South Africa has launched lenacapavir, a new injectable form of pre-exposure prophylaxis, or PrEP. The injection provides six months of protection against HIV infection. It is given twice a year.
Health experts say the Lenacapavir PrEP Rollout could be a major step forward for HIV prevention. It offers an alternative to oral PrEP, which requires people to take tablets regularly.
This could help people who struggle with daily adherence. It could also expand prevention choices for people at higher risk of HIV.
However, the launch comes at a difficult time. Cuts to United States aid have weakened South Africa’s HIV prevention programme. These cuts have forced the closure of many specialised services for high-risk groups.
Lenacapavir PrEP Rollout Faces Service Delivery Gaps
South Africa was the first African country to roll out oral PrEP in 2016. The programme first focused on key populations. These included groups at increased risk of HIV.
Over time, the programme became one of the largest in the world. It recorded millions of PrEP initiations.
But experts warn that initiation figures do not show how many people remain on PrEP. Many users start and stop treatment.
Professor Francois Venter of Ezintsha estimates that the actual number of PrEP users is closer to 500,000. Thembisa modelling suggests that just over 350,000 people were taking PrEP by mid-2025.
Venter argues that much of South Africa’s PrEP progress relied on specialised services. USAID funded these services under PEPFAR.
When the US terminated large numbers of funded health projects in 2025, the cuts hit HIV prevention programmes hard. Activists say clinics closed, outreach services shrank, and programmes lost thousands of PrEP users to follow-up.
PEPFAR Cuts Weaken Key Population Services
The National Department of Health denies that the PrEP programme has collapsed, asserting that it has integrated oral PrEP into the public health system.
The department also says almost all public primary healthcare facilities offer oral PrEP.
But activists and researchers remain concerned. They question whether mainstream public clinics can reach people who already face stigma and discrimination.
This includes sex workers, men who have sex with men, adolescent girls and young women. These groups may avoid public clinics because of judgment, poor treatment or lack of privacy.
The first phase of the injectable PrEP rollout will make lenacapavir available at 360 health facilities. This is about 10% of public sector clinics.
Initial supply is limited. It will be prioritised for groups at higher risk of HIV.
Civil Society Calls For Community-Based Access
Civil society groups have criticised the rollout as too small.
They warn that a mainly clinic-based model may not reach the most vulnerable people. They say the success of injectable PrEP will depend on access, trust and follow-up support.
Experts have called for mobile clinics, pharmacies, outreach services, and community-based delivery models. These channels could help reach people whom traditional clinics do not serve well.
They could also support people who lost access to PrEP after specialised services closed.
The Lenacapavir PrEP Rollout gives South Africa a powerful new tool in its HIV prevention response. But the impact will depend on more than the medicine itself.
For the rollout to succeed, the health system must reach those most at risk. It must also rebuild the service networks weakened by aid cuts.