In a landmark development for global HIV prevention, England, Wales, and South Africa have each taken bold steps to expand access to long-acting injectable medications that promise to reshape the fight against the virus. These new interventions, hailed as "game-changing" by health leaders, offer hope to populations who have struggled with existing prevention methods and signal a new era in public health strategy.
On October 17, 2025, the National Health Service (NHS) in England and Wales approved cabotegravir (CAB-LA), a long-acting injection to prevent HIV, bringing their policy in line with Scotland’s earlier adoption. According to BBC News, this injection is administered every two months—just six times a year—and provides an alternative to the daily oral PrEP (pre-exposure prophylaxis) pills that have been the mainstay of HIV prevention. The move comes after England’s drug pricing regulator recommended cabotegravir for NHS use, making it the first long-acting pre-exposure treatment available within the UK’s public health system, as reported by ViiV Healthcare Ltd.
Wes Streeting, the Secretary of State for Health and Social Care, did not mince words about the significance of this advance. "The approval of this game-changing injection perfectly embodies what this government is determined to deliver—cutting-edge treatments that save lives and leave no one behind. For vulnerable people who are unable to take other methods of HIV prevention, this represents hope," he declared, as cited by BBC News.
Cabotegravir’s arrival comes at a time when the need for more flexible and discreet prevention options has become increasingly apparent. While daily PrEP pills remain highly effective, they are not always practical for everyone. Some individuals face challenges in accessing daily medication due to housing instability, domestic violence, or concerns about privacy—such as the fear that family members or housemates might discover their pills. For these people, a long-acting injection offers a welcome alternative, reducing the burden of daily adherence and the stigma that can sometimes accompany it.
The NHS has negotiated an undisclosed discount for cabotegravir, which has a list price of around £7,000 per patient per year. The injection will be offered initially to an estimated 1,000 adults and adolescents with a healthy weight who are at high risk of sexually acquired HIV and who find daily oral tablets difficult to take. These patients will be able to access the treatment through NHS-operated sexual health clinics "in coming months," according to the National Institute for Health and Care Excellence (NICE). The injection is to be used alongside safer sex practices, such as condom use, to maximize protection.
Richard Angell, of the Terrence Higgins Trust, underscored the potential of the new therapy, stating, "It's highly effective and acceptable for patients, and a vital tool for tackling inequalities—with the potential to reach those who are not currently accessing other HIV prevention." He also called for the NHS to explore delivering the "transformative therapy" in settings beyond traditional sexual health clinics, to reach more people in need.
Official figures for England reveal a growing demand for HIV prevention. In the previous year, 146,098 HIV-negative individuals accessing sexual health services were identified as needing PrEP due to substantial risk, with about 76% (111,123) beginning or continuing PrEP—a 7.7% increase from 2023. However, uptake is not uniform across all groups. According to BBC News, PrEP use is highest among white and ethnic minority gay, bisexual, and other men who have sex with men (with 79.4% and 77.8% uptake, respectively), but considerably lower among black African heterosexual women (34.6%) and men (36.4%). This disparity highlights the ongoing challenge of ensuring equitable access to prevention tools.
England has also expanded routine HIV testing in hospital accident and emergency departments, with 89 facilities now routinely screening anyone who has blood drawn in areas of high HIV prevalence—a move designed to identify undiagnosed cases and further curb transmission.
Meanwhile, South Africa is preparing for its own pivotal moment in HIV prevention. On October 16, 2025, Health Minister Dr. Aaron Motsoaledi announced the forthcoming introduction of Lenacapavir, a novel injectable drug that requires just two shots per year. As reported by eNCA and SocialNews.XYZ, Lenacapavir has demonstrated remarkable efficacy in clinical trials, offering 100% protection among women and 96% protection among men who have sex with men and transgender women. The initial rollout, scheduled for March 2026, will target 23 high-incident districts across six provinces, focusing on approximately 360 high-performing public clinics.
"We need prevention methods that fit into people’s lives, that address the gaps left by existing tools," Motsoaledi said at a national roundtable, emphasizing the transformative potential of the new drug. "This is where Lenacapavir comes in as a timely and much-needed innovation to help us overcome the persistent challenges in our HIV/AIDS response, especially when it comes to prevention."
South Africa’s HIV epidemic remains one of the world’s most severe, with about eight million people living with the virus and 149,000 new diagnoses in 2023 alone, the majority among women and adolescent girls. The government has secured an initial supply of Lenacapavir through a Global Fund grant of about 29 million US dollars, which will provide approximately 456,000 initiations and 912,000 doses over two years. Yet, as Motsoaledi acknowledged, this will only cover a fraction of the total need in the early years.
The initial rollout will prioritize groups most vulnerable to HIV infection, including pregnant and breastfeeding women, adolescent girls, female sex workers, and men who have sex with men. Health officials hope that the twice-yearly injection will improve adherence in these populations, who often face barriers to consistent use of existing prevention tools.
South Africa’s approach mirrors the UK’s in recognizing that one-size-fits-all solutions are not enough. By tailoring strategies to reach those who are most at risk and least served by current methods, both countries are taking significant steps toward ending new HIV cases. The World Health Organization and UNAIDS have long advocated for diversified prevention options, noting that cultural, social, and economic factors can influence uptake and effectiveness.
Looking ahead, early results for Lenacapavir and other long-acting injectables suggest the possibility of even more convenient regimens in the future—perhaps even a single annual jab. For now, though, the focus remains on delivering these proven innovations quickly and equitably, ensuring that no one is left behind in the global effort to defeat HIV.
As the world watches these rollouts unfold, the hope is that these new tools will not just save lives, but also help close the persistent gaps in access and adherence that have long frustrated public health officials. The next few years will be critical in determining whether these "game-changing" interventions can truly turn the tide against HIV.
