South Africa Rolls Out Lenacapavir to 456,000 People Amid Debate Over Scale and Speed

South Africa this month began distributing the first 37,920 doses of lenacapavir across 360 health facilities in six provinces with high HIV rates. The twice-yearly injectable drug is being offered first to injectable drug users, sex workers, transgender people, women aged 15 to 24, and pregnant or nursing women.

The 19-year-old Olwam Plaatjie, who began preventive medication three years ago after seeing family members lose weight and fall ill, joined clinical trials of the drug and continues despite night sweats and other side effects.

She told The Associated Press she did not want the daily pill routine she saw others manage. President Cyril Ramaphosa told a stadium crowd at the rollout launch that lenacapavir marks a “turning point” in a country with more than 8 million people living with HIV and 140,000 to 170,000 new infections each year.

The government acquired doses for 456,000 people for one year through a $29 million Global Fund grant.

Clinical trials conducted in South Africa and Uganda showed a six-month injection provided 100 percent protection against HIV in a Johannesburg study. Dr. ” Lenacapavir was developed by Gilead Sciences.

Health Minister Aaron Motsoaledi said South Africa plans to fund the program independently after the initial grant, with donor support. He added that Gilead committed to a voluntary manufacturing license for a South African company, following six licenses granted to other countries last year.

The license permits generic production for lower-middle-income countries at $40 per person annually, down from the original $28,000 price.

Some civil society groups say the scale remains insufficient. They argue at least 2 million doses per year are needed to affect infection rates meaningfully. Ramaphosa has pledged to reach 3 million South Africans over three years but has not detailed timelines.

Tian Johnson, health strategist for the Johannesburg-based African Alliance, noted that South African communities hosted trials and produced data yet still await decisions on supply volume and speed of expansion. Leila Mansoor, senior scientist at the University of KwaZulu-Natal’s Center for the AIDS Program of Research in South Africa, said equitable delivery at scale could reduce new infections.

U.S. Aid cuts by the Trump administration closed 12 clinics that had served key populations. Patients were transferred to government facilities. Motsoaledi said staff are being trained to provide confidentiality previously available at the specialized sites.

Bellinda Thibela, international policy and advocacy coordinator for the Health Global Access Project, warned that long lines and staff attitudes may deter sex workers and drug users from public clinics unless outreach resources are increased quickly.