UNAIDS applauds South Africa’s landmark Lenacapavir rollout in HIV prevention drive

UNAIDS has hailed South Africa's national rollout of Lenacapavir as a historic milestone in the global fight against HIV, describing it as the first public HIV prevention programme of its scale anywhere in the world.

The launch, held at the Lilian Ngoyi Stadium in Secunda, Mpumalanga, was led by President Cyril Ramaphosa and Health Minister Dr Aaron Motsoaledi. President Ramaphosa described the initiative as a defining moment for both South Africa and the global HIV response.

South Africa joins Eswatini, Kenya, Lesotho, Nigeria, Zambia and Zimbabwe in introducing Lenacapavir, a twice-yearly injectable HIV prevention medication that has demonstrated near 100% effectiveness in preventing HIV infection.

The medication is currently available at 360 public health facilities across six provinces and 24 high-burden districts. Government aims to reach nearly one million people by the end of 2027 and expand coverage to three million people within three years.

The rollout is being supported by a combined investment of R1.3 billion from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Children's Investment Fund Foundation (CIFF), and government funding.

UNAIDS Multi-Country Director for South Africa, Lesotho and Eswatini, Alankar Malviya, praised the country's leadership and commitment to transforming the HIV response.

He welcomed the focus on adolescent girls and young women, men who have sex with men, sex workers and people who use drugs, as well as plans to explore local generic production through discussions between government and pharmaceutical company Gilead Sciences.

UNAIDS Regional Director for Eastern and Southern Africa, Anne Githuku-Shongwe, described the rollout as a breakthrough that many in the HIV sector had long awaited.

However, she warned that affordability remains a significant challenge despite progress in securing licensing agreements that could reduce the cost of generic versions to around US$40 per person annually.

She cautioned that declining health budgets and reduced international HIV funding could limit access unless governments and partners move quickly to scale up implementation.

The urgency of the intervention is reflected in South Africa's HIV statistics. In 2024, the country recorded approximately 150,000 new HIV infections, with women and girls accounting for 59% of those cases. More than 71,000 new infections occurred among adolescent girls and young women aged between 15 and 24.

According to UNAIDS modelling, providing Lenacapavir to one million people for a year could prevent around 30,000 new HIV infections. Research by the Wits Health Consortium further suggests that placing one to two million people on the injectable annually could help South Africa reach its goal of ending AIDS seven to ten years sooner than relying solely on oral pre-exposure prophylaxis (PrEP).

UNAIDS emphasised that Lenacapavir should form part of a broader HIV prevention strategy that includes condoms, family planning services, sexual and reproductive healthcare, and community-based prevention programmes.

The organisation noted that programmes combining HIV prevention with education, economic opportunities and protection from gender-based violence have proven particularly effective in reducing infection rates among young women.

As Chair of the Southern African Development Community (SADC), South Africa has also been encouraged to champion regional cooperation on the procurement, manufacturing and distribution of Lenacapavir.

UNAIDS has called on governments, donors, global health organisations and the pharmaceutical industry to accelerate generic production and ensure that the life-saving prevention tool becomes accessible to all who need it across Africa and beyond.