South Africa’s first consignment of lenacapavir, a six-monthly HIV prevention injection for high-risk HIV-negative people, will cover fewer than a quarter of the target population. Deliveries are underway and will continue through April. Rollout will begin immediately after delivery, with an initial two-year implementation plan.
Lenacapavir has been described as an HIV game-changer because trial outcomes show it is close to 100% effective when used correctly. But its impact will depend on demand, adherence and how quickly the country can scale access beyond the first shipment.
The injection arrives during a difficult period for the HIV response. The withdrawal of US funding has added pressure to already stretched prevention and treatment programmes. Lenacapavir will not solve that gap on its own. Still, it could provide a significant new prevention option for people who struggle with daily oral pills.
South Africa Needs Scale and Adherence
Mathematical models suggest South Africa may need between 2 million and 4 million HIV-negative people to receive lenacapavir each year for eight years to shift the epidemic curve decisively. At that scale, new infections could fall below 0.1% by 2039, bringing the end of Aids as a public health threat closer.
For now, a $29 million Global Fund grant will fund doses for about 500,000 at-risk people. That is meaningful, but small relative to need. South Africa still records an estimated 180,000 new infections a year, and between 7 million and 8 million people are living with HIV.
Lenacapavir is also entering a prevention landscape where oral PrEP has already expanded. Oral PrEP now reaches about 2.1 million people, with most public clinics offering it. But oral PrEP requires daily adherence. Lenacapavir needs only two injections a year, which could improve persistence for some users.
Clinic Rollout Will Start With Proven PrEP Sites
The Department of Health plans to begin with around 10% of primary healthcare clinics, roughly 360 facilities, over two years. The early sites have been selected based on stronger oral PrEP performance, higher numbers of HIV-negative clients, and high local HIV incidence.
Researchers and implementers are also emphasising targeted delivery. Prof Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation, has argued for a focus on communities where transmission is high, especially among sexually active young people. She has also highlighted antenatal and postnatal services as high-value entry points. Preventing infection during pregnancy and breastfeeding protects women and reduces the risk of vertical transmission.
Evidence Suggests Faster Gains Than Oral PrEP Alone
Wits University research indicates lenacapavir scale-up could bring the end of Aids forward by seven to 10 years compared with oral PrEP scale-up alone. Estimates suggest South Africa may need 1 million to 2 million new starters a year, with additional annual costs of roughly R650 million to R1.5 billion. Modelling also suggests infections could fall by tens of thousands a year if annual injections reach 1.4 million to 2.1 million by 2030.
Modelling from Prof Nora Rosenberg’s Africa-focused work reinforces a central point. Coverage and adherence drive outcomes. Real-world barriers, including unsuppressed virus in communities and relationship instability linked to migrant work, could weaken the impact if services are not designed around people’s lives.
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