South Africa is set to make a historic leap in its decades-long fight against HIV, with the government announcing plans to roll out the groundbreaking injectable prevention drug lenacapavir as soon as March 2026. The move, revealed by Health Minister Dr. Aaron Motsoaledi during a national roundtable in Johannesburg on October 14, 2025, is being hailed as a potential game-changer for a country that still sees about 400 new HIV infections each day—more than a quarter of them among teen girls and young women.
"We need prevention methods that fit into people's lives," Motsoaledi said at the roundtable, according to Kaya 959. "Lenacapavir expands the choices within our combination prevention strategy. 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."
The injectable, known as lenacapavir or LEN, offers six months of protection per dose, meaning it only needs to be administered twice a year. Clinical trials have shown remarkable efficacy, with 100 percent protection among women and 96 percent among men who have sex with men and transgender women, according to APA News and Kaya 959. These results have fueled optimism that South Africa could dramatically reduce new HIV transmissions and even end AIDS as a public health threat within the next two decades.
The initial rollout will focus on 23 high-incidence districts spread across six provinces, targeting approximately 360 public clinics. Priority groups include adolescent girls, pregnant and breastfeeding women, female sex workers, and men who have sex with men—populations that remain disproportionately vulnerable to HIV infection. "About 400 people in South Africa still get infected daily, with more than a quarter being teen girls and young women," Motsoaledi noted, according to The South African. This targeted approach aims to put the country on a path to reducing new infections to below 0.1% by 2032.
Financing for the ambitious rollout is being secured through a combination of international and domestic support. A R500 million (approximately £21.8 million or US$29.2 million) grant from the Global Fund will cover around 456,000 lenacapavir initiations over the first two years, translating into 912,000 doses. An additional US$5 million has been allocated by the Networking HIV and AIDS Community of Southern Africa, as reported by The South African. The United States, meanwhile, has announced plans to purchase two million doses of the drug for distribution in low-income countries, underscoring the global momentum behind the new intervention.
Despite the hope, there are immediate challenges. The initial supply of lenacapavir will be limited, with the donated stock expected to reach about half a million people across the country. Motsoaledi was candid about the constraints: "The initial donated supply would be limited," he said, as quoted by The South African. Still, the government is committed to scaling up access as quickly as possible, with plans to integrate the drug into routine domestic funding after the two-year donor-supported period.
One of the most remarkable aspects of the initiative is the dramatic reduction in cost. Through negotiations with Gilead—the drug's manufacturer—and generic producers, the annual price per person has been slashed from an estimated R484,000 to just R690. This unprecedented price drop, as highlighted by Kaya 959, is expected to make the program sustainable in the long run and accessible to those who need it most. The government is also pursuing local manufacturing deals to further lower costs and ensure a reliable supply.
The rollout comes at a critical juncture. South Africa, home to the world's highest HIV prevalence rate, recorded an estimated 149,000 new infections in 2022 and 2023 alone, according to APA News. While significant progress has been made with existing prevention tools—such as daily oral pre-exposure prophylaxis (PrEP) and condoms—gaps remain, especially for populations who struggle with daily adherence or face stigma in accessing services. "We need prevention methods that fit into people's lives," Motsoaledi emphasized. Lenacapavir, with its twice-yearly dosing and discreet delivery, is seen as a solution that could overcome many of these hurdles.
The optimism surrounding lenacapavir is tempered by lessons from the past. Abrupt cuts to funding from USAID and other international sources have previously disrupted HIV/AIDS and tuberculosis treatment, prevention, and research programs across the country, The South African noted. To safeguard the new initiative, the government is working closely with international partners, including the US Centers for Disease Control and Prevention, which recently committed an additional R2 billion to support existing HIV programs.
Motsoaledi and his team are also mindful of the need for community engagement. Success will depend not just on the availability of the drug, but also on public awareness, trust, and uptake—especially among groups that have historically faced barriers in accessing healthcare. The government has pledged to work with civil society organizations, healthcare workers, and local leaders to ensure that information about lenacapavir is widely disseminated and that stigma is addressed head-on.
Experts say the stakes could not be higher. If enough people take up the new jab, South Africa could see a dramatic decline in new HIV infections within a decade and potentially end AIDS as a public health threat within 14 to 18 years, according to projections cited by The South African. "Taken only twice a year, the new drug, lenacapavir (LEN), could end HIV/AIDS in South Africa within 14 to 18 years, if enough people take it," the publication reported.
For now, the focus is on the immediate next steps: finalizing supply agreements, preparing clinics and healthcare workers, and launching public education campaigns ahead of the scheduled start in March or April 2026. The government’s commitment to integrating lenacapavir into routine care after the initial donor-funded phase signals a long-term approach, one that aims to make HIV prevention a standard part of healthcare for all South Africans.
As the world watches South Africa’s bold experiment with lenacapavir, there is a palpable sense of hope—and a recognition that, with the right mix of science, funding, and political will, the end of the HIV epidemic may finally be within reach.
