By JD GLOBAL MEDIA
South Africa’s rollout of lenacapavir, a long-acting medicine that can prevent HIV infection, is facing a challenge that goes beyond medical effectiveness: ensuring that people who could benefit from it know the medicine exists, understand how it works and can access it through appropriate healthcare services.
An analysis published by TimesLIVE on 9 October 2026 highlights lessons from South Africa’s earlier experience with oral pre-exposure prophylaxis, commonly known as PrEP. Although daily HIV-prevention pills have been available through the public health system for several years, awareness and uptake have remained far below the number of people who could potentially benefit.
Lenacapavir, often referred to as LEN, offers a different approach. It is a long-acting injectable HIV-prevention medicine administered twice a year, making it an important additional option for HIV-negative people who want protection against acquiring the virus.
South Africa began rolling out the injection at 360 government clinics in June 2026. Health Department figures cited in the analysis showed that just over 71,000 people had received LEN by 5 October.
The early uptake demonstrates that people are beginning to access the new prevention option. However, the figures also raise questions about how quickly the programme can reach more people, especially when the population that could potentially benefit is much larger.
Researchers from Wits University’s Health Economics and Epidemiology Research Office have argued that South Africa needs to learn from its experience with daily prevention pills. Their findings suggest that making a medicine available for free does not automatically mean that people will know about it, feel comfortable using it or attend a clinic to obtain it.
The challenge for health authorities is to combine the availability of an effective prevention medicine with clear communication, accessible services and approaches that respond to the needs of different communities.
What Is Lenacapavir And How Does It Prevent HIV?
Lenacapavir is an antiretroviral medicine that works by targeting the HIV capsid, a protein structure that plays an important role in the virus’s life cycle.
When used for HIV prevention in eligible HIV-negative people, it can substantially reduce the risk of acquiring HIV. Its long-acting formulation allows it to be administered at intervals rather than requiring a daily tablet.
The twice-yearly schedule is particularly important for people who find daily medication difficult to maintain. Taking a pill every day can involve reminders, privacy concerns, travel, changes in routine and the need to collect repeat prescriptions. An injectable option may reduce some of those practical burdens.
Lenacapavir is not a vaccine, and it does not provide a permanent guarantee against HIV infection. People need to follow the recommended clinical schedule and receive appropriate healthcare guidance.
Before starting HIV prevention medication, a person must be assessed by a qualified healthcare professional, including testing to establish HIV status. Follow-up appointments and testing are important because prevention medicines are intended for people who are HIV-negative, and a person who acquires HIV needs appropriate treatment rather than prevention medication alone.
The medicine is also not a treatment that cures an existing HIV infection. People living with HIV require appropriate antiretroviral treatment and ongoing clinical care.
For eligible people, LEN adds another option to the existing range of HIV-prevention measures. These can include oral PrEP, condoms, regular HIV testing and other strategies chosen according to individual circumstances and clinical advice.
The availability of multiple prevention options matters because no single approach will suit everyone. Some people may prefer a daily tablet, while others may find a long-acting injection more practical.
The purpose of expanding the range of options is to help more people obtain protection that fits their needs and circumstances.
South Africa Has Started The Rollout, But Uptake Remains An Issue
South Africa’s introduction of LEN at 360 government clinics represents an important step in bringing long-acting HIV prevention into public healthcare.
The initial rollout gives eligible people access to an option that can reduce the need for daily dosing. It also provides health authorities with an opportunity to learn how the medicine is received by patients and how delivery systems can be strengthened before any broader expansion.
However, the figures cited in the October analysis show that uptake remains limited relative to the potential population that could benefit.
By 5 October, just over 71,000 people had received LEN, according to Department of Health figures referenced in the report. That is a measure of early use, not a complete assessment of the programme’s long-term performance.
The number alone does not show how many eligible people have heard of the medicine, how many have been assessed for suitability, how many have been offered it or how many have chosen another prevention option.
Those distinctions matter when evaluating a new public-health programme. A low number of recipients can reflect limited awareness, geographic barriers, appointment availability, supply constraints, personal preferences or other factors. The available figures do not establish that any one explanation accounts for the entire gap.
Health authorities will need detailed information on each stage of the process to determine where additional effort is most needed.
For example, if many people are unaware of LEN, public information and community engagement may be priorities. If people know about it but cannot reach participating clinics, service availability and referral arrangements may require attention. If patients begin the programme but struggle to return for follow-up, clinics may need stronger appointment and reminder systems.
The rollout should therefore be evaluated not only by how many injections have been administered but also by whether eligible people can obtain the medicine, return at the required intervals and make informed decisions about their prevention choices.
Lessons From Daily HIV Prevention Pills
South Africa’s experience with oral PrEP offers a warning about the difference between making a medicine available and ensuring that people use it.
The TimesLIVE analysis cites Department of Health figures showing that approximately 2.3 million people had ever used oral HIV-prevention pills by June 2026. This is a cumulative figure for people who had taken the medication at least once, rather than a measure of how many people were using it consistently at that time.
The number is significant, but it remains far below the estimated population that could potentially benefit from HIV prevention.
