高，而剂量很少。谁会不想服用（来那卡帕韦）六个月呢？谁又会希望每天都吃药呢？”
“It is a challenge, because the demand is high and the doses are few,” she said. “Who would not wish to take (lenacapavir) for six months? Who would wish to be on drugs every day?