Lenacapavir, an injectable drug for HIV prevention administered every six months, has been introduced in South Africa, marking a significant step forward in the fight against HIV and offering new hope to high-risk groups. Since its national launch in June, over 55,000 people have started using this drug, with women constituting nearly three-quarters of recipients.
According to the Department of Health, as of September 7, 55,123 people had started receiving the injection, with 71% of all recipients being women. The Department specified that most women receiving the injection are mothers who are pregnant or breastfeeding.
Lenacapavir, used as pre-exposure prophylaxis (PrEP) twice a year, was officially launched nationally by President Cyril Ramaphosa and Minister of Health Dr. Aaron Motsoaledi on June 5. Currently, the drug is available in 360 public health facilities across 24 districts in six provinces.
Reasons for the High Number of Female Recipients
The gender disparity can be partially explained by the groups prioritized during the program's rollout. Before the national start, South Africa identified adolescents and young women, as well as pregnant and breastfeeding women, as groups eligible to access lenacapavir.
Unitaid, which supported the early launch efforts, quoted Health Minister Motsoaledi, who stated that South Africa aimed to make lenacapavir accessible to populations at increased risk of HIV infection, especially adolescent girls, young women, and pregnant and breastfeeding women.
Pregnancy and the postpartum period represent critical times when HIV prevention can be offered to women. Furthermore, there is growing evidence supporting the safety and efficacy of long-acting HIV prevention methods during pregnancy and breastfeeding. A study presented at the International AIDS Society conference in 2025 showed that lenacapavir and another injectable PrEP option, cabotegravir, are safe and well-tolerated during pregnancy and breastfeeding, supporting their use as HIV prevention options for people at risk.
Advantages of Twice-a-Year Injection
Another factor relates to the method of administering lenacapavir. Instead of daily pill intake for HIV prevention, which can be burdensome or lead to missed doses, people receiving lenacapavir receive an injection twice a year. The World Health Organization recommends lenacapavir as an additional HIV prevention option, noting that providing various PrEP options helps people choose a method that suits their preferences and potentially increases the effective uptake of HIV prevention.
For those who find it difficult to take a daily pill, the semi-annual injection offers an alternative. However, this does not mean that lenacapavir replaces other forms of PrEP. The Department of Health emphasized that it is being implemented as part of a PrEP choice program, alongside other HIV prevention methods.
Young Women Remain in Focus
The focus on women also reflects South Africa's challenges in HIV prevention. UNAIDS reported that after the June launch, women and girls accounted for 59% of new HIV cases in the country in 2024, with adolescent girls and young women aged 15 to 24 accounting for over 71,000 such cases. This explains why young women were identified as a key group for implementing long-acting PrEP.
Gauteng Leads in Implementation
The province of Gauteng registered the highest number of lenacapavir initiations, with 26,357 people receiving the prevention injection by September 7. KwaZulu-Natal followed with 11,941 people, North West with 4,479, Western Cape with 4,446, Mpumalanga with 4,294, and Eastern Cape with 3,606. The Department of Health stated that it continues to monitor coverage rates, drug availability, quality of service delivery, client follow-up, and safety as the program expands. The World Health Organization welcomed the launch in South Africa, calling it a major milestone in expanding people-centered HIV prevention options.