HIV protection by injection: almost 77,000 people in South Africa use lenacapavir

South Africa is expanding HIV prevention with an injection that only needs to be given every six months. Lenacapavir has been offered since 5 June at 360 public health facilities in six provinces. By 8 October, 76,922 people nationwide had started it, including 36,733 at 133 facilities in Gauteng province, the health news site Spotlight reported on 23 October. In mid-October, according to The Herald newspaper, Eastern Cape province also began its rollout at selected facilities; the injection is an alternative to the daily pill for pre-exposure prophylaxis (PrEP).

At the start, patients receive two injections at one visit and also take tablets on the same day and 24 hours later; after that, a follow-up dose is given every six months. Nurses – Spotlight spoke to staff in Gauteng – first complete a mandatory course and then practical training. Because the solution is thick, it has to be injected slowly. Professor Saiqa Mullick, director of implementation science at Wits RHI, told delegates, according to Spotlight: "People want options that fit into their lives."

The need is great: South Africa had an estimated 140,000 new HIV infections in 2025. According to modelling, 1.4 to 2.1 million initiations a year by 2030 could avert an average of 32,200 to 51,700 infections annually. Alongside the rollout, Wits RHI's Len4PrEP study is examining implementation in practice; it enrolled 1,544 participants between November 2025 and June 2026, who will be followed up until June 2027.