JOHANNESBURG — South Africa introduced Lenacapavir, a biannual injectable drug for HIV prevention, in 360 health facilities across high-burden districts. This pre-exposure prophylaxis is administered via an injection into the stomach every six months, making South Africa the ninth African nation to implement this form of prevention.
President of South Africa Cyril Ramaphosa said: "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." Scientific models project that if 1 million to 2 million HIV-negative individuals in South Africa receive the injection between now and 2043, AIDS could cease to be a major public health issue in the country.
Approximately 8 million people in South Africa are living with HIV, and the country records about 160,000 new HIV infections annually. Adolescent girls and young women aged 15 to 24 account for most of these new infections, with about 1,000 contracting HIV each week. Unequal and sometimes transactional relationships with older men contribute to these high infection rates. South Africa currently provides daily oral pre-exposure prophylaxis pills, but patient adherence has been inconsistent.
Saiqa Mullick, a PrEP specialist at the University of Witwatersrand, said: "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. We have a game-changing technology, but impact will depend on implementation. A breakthrough product only changes the epidemic if it reaches the people who need it most." She noted that "U.S. funding cuts have affected HIV prevention infrastructure, community programmes, outreach, youth services and key population services."
Global Fund financing in South Africa will cover Lenacapavir for approximately 456,000 people over two years. Mullick said: "Some replacement financing is emerging but it doesn't fully replace the scale of PEPFAR funding." Linda-Gail Bekker, an HIV specialist at the Desmond Tutu Health Foundation, 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 and Pepfar support in this regard."
The U.S. pharmaceutical company Gilead manufactures Lenacapavir. The drug costs approximately $28,000 per person per year in the United States, but a licensing agreement allows generic production for 120 low- and middle-income countries. Generic versions are expected in 2027 at approximately $40 per person per year. Mullick said: "South Africa is also seeking local manufacturing capacity to improve regional access and reduce dependency on external supply." Bekker said: "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."