Imagine staying protected against HIV with just two injections a year. That prospect is now firmly on South Africa’s horizon: the first batch of 37 920 doses of lenacapavir, a long-acting HIV prevention injectable described by the Department of Health as a game changer, arrived in the country in early April, and preparations for a carefully targeted rollout are under way, SAnews reports.
Six months of protection per dose
Lenacapavir is a new long-acting antiretroviral — an HIV-1 capsid inhibitor used for pre-exposure prophylaxis (PrEP). Administered by injection twice a year, each dose offers six months of continuous protection, a welcome alternative to daily pills or two-monthly injections.
That matters because adherence has long been the Achilles heel of oral PrEP. Many users struggle to take a pill every single day because of stigma, pill fatigue or life circumstances. A discreet, six-monthly injection removes many of those barriers at a stroke — offering greater convenience and likely far better adherence.
Remarkable trial results
The evidence behind the injectable is striking. In the multi-centre, double-blind PURPOSE clinical trials, the Department of Health noted, lenacapavir showed 100 percent efficacy among women within the study period in one trial, and around 96 percent efficacy in another involving men who have sex with men and transgender women.
On the strength of that evidence, the World Health Organisation issued new guidelines recommending lenacapavir as an additional HIV prevention choice. The WHO also noted the injectable need not be discontinued during pregnancy and breastfeeding for HIV-negative women at high risk of exposure.
The South African Health Products Regulatory Authority registered the medicine in October 2025. It is indicated for HIV-negative adults and adolescents weighing at least 35 kilograms who are at risk of HIV, used alongside safer sex practices.
A data-driven rollout
The department plans to introduce lenacapavir in about 23 high-incidence districts across six provinces, targeting around 360 high-performing public clinics in the first phase. The rollout will prioritise pregnant and breastfeeding women, adolescent girls and young women, female sex workers and men who have sex with men — the groups where prevention can achieve the greatest impact.
“To reach our goal of ending AIDS as a public health threat and achieve the UNAIDS target of 95% of people at risk having access to prevention options, we must continually improve and expand our prevention toolkit,” Health Minister Dr Aaron Motsoaledi said.
With doses in the country and clinics being readied, South Africa is positioning itself at the front of one of the most significant HIV prevention advances in years — new hope, delivered twice a year.
Photo: commons.wikimedia.org
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