We are managing HIV with selective lenacapavir roll-out, not ending it
South Africa’s limited rollout of lenacapavir, an HIV prevention injection, to just 456,000 people across 300 clinics is criticized as insufficient to curb daily new infections, with activists arguing the approach prioritizes geography over equitable access. The government’s reliance on a controlled pilot program, influenced by Gilead’s supply constraints and U.S. PEPFAR exclusion, is seen as a political choice that abandons millions of vulnerable individuals and fails to address systemic inequities in HIV prevention efforts.
South Africa’s rollout of lenacapavir, a twice-yearly HIV prevention injection, has been restricted to only 456,000 people across 300 clinics in 23 districts, despite the country recording hundreds of new HIV infections daily. Critics argue this selective approach—framed as a ‘pragmatic’ pilot—is insufficient to slow the epidemic and risks repeating historical inequities seen with earlier prevention methods like oral pills. The announcement of lenacapavir in 2024 was celebrated as a scientific breakthrough, but its deployment lacks a scaled strategy. Instead of a national rollout, the government has adopted a controlled experiment, limiting access based on geography. This decision excludes millions living outside designated districts, despite evidence showing universal prevention works best. The rollout’s constraints stem from political and corporate factors: the government has not taken action against pharmaceutical company Gilead, and the U.S. government excluded South Africa from PEPFAR’s allocations. Activists warn this approach prioritizes containment over prevention, abandoning vulnerable populations to high infection risks. For over a decade, communities and researchers have cautioned that scientific advancements without access commitments would perpetuate old injustices. South Africa’s central role in HIV research contrasts sharply with its current rollout strategy, which activists describe as a broken social contract. The limited supply and pilot-focused approach signal a failure to challenge pharmaceutical power or ensure equitable healthcare. Health Minister Motshekga’s office has not responded to requests for comment on the rollout’s design or plans to expand access beyond the pilot phase. Meanwhile, the South African Health Products Regulatory Authority (SAHPRA) has not yet finalized lenacapavir’s approval, further delaying widespread availability.
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