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South Africa accounts for more than half of Africa’s users of the six‑monthly HIV prevention injection lenacapavir, a figure that shows both the country’s early adoption and the gaps that remain in reaching all at‑risk groups.

Roll‑out numbers show strong preference for the injection

Data from the health department, presented at the International AIDS Conference in Rio de Janeiro, indicate that 31,297 of the continent’s roughly 60,000 lenacapavir users reside in South Africa. The jab was introduced on 5 June at 360 government clinics across six provinces, representing about 8 % of the nation’s public facilities.

Within six weeks, 98.5 % of HIV‑negative patients offered a choice between the daily PrEP pill and lenacapavir opted for the injection. The high uptake mirrors findings from the LEN4PrEP implementation study, where 85 % of participants have returned on time for their follow‑up dose.

Gauteng and KwaZulu‑Natal together host just over two‑thirds of the country’s lenacapavir users, reflecting the concentration of clinics that provide the service—129 in Gauteng and 94 in KwaZulu‑Natal. These provinces contain nearly half of South Africa’s population, which may partly explain the skewed distribution.

Who is using the new prevention method?

Women dominate the early user base, reflecting higher clinic attendance among women, especially during pregnancy and child‑vaccination visits.

Men represent a portion of lenacapavir users, and in the LEN4PrEP study, a large majority of men offered a choice chose the injection.

Uptake among key populations at higher risk—sex workers, gay and bisexual men, transgender people, and people who inject drugs—remains low, with only a few hundred users in each category. Clinic closures after the termination of U.S. funding and concerns about disclosing personal information may contribute to these shortfalls.

From a practical standpoint, the injection’s appeal seems rooted in convenience. Fewer clinic visits and the reduced risk of forgetting daily pills make lenacapavir a more user‑friendly option, even though clinical trials have shown it to be slightly more effective than daily oral PrEP.

Supply outlook and future challenges

By mid‑June, 115,320 doses of lenacapavir had arrived in South Africa, with 43,813 already distributed to clinics. As of 19 July, 25,730 doses were used, leaving a stock of 18,083 that should last until mid‑August at the current uptake rate. The remaining 71,507 doses, once entered into the supply chain, are projected to sustain the programme through mid‑December.

The Global Fund has pledged 974,450 doses over two years; with just under 860,000 still to arrive, the existing supply should support the current rollout pace for roughly 200 more weeks. Generic versions, expected after 2027, could further alleviate pressure.

Health Minister Aaron Motsoaledi noted that early concerns about vaccine hesitancy—stemming from the COVID‑19 pandemic—have not turned into widespread reluctance to use lenacapavir. “Our data tells us South Africans are realising lenacapavir’s value,” he said.

Despite sufficient doses for now, experts warn that scaling the programme to reach half a million people will test the health system’s capacity to deliver injections and accompanying HIV tests every six months. Infrastructure, rather than supply, may become the limiting factor as the programme expands.