South Africa rolled out a biannual HIV prevention injection, Lenacapavir, on Friday that officials said could drastically cut infection rates.
Lenacapavir is injected into the stomach every six months and the rollout is beginning in 360 health facilities in high-burden districts; South Africa is the ninth country on the continent to launch the drug and it is rolling out across Africa faster than any previous HIV prevention option.
"The launch today of Lenacapavir marks a turning point in our nation's fight against HIV. To us, this incredible, incredible treatment is not just a medicine or a drug, to us it represents a major turning point in South Africa's national story," said South African President Cyril Ramaphosa at the launch.
South Africa has about 8 million people living with HIV, according to UNAIDS, and records about 160,000 new infections every year; most new infections occur in adolescent girls and young women aged 15 to 24, with about 1,000 in this demographic infected each week.
"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," said Dr. Saiqa Mullick, a PrEP specialist at Wits RHI at the University of Witwatersrand. Mullick said South Africa will need far more than what the Global Fund has provided — enough to put about 456,000 people on the drug over two years.
The rollout is being hampered by funding and pricing: the Trump administration slashed the U.S. President's Emergency Plan for AIDS Relief funding to South Africa last year and the lack of a cheap generic. "U.S. funding cuts have affected HIV prevention infrastructure, community programmes, outreach, youth services and key population services. The cuts have undermined prevention programmes just as South Africa needs them for Lenacapavir rollout," Mullick said. "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," said Linda-Gail Bekker, who leads the Desmond Tutu Health Foundation.
Lenacapavir, made by U.S. pharmaceutical company Gilead, costs about $28,000 per person a year in the U.S.; a deal will make generics available to 120 low and middle-income countries and the generic version is expected to become available in 2027 at a cost of around $40 per person per year. "South Africa is also seeking local manufacturing capacity to improve regional access and reduce dependency on external supply," Mullick said.
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.
"Clearly once the generics come online we're very hopeful that the South African government will also be able to make a large contribution towards purchasing Len on a larger scale," Bekker said.