The analysis also references a 2022 national survey in which only about one-third of sexually active South Africans older than 15 said they had heard of oral PrEP.
That finding suggests that awareness has been an important barrier. A person cannot make an informed decision about a prevention option if they do not know it exists or misunderstand what it does.
The experience also demonstrates that a medicine’s clinical effectiveness is only one part of its public-health impact. To reduce infections at population level, prevention services must reach people who need them and support them in using the option they choose.
Daily pills may be difficult for some people because taking medication regularly can be challenging. Others may worry that someone will discover they are using HIV-prevention medication and make assumptions about their sexual behaviour. Some may face difficulties reaching clinics or obtaining repeat supplies.
These challenges can affect people differently according to their circumstances, age, location, relationships and access to healthcare.
A long-acting injection may help address some barriers, but it will not automatically solve all of them. People still need information, confidential services, suitable appointments and follow-up care.
South Africa’s experience with oral PrEP therefore provides an important lesson for LEN: the introduction of a new product must be accompanied by a deliberate plan to explain it, make it accessible and build confidence in its use.
Why Awareness Campaigns Matter
The analysis draws on research involving projects funded by the Gates Foundation in 2022 to test approaches for informing young people about oral HIV prevention.
The projects explored different ways of reaching potential users, including community radio, printed materials, social media, community outreach and peer education. Researchers interviewed more than 1,000 young people who were beginning HIV-prevention medication for the first time.
The findings were used to examine how people first heard about prevention pills and what influenced their decision to start using them.
This type of research is valuable because it moves the discussion beyond the assumption that one large national campaign will reach everyone equally. Different communities may receive information through different channels, and people may need more than one opportunity to understand a new medicine before deciding whether it is right for them.
For example, a radio message may introduce the existence of a prevention option, while a discussion with a trusted healthcare worker can address questions about eligibility, side effects and follow-up. Community organisations may help reach people who have limited contact with formal healthcare services, while digital platforms may be useful for people who prefer to seek information privately.
The most effective combination will depend on the audience, local conditions and the quality of the information being delivered.
Campaigns also need to avoid creating unrealistic expectations. Lenacapavir is a powerful prevention option, but it does not eliminate the need for clinical assessment, follow-up and other relevant sexual-health services.
Communication should explain what the medicine can do, who may be eligible, how often it is administered and where people can obtain reliable advice.
Information should also make clear that seeking HIV prevention is a responsible healthcare decision. People should not be stigmatised or treated as though asking about PrEP reveals their HIV status or personal behaviour.
Young People Need Accurate, Accessible Information
Young people are an important audience for HIV-prevention services, but they are not a single group with identical needs.
Some may be comfortable discussing sexual health with healthcare professionals, while others may worry about privacy, judgement or whether their questions will be taken seriously. Some may have easy access to clinics, while others face transport, cost or scheduling barriers.
Accurate information can help people understand that HIV prevention is relevant to anyone who may be exposed to the virus and that different options are available.
Healthcare workers need to be able to explain the differences between daily oral PrEP and long-acting injectable prevention without pressuring patients towards a particular choice.
For some individuals, a daily pill may be convenient and familiar. For others, a twice-yearly injection may fit their circumstances better. Decisions should be made through informed discussion with qualified healthcare providers, taking account of clinical suitability and the person’s preferences.
Confidentiality is also essential. Young people may be more willing to seek information if they trust that their questions and medical records will be handled appropriately.
Health services should provide clear explanations of the rules governing consent, confidentiality and access for younger patients. These requirements must be applied in accordance with South African law and relevant clinical guidance.
A prevention programme cannot depend solely on young people taking the initiative to ask about a medicine they may never have heard of. Schools, community organisations, clinics and public-health campaigns can all help make accurate information easier to find, while respecting privacy and avoiding stigma.
The Role Of Clinics In Building Trust
Government clinics are central to South Africa’s LEN rollout because they provide the setting for assessment, administration and follow-up.
A person considering injectable prevention needs more than a brief announcement that the medicine is available. They need an opportunity to ask questions, understand the benefits and limitations, discuss any relevant health considerations and decide whether the option suits them.
Healthcare workers also need sufficient training and clear procedures to deliver the medicine safely and consistently.
Clinic readiness includes appropriate stock management, appointment systems, testing arrangements, documentation and the ability to provide follow-up. Staff should be able to explain when the next dose is due and what a patient should do if they miss an appointment or have concerns after receiving the injection.
The service must also respect patients who decide that another prevention option is more suitable. A programme that treats one product as the only acceptable choice could discourage people who would otherwise benefit from a different approach.
Trust is strengthened when patients receive clear information and are treated respectfully, regardless of whether they accept the injection immediately.
The number of clinics participating in the initial rollout is only one measure of access. Authorities must also consider where those facilities are located, how far people need to travel and whether the clinics can accommodate demand.
The available reporting does not provide a complete national assessment of clinic waiting times, stock availability or the distribution of patients across the 360 participating sites. Those details will be important for understanding whether the service is accessible to people in different provinces and communities.
