Sovereign governance and HIV prevention. Kenya's grounded HIV response and the challenge of product-led prevention in eastern and southern Africa. A policy analysis.

This policy analysis paper explores sovereign epidemic governance, HIV prevention prioritisation, and the introduction of lenacapavir in eastern and southern Africa. Using Kenya as an example of a mature, multisectoral, data-driven HIV response, it examines the risks of product-led prevention when a highly efficacious biomedical technology is introduced without sufficient public evidence of epidemiological need, real-world effectiveness, implementation feasibility, affordability, opportunity cost, and country-defined prioritisation. The paper argues that lenacapavir may have selective value for people and networks with high and continuing HIV incidence, but that it should be governed within country-defined combination prevention architectures rather than positioned as the organising centre of HIV prevention. The core principle advanced is: protect what works, govern what is new, and retain sovereign authority over prevention priorities.