Women make up 71% of recipients as the country expands access to long-acting HIV prevention
By Bunmi Yekini
More than 55,000 people in South Africa have started using lenacapavir, a twice-yearly injection that prevents HIV infection, since its national rollout in June, with women accounting for 71% of recipients, the health department said.
A total of 55,123 people had received the injectable pre-exposure prophylaxis, or PrEP, by Sept. 7, according to the department. Most of the women receiving it are pregnant or breastfeeding, it said.
South Africa launched lenacapavir nationally on June 5, with the injection now available at 360 public health facilities across 24 districts in six provinces.
The high proportion of women among recipients partly reflects the groups prioritised under the rollout, including adolescent girls and young women as well as pregnant and breastfeeding women.
Health Minister Aaron Motsoaledi has said the government wants to make lenacapavir available to groups at higher risk of acquiring HIV, particularly adolescent girls, young women and pregnant and breastfeeding women.
Pregnancy and breastfeeding provide opportunities to integrate HIV prevention into routine maternal healthcare. WHO’s current guidance says lenacapavir can be offered as an additional PrEP choice and notes that available data do not show an increase in adverse pregnancy or birth outcomes among reported pregnancies exposed to the drug.
Unlike daily oral PrEP, lenacapavir is administered twice a year. WHO says the availability of different PrEP options can allow people to choose a method that fits their preferences and may improve uptake and effective use of HIV prevention.
The injection is being introduced alongside other HIV prevention methods rather than replacing them, with South Africa using what the health department describes as a PrEP-choice approach.
The focus on women also reflects the country’s HIV burden. UNAIDS reported after the June rollout that women and girls accounted for 59% of new HIV infections in South Africa in 2024, while more than 71,000 new infections were recorded among adolescent girls and young women aged 15 to 24.
Gauteng has recorded the largest number of lenacapavir initiations, with 26,357 people receiving the injection by Sept. 7, followed by KwaZulu-Natal with 11,941.
North West recorded 4,479 initiations, Western Cape 4,446, Mpumalanga 4,294 and Eastern Cape 3,606.
The health department said it was monitoring uptake, medicine availability, quality of services, follow-up of clients and safety as the programme expands.
WHO recommends twice-yearly injectable lenacapavir as an additional HIV prevention option, alongside other forms of PrEP.