The Importance Of Privacy And Stigma Reduction
HIV prevention has long been affected by stigma, misinformation and assumptions about who might need protection.
Some people may hesitate to ask for PrEP because they fear that others will interpret the request as evidence of an HIV infection or particular sexual behaviour. Others may be concerned about being seen entering a clinic or collecting medication.
Long-acting prevention may offer some privacy advantages for people who do not want to manage daily tablets. However, an injection still requires contact with a healthcare service and follow-up at the appropriate intervals.
Services should therefore be designed to protect confidentiality and make conversations about prevention routine rather than exceptional.
Healthcare professionals can help by presenting PrEP as one part of ordinary preventive healthcare, explaining eligibility without judgement and ensuring that patients understand how their information will be handled.
Public communication also matters. Campaigns that rely on fear or moral judgement can discourage people from seeking services. Clear, respectful messages are more likely to help individuals understand the options available to them.
Reducing stigma does not mean ignoring the seriousness of HIV. It means recognising that people are more likely to engage with prevention and testing when they can do so without unnecessary shame or discrimination.
For LEN to reach more people, public-health communication must explain the medicine while helping create an environment in which asking about HIV prevention is accepted as a normal part of healthcare.
Measuring Success Beyond The Number Of Injections
The initial uptake figure provides a starting point for evaluating South Africa’s rollout, but a complete assessment will require a broader set of indicators.
Authorities need to understand how many people are aware of LEN, how many are eligible, how many are offered the medicine and how many decide to start it. They also need to know whether people return for subsequent doses and whether services are reaching communities that have historically faced barriers to HIV prevention.
These measures can help distinguish between an awareness problem and a service-delivery problem.
For instance, strong awareness combined with low clinic attendance may indicate that other obstacles are preventing people from obtaining the medicine. Low awareness may suggest that information is not reaching intended audiences. Difficulty returning for follow-up could indicate the need for better appointment arrangements or reminders.
Monitoring should also consider whether people are able to make informed choices among available prevention options. The goal is not simply to maximise injections, but to ensure that people who could benefit can access appropriate prevention and use it according to clinical guidance.
Programme data must be collected and used in ways that protect privacy. Sensitive health information should not be exposed unnecessarily, and reporting should avoid identifying individuals or small groups.
Evaluation also needs to account for the fact that the programme is still in its early stages. Initial figures can show whether delivery has begun, but they cannot by themselves establish long-term effects on HIV incidence or the overall cost-effectiveness of the programme.
As more evidence becomes available, health authorities and researchers will be better placed to determine which communication strategies, service arrangements and delivery models work most effectively.
Access And Affordability Will Shape The Future
The initial availability of LEN through selected government clinics gives eligible people a route to access the medicine within the public health system. Broader availability, however, depends on decisions about procurement, supply, funding, service capacity and the timing of future expansion.
The October analysis notes that wider availability of generic versions is expected to become possible in 2027. The scale and timing of any expansion will depend on the relevant regulatory, procurement and implementation arrangements.
Generic competition can be important for affordability, particularly when governments are seeking to extend a medicine to large populations. However, the availability of generic products does not automatically mean that every facility will immediately have stock or that every eligible person will be able to access treatment without delay.
The cost of a medicine is only one part of the delivery equation. Programmes also need funding for clinic visits, testing, staff, distribution, information systems and follow-up.
If demand rises rapidly, health authorities must ensure that supplies and services can support the increase. If awareness campaigns succeed but clinics cannot provide appointments or maintain reliable stocks, people may become frustrated and lose confidence in the programme.
Planning must therefore link communication with delivery capacity. Public messages should accurately describe where services are available and what people can expect when they seek care.
For communities distant from participating clinics, transport and travel time may remain significant barriers. Authorities may need to assess whether additional facilities or other delivery arrangements could improve access while maintaining appropriate clinical standards.
What This Means For South Africa’s HIV Response
South Africa continues to face a major public-health challenge from HIV, and prevention remains an essential part of reducing new infections.
Lenacapavir adds an important option because its long-acting schedule may suit people who struggle with daily medication or prefer a different form of prevention. But the medicine’s potential impact will depend on more than its biological effectiveness.
People must know that the option exists, understand how it works and be able to access it through services they trust. Healthcare workers need the resources and training to provide it properly, while public-health authorities must monitor whether the rollout is reaching the people who could benefit.
The experience with oral PrEP shows why these factors matter. Availability alone did not ensure widespread awareness or use, and the same challenge could affect injectable prevention if communication and access are not prioritised.
South Africa’s initial rollout at 360 government clinics provides a foundation, but the figures reported in early October show that there is still considerable work ahead if the medicine is to reach a much larger eligible population.
The next phase will require a combination of evidence-based communication, respectful healthcare, reliable supply and clear monitoring of access and outcomes. It will also require continued efforts to reduce stigma and ensure that people can discuss prevention without fear of judgement.
Lenacapavir offers a significant new opportunity in HIV prevention. Whether that opportunity translates into a substantial public-health benefit will depend on the ability of South Africa’s healthcare system to connect the medicine with the people who need it.
JD GLOBAL MEDIA
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