A twice-yearly injection transforms prevention
South Africa rolled out Lenacapavir on Friday, a twice-yearly HIV prevention injection that experts say could drastically cut infection rates in a nation with about 8 million people living with the virus. The drug, a type of Pre-exposure Prophylaxis (PrEP) injected into the stomach every six months, is basically failproof at preventing high-risk individuals from contracting HIV. President Cyril Ramaphosa called the launch "a turning point in our nation's fight against HIV" and "a major turning point in South Africa's national story." The rollout is beginning in 360 health facilities in high-burden districts.
South Africa records about 160,000 new HIV infections every year despite making great strides in treatment, with a majority of the population on antiretroviral drugs. Most new infections occur in adolescent girls and young women aged 15 to 24, with about 1,000 in this demographic infected each week. The country already has some PrEP available as a daily pill, but adherence remains a problem. Dr. Saiqa Mullick, a PrEP specialist at Wits RHI at the University of Witwatersrand, told NPR that "Lenacapavir gives us something we have never had before in HIV prevention: a twice-yearly option that might be significantly easier to fit into people's lives."
Funding shortfalls threaten scale
The Trump administration slashed U.S. President's Emergency Plan for AIDS Relief (PEPFAR) funding to South Africa last year, creating a major obstacle to widespread access. Mullick said the cuts "have affected HIV prevention infrastructure, community programmes, outreach, youth services and key population services" and have "undermined prevention programmes just as South Africa needs them for Lenacapavir rollout." The Global Fund has provided enough financing to put about 456,000 people on the drug over two years, but Mullick emphasized that "a breakthrough product only changes the epidemic if it reaches the people who need it most."
Linda-Gail Bekker, an HIV expert who leads the Desmond Tutu Health Foundation, noted the direct impact of the U.S. cuts. "Had Pepfar been in place, we would have I think been the recipients of more Len doses, as it happens, we're getting at least some from the Global Fund, but clearly we would have been able to receive both Global Fund as well as Pepfar support in this regard," she said.
Cost barriers and future relief
The current price of Lenacapavir, made by U.S. pharmaceutical company Gilead, is prohibitive at about $28,000 per person a year in the U.S. However, generics are on the way after a deal to make them available to 120 low and middle-income countries. The generic version is expected to become available in 2027 at a cost of around $40 per person per year. Bekker expressed hope that once generics arrive, "the South African government will also be able to make a large contribution towards purchasing Len on a larger scale."
South Africa is also seeking local manufacturing capacity to improve regional access and reduce dependency on external supply. Scientific modeling shows that if one to two million HIV-negative people take the shot between now and 2043, AIDS could cease to be a major public health problem in South Africa. The availability of affordable generics in 2027 will be crucial to determining whether the rollout can reach the scale needed to transform the epidemic.
