The Lenacapavir injection, designed for every six months of HIV prevention, has arrived in South Africa, marking a significant step forward in the fight against HIV and instilling hope in high-risk groups. In just three months, over 55,000 people began using the new injectable HIV prevention regimen, indicating high demand for long-term disease prevention methods.
The Ministry of Health reported that as of September 7, Lenacapavir had been initiated for 55,123 people. This occurred just over three months after the national program was launched on June 5 by President Cyril Ramaphosa and Minister of Health Dr. Aaron Motsoaledi. The drug is being distributed across 360 public health facilities in 24 districts across six provinces.
Lenacapavir is administered twice a year as pre-exposure prophylaxis (PrEP), allowing individuals to protect themselves against HIV without the need for daily pill intake.
Gauteng accounts for nearly half of treatment initiations
The largest number of people who started taking Lenacapavir were registered in Gauteng—26,357 people. This is followed by the provinces of KwaZulu-Natal (11,941 people), North West (4,479 people), Western Cape (4,446 people), Mpumalanga (4,294 people), and Eastern Cape (3,606 people). These figures show that Gauteng alone accounts for almost half of all registered cases across the six provinces.
Most recipients are women; the Ministry of Health notes that 71% of them are women, with pregnant and breastfeeding mothers being predominant among them. The Ministry continues to collaborate with provincial health departments, healthcare workers, and implementation partners to monitor drug use, resource availability, quality of services, follow-up, and safety.
From launch to tens of thousands of users
The speed of program adoption is notable because the national Lenacapavir program in South Africa was officially launched only in June. At the time of the start, Ramaphosa stated that 360 public facilities in six provinces and 24 high-burden districts were ready to provide this injection. The government set a goal to reach nearly one million people by the end of 2027, with a long-term target to cover three million people within three years.
With over 55,000 people already on treatment, the program has reached approximately 5.5% of the target of one million in the first three months. However, the current pace should not be viewed as a direct forecast of future usage, as the program is in its early stages, and the rate of user growth may depend on expansion, demand, supply, and service capacity.
What makes Lenacapavir different?
The main change for users is the frequency of prevention. Instead of daily PrEP pill intake, Lenacapavir is administered twice a year. The World Health Organization (WHO) recommends it as an additional option for HIV prevention alongside comprehensive prevention approaches.
WHO states that providing more choices of PrEP methods can increase coverage, as people can choose the prevention method that suits their preferences and circumstances. The organization named Lenacapavir the first twice-yearly injectable PrEP product and emphasized its potential in removing barriers associated with daily pills, including adherence, stigma, and access to healthcare.
The introduction of this drug in South Africa has attracted international attention. Following the national launch, WHO highly praised South Africa for transitioning from policy to practical implementation and called this launch an important milestone in the country's response to HIV.
South Africa becomes one of the first users
The introduction in South Africa occurred after the country included Lenacapavir in its National Essential Medicines List and after its approval by the South African Health Products Regulatory Authority (SAHPRA). WHO reported in December 2025 that SAHPRA became the first African regulatory body to approve Lenacapavir following its regulatory review.
The Ministry of Health's own clinical review also considered data from the PURPOSE-1 and PURPOSE-2 trials. The PURPOSE-1 trial included adolescent girls and young women, while PURPOSE-2 covered men and gender diverse individuals. The ministry's review found a significant reduction in new HIV cases when using Lenacapavir compared to daily oral PrEP based on available trial data.
What does the figure of 55,000 mean?
It is important to understand that the 55,123 treatment initiation cases do not mean that 55,123 people have gained new protection against HIV, nor do they demonstrate how many new infections the program will prevent on its own. This figure shows the speed at which the new prevention method is being adopted through the public health system.
In just over three months, tens of thousands of people have already started using a prevention method that requires only two injections per year. The demographic composition is also significant: given that women constitute 71% of those who started treatment, and most of them are pregnant and breastfeeding mothers, early uptake is concentrated among women utilizing maternal and other public health services.
The Ministry of Health states that it will continue to monitor drug use, medication availability, quality of services, follow-up, and safety as the program develops. Currently, the 55,123 cases over approximately three months indicate that South Africans are actively adopting the new method of HIV prevention at a noticeable pace.
