The introduction of Lenacapavir for HIV prevention in South Africa represents the culmination of more than a decade of strategic leadership and health system strengthening led by the National Department of Health. South Africa has been one of the few countries globally to make antiretroviral-based pre-exposure prophylaxis (PrEP) available as part of the Essential Medicines List and integrated within the country’s public primary healthcare (PHC) system.
The rollout of Lenacapavir, therefore, does not represent a stand-alone intervention, but rather builds on a strong and mature HIV prevention platform that has progressively expanded access to HIV prevention services across the country.
In 2016, the Department of Health adopted a bold and pioneering approach to HIV prevention by introducing oral PrEP. By 2021, South Africa had successfully scaled oral PrEP across the public health sector, even as many countries were still debating its feasibility, affordability and implementation in routine health services. Today, more than 2.2 million South Africans have been initiated on oral PrEP through public sector programmes.
Government recognised early that ending new HIV infections would require not only the expansion of HIV treatment, but also sustained investment in innovative HIV prevention technologies that empower people to protect themselves from HIV.
This strategic vision positioned the country as a global leader in HIV prevention innovation and laid the foundation for the introduction of next-generation long-acting prevention options such as Lenacapavir.
We have made efforts in ensuring that oral PrEP was integrated into routine PHC services, ensuring that HIV prevention became part of comprehensive healthcare that includes HIV testing services, sexual and reproductive health services, sexually transmitted infection management, TB screening, maternal and child health services, and linkage to HIV treatment and care.
The introduction of Lenacapavir now builds directly on this solid foundation. South Africa’s established PHC infrastructure, trained healthcare workforce, HIV prevention guidelines, supply chain systems, monitoring platforms and community mobilisation networks created the enabling environment necessary for the rapid introduction of long-acting HIV prevention technologies. Without the earlier strategic investments in oral PrEP and integrated prevention services, the country would not have been positioned to move so quickly towards implementing Lenacapavir at scale.
Lenacapavir represents a major scientific breakthrough in HIV prevention. Unlike daily oral PrEP, Lenacapavir is administered as two injections every six months, offering individuals a highly effective long-acting prevention option that reduces the burden of daily pill-taking and may improve adherence and convenience for many users. Clinical trials demonstrated unprecedented effectiveness in preventing HIV infection, leading to global recognition of Lenacapavir as one of the most important advances in HIV prevention in recent years.
Through coordinated engagement with regulatory authorities, researchers, international partners, provincial health departments and civil society, we have overseen the introduction of Lenacapavir into the public health system as part of a broader combination HIV prevention programme.
Importantly, we have consistently emphasised that Lenacapavir is an additional HIV prevention choice rather than a replacement for existing prevention methods.
This reflects South Africa’s broader prevention philosophy of informed choice and combination prevention, recognising that different individuals require different prevention options at different stages of their lives. By expanding prevention choices, we are ensuring that more people can access prevention methods that suit their circumstances and preferences.
The significance of Lenacapavir extends beyond the introduction of a new medicine. It signals the next phase in the evolution of HIV prevention and strengthens South Africa’s efforts to end new HIV infections. Long-acting prevention technologies have the potential to overcome many of the adherence and access barriers associated with daily prevention methods, particularly among populations most vulnerable to HIV infection, including adolescent girls and young women, sex workers, men who have sex with men, transgender persons, and pregnant and breastfeeding women.
Government will continue to mobilise resources and strengthen partnerships to support the rollout of this game-changer as part of our ongoing efforts to prevent new HIV infections in our country.
South Africa’s approach reflects a balanced model of domestic ownership and catalytic international support. While development partners have assisted with catalytic support for the early introduction of Lenacapavir, I reaffirm government’s commitment to long-term sustainability and future domestic financing as more affordable generic products become available.
By building on the strong foundation established through the national oral PrEP programme, South Africa is undoubtedly positioned to once again lead globally in expanding equitable access to life-saving HIV prevention technologies and accelerating progress towards ending new HIV infections.
*This article first appeared in Public Sector Manager Magazine by the Minister of Health, Dr Aaron Motsoaledi
