Ina Skosana
South Africa recently announced the arrival of the first shipment of lenacapavir, the injection proven highly effective in preventing HIV with only two jabs a year.
While there’s been a lot of excitement around the delivery of this consignment, this doesn’t mark the start of the rollout. In fact, it’s not clear when the rollout will start.
According to national health spokesperson, Foster Mohale, “the rollout is scheduled for early in June 2026, an exact date to be announced soon”. This is months later than the government’s initial projection of March or April.
The reason for the delay?
“The duration of some of the steps involved in the logistics to be followed took longer than anticipated, and this affected the entire implementation plan,” Mohale explains.
Several countries, including neighbouring Eswatini, Lesotho, and Zimbabwe, have already started rolling out lenacapavir. These drugs are made available through a 2025 agreement between the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and Gilead Sciences. The Global Fund will buy lenacapavir on behalf of low- and middle-income countries. At the time, the Global Fund wanted to provide the drug to two million people around the world. This target has since increased to three million people by 2028.
Limited doses, big expectations
In South Africa, which has the world’s largest PrEP programme, an estimated 170 000 people still acquire HIV every year. Lenacapavir is not a vaccine, but a preventive medicine that has shown nearly 100% effective in HIV prevention. But the country’s allocation of lenacapavir is enough to cover less than 500 000 people over the next two years. Civil society has been calling on this figure to increase to at least two million South Africans if this jab is to make a difference in the country’s efforts to end AIDS.
But the government is determined to forge ahead with its plans.
“The 37 920 doses received in this first consignment will be used as the first injection for the people most at risk of acquiring HIV,” says Mohale.
“We are waiting for an indication from the manufacturer on the date of delivery of the second consignment, but our immediate priority is to drive demand creation for the currently available doses.”
But the government’s roll-out is going to be in a phased approach, starting in over 350 designated sites across the country. A list of these sites will be made available later, according to Mohale, who says communicating the government’s implementation plan is a work in progress.
Balancing access and stigma
People who will be prioritised for the jab include adolescent girls and young women, sex
workers, and men who have sex with men.
Sisonke National Movement is an organisation that advocates for the rights of sex workers, and is part of the South African National AIDS Council Civil Society Forum. Media, communications and advocacy officer, Yonela Sinqu, says the organisation has been instrumental in advocating for sex workers to receive lenacapavir alongside the rest of the country.
When South Africa first introduced PrEP, the country piloted the oral HIV prevention services among sex workers and men who have sex with men. While these individuals form part of key populations at a higher risk of acquiring HIV, prioritising these groups for PrEP had unintended consequences.
“That approach resulted in police using oral PrEP as evidence to profile and detain sex workers,” Sinqu. Sisonke is one of the organisations advocating for the decriminalisation of sex work in South Africa.
One of the biggest lessons learned was that prioritising sex workers for PrEP put a target on their backs. It increased stigma and made them much more vulnerable to discrimination.
“Therefore, we advocate for an equal and equitable rollout of any treatment. We also advocate for the treatment of people rather than having people segregated by the work they do,” Sinqu says.
At this stage, adolescent girls and young women aged 15 to 24 are among those who will be prioritised for lenacapavir. Women and girls account for almost 60% of new HIV cases in South Africa. Sinqu argues this is a good approach as sex workers are part of the population group, so they would not be singled out.
“This is a move we welcome, rather than the previous rollout of oral PrEP, which heightened stigma and discrimination while also fuelling GBV.” – Health-e News
*Additional reporting by Keletso Mkhwanazi
