Researchers warn that the introduction of Lenacapavir injections in South Africa, a long-acting drug for HIV prevention, has the potential to fundamentally change the approach to HIV prevention, but the success of this process will depend on ensuring equal access and strengthening community-level healthcare systems.
Barriers to Success
According to researchers and public health specialists addressed during the Rural Health Advocacy Project (RHAP) webinar on Wednesday, the successful rollout of the world's first injectable for HIV prevention may not meet expectations if long-standing obstacles to accessing medical services are not resolved.
Although the introduction of long-acting injectable pre-exposure prophylaxis (PrEP), known as Lenacapavir, represents a significant breakthrough in the fight against HIV, existing systemic barriers in the country continue to prevent many vulnerable groups from utilizing this medication.
Program Launch and Priorities
South Africa officially began deploying Lenacapavir on June 5, becoming one of the first countries globally to integrate this injectable drug for HIV prevention into its national health program.
Implementation has started in specific healthcare facilities in the Western Cape province. The initial phase targets adolescents and young women, sex workers, men who have sex with men, and transgender individuals.
Calls for Delivery Model Change
Jacqueline Pina, a psychologist and public health specialist supporting the National Department of Health's adoption of Lenacapavir, noted that clinical trials confirmed the drug's high efficacy. However, she argued that the country's focus must shift to ensuring equitable access.
Pina emphasized that the main question for South Africa is not the functionality of the injection, but the ability to reach those in need. She questioned whether adolescents, young women, men who have sex with men, transgender individuals, and sex workers—who often avoid facilities due to stigma, discrimination, and humiliation—are being reached.
She stated that the current clinic-based approach risks excluding precisely the communities for whom this rollout is intended. Pina proposed making Lenacapavir available through community organizations, mobile aid groups, pharmacies, and youth-oriented services, asserting that HIV prevention should be delivered where people live, learn, and work, rather than requiring healthy citizens to travel to clinics.
Avoiding Past Mistakes
Pina also cautioned against repeating errors made during the implementation of oral PrEP, noting that limited information campaigns and targeted messaging contributed to increased stigma. She cited an example where the community might mistakenly perceive someone taking PrEP as promiscuous because it is associated with sex workers.
Instead of creating a separate HIV program, Pina insisted on integrating the injectable drug into sexual and reproductive health services alongside contraception, STI screening, and family planning services. She concluded that the innovation lies not only in the injection itself but in the method of its delivery, and the greatest risk is that the drug will be successfully implemented while the healthcare system fails to transform.
Risks for Vulnerable Groups
Dr. Zoe Dubbe, a senior researcher at the South African Council for Medical Research and an honorary fellow at the University of Cape Town, pointed out that adolescents and young women remain among the most at-risk populations for HIV infection, and pregnant and breastfeeding women also face elevated risks.
Dubbe believes that the success of Lenacapavir will depend on how acceptable and accessible the services become for these groups. She noted that judgments, gossip, rumors, fear of disclosure, and the inconvenience of clinic services can affect a young woman's consistent use of prevention. Therefore, not only is a clinically effective product important, but also the delivery model that ensures accessibility and acceptability.
She added that the program's success should be measured not only by the number of injections administered but also by whether people continue to receive their six-month doses regularly and remain protected during periods of highest HIV vulnerability.
Addressing Rural Needs
Associate Professor Sakumzi Mkhize-Kaane of the University of the Western Cape stated that the realities of rural communities must be considered during deployment, where transportation difficulties, cultural norms, and limited healthcare access continue to affect male participation in HIV prevention programs. He stressed the need to meet men where they are, and not just the men themselves, but entire communities, as programs designed without considering the local context are unlikely to achieve full impact.
