JOHANNESBURG — South Africa rolled out a new, biannual HIV prevention drug on Friday that has the potential to drastically cut infection rates, but U.S. aid cuts mean access will be limited.
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Lenacapavir, a kind of Pre-exposure Prophylaxis (PrEP), is injected into the stomach every six months and is basically failproof at preventing high-risk individuals from contracting the virus.
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South Africa is not the first African country to introduce injectable Lenacapavir. The drug is rolling out across Africa faster than any HIV prevention option to date, and South Africa becomes the ninth country on the continent to launch it. But in a nation with the highest number of HIV cases in the world, the long-acting injection is being hailed as a potential game changer.
“The launch today of Lenacapavir marks a turning point in our nation’s fight against HIV. To us, this incredible, incredible treatment is not just a medicine or a drug, to us it represents a major turning point in South Africa’s national story,” said South African President Cyril Ramaphosa at the launch.
The rollout is beginning in 360 health facilities in high-burden districts.
South Africa, which has about 8 million people living with HIV, according to UNAIDS, has made great strides in treatment, with a majority of the population on Antiretroviral drugs. But prevention is still an issue, with about 160,000 new infections every year.
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Most of those infections occur in adolescent girls and young women aged 15 to 24, with about 1,000 in this demographic infected each week. Among the reasons for this are unequal relationships, sometimes transactional, that these girls and women have with older men.
South Africa already has some PrEP in the form of a daily pill, but adherence is a problem. Experts are hopeful that Lenacapavir could be the breakthrough that makes prevention more effective and accessible.
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“Lenacapavir gives us something we have never had before in HIV prevention: a twice-yearly option that might be significantly easier to fit into people’s lives,” Dr. Saiqa Mullick, a PrEP specialist at Wits RHI at the University of Witwatersrand, told NPR.
But to really turn the tide on the epidemic, Mullick says South Africa will need far more than what International health financing partnership the Global Fund has provided — enough to put about 456,000 people on the drug over two years.
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“We have a game-changing technology, but impact will depend on implementation. A breakthrough product only changes the epidemic if it reaches the people who need it most,” she said.
Currently, access is being hampered by two things: the fact the Trump administration slashed the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) funding to South Africa last year, and the lack of a cheap generic.
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“U.S. funding cuts have affected HIV prevention infrastructure, community programmes, outreach, youth services and key population services. The cuts have undermined prevention programmes just as South Africa needs them for Lenacapavir rollout,” said Mullick. “Some replacement financing is emerging but it doesn’t fully replace the scale of PEPFAR funding.”
Linda-Gail Bekker, an HIV expert who leads the Desmond Tutu Health Foundation, also noted the impact of the U.S. cuts.
“Had Pepfar been in place, we would have I think been the recipients of more Len doses, as it happens, we’re getting at least some from the Global Fund, but clearly we would have been able to receive both Global Fund as well as Pepfar support in this regard,” she said.
Currently the cost of Lenacapavir, made by U.S. pharmaceutical company Gilead, is prohibitive: about $28,000 per person a year in the U.S.
But generics are on the way after a deal to make them available to 120 low and middle-income countries, says Mullick. And sub-Saharan African countries are a priority.
“South Africa is also seeking local manufacturing capacity to improve regional access and reduce dependency on external supply,” she said.
The generic version of Lenacapavir is expected to become available in 2027 at a cost of around $40 per person per year.
“Clearly once the generics come online we’re very hopeful that the South African government will also be able to make a large contribution towards purchasing Len on a larger scale,” said Bekker.
Scientific modeling shows that if one to two million HIV-negative people take the shot between now and 2043, AIDS could cease to be a major public health problem in South Africa.
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