South Africa Expands HIV Prevention with Lenacapavir Rollout

South Africa was among the first countries to include pre-exposure prophylaxis (PrEP) in its Essential Medicines List and integrate it into public primary healthcare services.

South Africa is entering a new chapter in HIV prevention with the introduction of Lenacapavir, a long-acting injectable medicine that offers people a new option to protect themselves against HIV. Health Minister Dr Aaron Motsoaledi said the rollout reflects years of planning and investment rather than a single policy decision, building on the country's well-established HIV prevention programme.

South Africa was among the first countries to include pre-exposure prophylaxis (PrEP) in its Essential Medicines List and integrate it into public primary healthcare services. The government introduced oral PrEP in 2016 and expanded access across the public health system by 2021, allowing HIV prevention services to become part of routine healthcare alongside HIV testing, sexual and reproductive health services, tuberculosis screening, maternal healthcare and HIV treatment. According to the Health Minister, more than 2.2 million South Africans have started oral PrEP through public sector programmes, creating a strong platform for introducing newer prevention technologies.

Twice-yearly injections offer a new prevention choice

Unlike oral PrEP, which requires daily medication, Lenacapavir is given as two injections every six months, offering a long-acting alternative for people who may find it difficult to take tablets every day.

Dr Motsoaledi described the medicine as one of the most significant scientific advances in HIV prevention in recent years, noting that clinical trials demonstrated exceptionally high effectiveness in preventing HIV infection. He said South Africa's existing healthcare infrastructure, trained workforce, supply chains, clinical guidelines and community health networks made it possible to introduce the new medicine quickly into the public health system.

The Minister stressed that Lenacapavir is not intended to replace existing HIV prevention methods. Instead, it expands the range of choices available, allowing individuals to select prevention options that best suit their personal circumstances and lifestyles. This approach reflects South Africa's strategy of combination prevention, which recognises that different people benefit from different interventions at different stages of life.

The long-acting injection is expected to benefit groups at higher risk of HIV infection, including adolescent girls and young women, sex workers, men who have sex with men, transgender people, and pregnant and breastfeeding women.

Government commits to long-term access and sustainability

The Health Minister said the introduction of Lenacapavir represents another step towards South Africa's goal of reducing new HIV infections while strengthening the country's broader HIV prevention strategy. He noted that the rollout has been supported through collaboration between government departments, researchers, regulatory authorities, provincial health departments, civil society organisations and international development partners. While external partners have helped support the early introduction of the medicine, the government intends to ensure long-term sustainability through increased domestic financing as more affordable generic versions become available.

Dr Motsoaledi said South Africa's experience with oral PrEP has demonstrated the value of investing in prevention alongside treatment. By expanding access to innovative prevention technologies, the country hopes to reach more people, improve adherence to HIV prevention programmes and continue its leadership role in advancing equitable access to life-saving healthcare.