New six-month HIV injection, lenacapivir, hailed as breakthrough, but access and awareness remain key

The arrival of a new HIV drug called lenacapivir is one of the most talked-about advances in HIV prevention in decades.

Health officials consider the injection an important development in efforts to reduce new HIV infections in the country.

This innovation offers renewed hope in the country’s integrated and people-centred HIV prevention strategy and marks a turning point in reshaping how communities are protected.

Unlike daily PrEP, the injection is administered once every six months, offering continuous protection over that period.

This approach is expected to improve adherence, particularly for individuals who struggle to take daily medication or access prevention tools consistently.

Health Department spokesperson Foster Mohale said: "This is a game changer and will complement existing prevention methods such as condoms, PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis)."

From a clinical perspective, doctors say the advantages are very clear.

Dr Vincent Nhlapo, who runs a private practice in Protea Glen, said the six-month injection will reduce the risk of missed doses, which is a common challenge with oral PrEP.

“With a daily pill, you can forget, you may experience side effects like vomiting or struggle with consistency. But with the injection, once it’s administered, it’s in your body and provides protection for six months,” he said.

He added that while oral medications can cause gastrointestinal side effects, the injectable option may be easier for many patients to tolerate.

However, like any medication, lenacapivir is not entirely without side effects and patients will be screened and counselled before receiving it.

Both Mohale and Nhlapo have stressed that viewing lenacapivir as a standalone solution should be approached with caution. They emphasise the continued importance of condom use and responsible sexual behaviour.

Nhlapo said: “You still need to protect yourself against other infections.”

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According to the Department of Health, the rollout of the injection will be phased, beginning with around 30 sites across South Africa, particularly in high-burden districts. The programme will initially prioritise groups at highest risk of HIV infection, including sex workers, men who have sex with men, adolescent girls and young women, as well as pregnant or breastfeeding women.

However, supply constraints may be a concern for the broader population. According to Nhlapo, current stock, which is largely donor-funded, will only cover a fraction of the demand for now.

“We want to give it to everyone, but not everyone will be able to get it because of low supply.”

In the private sector, access may depend on whether patients can afford to purchase the medication themselves, while public health facilities will only provide it at selected sites.

On the other side of the spectrum, organisations working on the ground say the success of lenacapivir will depend not only on access, but also on education and behaviour change.

CEO of HIVSA, Yashmita Naidoo, said the injection could be transformative, especially for high-risk populations, but warned that misconceptions and systemic gaps could limit its impact.

“The idea is to target key populations most at risk initially.”

She noted that many people struggled with daily PrEP due to stigma, the visibility of pills and the burden of remembering to take medication.

“There’s much work to be done in demand creation and education. People need to understand the benefits and we need to ensure they come back for their next injection,” she said.

Naidoo also highlighted a broader gap in South Africa’s HIV response, including reduced community-level prevention efforts following United States funding cuts. She warned that without strong education campaigns and behaviour change programmes, biomedical interventions alone may not be enough.

Despite the challenges across different sectors, there is cautious optimism among healthcare providers and advocates.

Nhlapo believes that if widely adopted, lenacapivir could significantly reduce new infections.

“There’s no risk of forgetting. If people take it as scheduled, we could see far fewer new cases.”

In the same breath, Naidoo pointed to a growing awareness among young people about sexual health as a reason for hope.

“Young people are asking the right questions and are willing to take control of their health,” she said.

For the Health Department, success will ultimately be measured by one outcome: a sustained decline in new HIV infections. The broader goal, as Mohale has pointed out, is to end HIV as a public health threat in South Africa by 2030. - Article by Noluthando Ngeno