The HIV prevention jab scientists hoped for is finally here. Now comes the hard part
South Africa will launch lenacapavir (LEN), a twice-yearly HIV prevention injection, on June 5, marking a major advance in HIV prevention but facing challenges due to weakened health systems and funding cuts. The Global Fund and Pepfar have recognized LEN’s potential, though funding uncertainties, including a 50% reduction from Pepfar under the Trump administration, threaten its widespread distribution, limiting initial doses to around 456,000 people annually.
South Africa is set to launch lenacapavir (LEN), a groundbreaking HIV prevention injection administered once every six months, beginning June 5 in Mpumalanga. The rollout will cover 360 government clinics nationwide, offering an alternative to the existing daily HIV prevention pill, which many struggle to adhere to consistently. LEN’s effectiveness is nearly absolute in preventing HIV transmission through sex when taken as prescribed, addressing a critical gap in current prevention methods. However, its success depends on robust health systems and sustained funding, which have been compromised by political shifts and budget cuts. South Africa’s current daily pill program, provided for free at most clinics, has faced challenges due to low adherence, particularly among young people. The injection’s convenience could improve accessibility for vulnerable groups, including those without stable housing or facing stigma. Modeling studies estimate that 1 to 2 million people in South Africa would need annual LEN doses to significantly reduce new HIV infections and end AIDS as a public health threat within eight years. Funding for LEN’s distribution remains uncertain. The Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (Pepfar) have acknowledged its potential, but Pepfar’s funding for South Africa was cut by at least 50% in early 2025 under the Trump administration. These cuts, combined with the Global Fund’s limited initial allocation of 456,000 doses for 2024 and most of 2025, pose serious obstacles to scaling up the program effectively. Health Minister Aaron Motsoaledi announced the rollout, emphasizing the urgency of addressing systemic barriers to HIV prevention. The launch highlights both the promise of LEN and the ongoing struggle to ensure equitable access to life-saving medical interventions in resource-constrained settings.
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