As South Africa moves closer to introducing Lenacapavir, a ground-breaking HIV prevention injection taken twice a year, debate is mounting over who will benefit first and whether the health system is ready for another large-scale rollout.
Civil society organisations are demanding that the allocation of Lenacapavir in South Africa be expanded to reach at least 2-million people, arguing that the planned allocation of 480,000 doses will not make a meaningful dent in reducing new HIV infections.
Clinical trials have shown it to be highly effective, providing almost complete protection against HIV infection when administered every six months.
On Monday, the South African National AIDS Council (Sanac) and the department of health convened a multi-stakeholder roundtable to discuss the country’s preparedness for the rollout of Lenacapavir, an HIV-prevention method recommended by the World Health Organization (WHO) as an additional choice within combination HIV-prevention approaches.
The first batch of Lenacapavir is expected to be rolled out between March 2026 and April 2027, pending approval from the South African Health Products Regulatory Authority (Sahpra).
Speaking on behalf of Sanac’s Civil Society Forum, Gonondo Sheila Khama said the planned allocation is far too low for South Africa’s needs.
“The allocation of 480,000 doses will not have a meaningful impact. We can’t deceive ourselves into thinking those numbers are sufficient. If you look at key populations, they are already under-prioritised. For instance, we have around 50,660 sex workers, 20,685 transgender individuals, 43,505 gay and bisexual men, and many more men who have sex with men,” she said.
Katleho Rasebitse, from the Civil Society Forum’s Sex Worker Sector, echoed this sentiment, adding that the low allocation fails to consider the rising number of migrant sex workers entering South Africa.
“The number is too low for sex workers. However, Lenacapavir will give sex workers more privacy and reduce long queues at public clinics. Given our mobility, it will be a relief to only visit clinics twice a year,” he said.
South Africa already runs one of the world’s largest PrEP (pre-exposure prophylaxis) programmes, with over 2-million people on oral PrEP. Despite this, the country recorded 149,000 new HIV infections in 2023.
Sanac CEO Dr Thembi Xulu said Sahpra has now registered additional PrEP methods, including the monthly dapivirine vaginal ring and cabotegravir (CAB-LA), a two-monthly injectable PrEP option.
“We do not see Lenacapavir as a standalone, magic-bullet intervention,” said Xulu.
“Its effectiveness lies in complementing the comprehensive HIV prevention response and in helping re-engineer our prevention strategy. Communities have expressed frustration with accessing PrEP at health facilities, often facing long queues despite being well.”
She added that future success depends on learning from those who will benefit most, particularly around de-medicalising HIV prevention to improve access.
The Treatment Action Campaign (TAC) raised concerns about rationing, affordability and accessibility, especially for key populations and young people.
Bellinda Thibela, TAC’s National People Living with HIV representative, said many who need Lenacapavir might not be able to access it.
“Public healthcare is in a shambles and incoherent. The rollout of Lenacapavir will be a challenge because of the ongoing decline in public healthcare financing and other systemic issues,” she said.
Thibela warned against the commodification of healthcare, saying it deepens inequality.
“The price of this product will make it inaccessible to poor, disenfranchised and marginalised populations. Access to healthcare must not be treated as a privilege but as a fundamental human right,” she said.
https://www.sundaytimes.timeslive.co.za/news/2025-10-03-meet-the-ai-chatbot-thats-talking-to-young-south-africans-about-sex-hiv-and-self-harm/
Health minister Dr Aaron Motsoaledi acknowledged both the country’s progress and the challenges that remain in fighting HIV.
“We continue to carry the highest HIV burden globally, with an estimated 8-million people living with HIV. Yet our treatment programme is the largest in the world and our prevention efforts have expanded dramatically,” he said.
Motsoaledi said while South Africa has made progress, adolescent girls, young women and key populations continue to bear a disproportionate burden of new infections.
“For many individuals at risk, our current prevention options are not yielding the required results. Condoms are still not used as widely as we’d like and adherence to daily oral PrEP remains suboptimal due to stigma and pill fatigue,” he said.
He added that Lenacapavir offers a timely and much-needed innovation, expanding the prevention toolkit and empowering individuals with more choices.
Motsoaledi confirmed that the initial Lenacapavir allocation comes from a Global Fund grant worth about $29m, which will provide 456,000 initiations (912,000 doses) over two years.
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