More than 55,000 people have started using South Africa’s new twice-yearly HIV prevention injection in just three months, offering an early indication of strong demand for longer-acting HIV prevention options.
In a statement released ealier this week, the Department of Health said that 55,123 people had been initiated on lenacapavir as of September 7, just over three months after the national programme was launched by President Cyril Ramaphosa and Health Minister Dr Aaron Motsoaledi on June 5.
The rollout has been taking place at 360 public health facilities across 24 districts in six provinces. The department describing the uptake as evidence of “strong demand” for the long-acting HIV prevention option.
Lenacapavir is administered twice a year as pre-exposure prophylaxis (PrEP), meaning people can receive protection against HIV without having to take a daily prevention pill.
Gauteng accounts for almost half of initiations
Gauteng has recorded by far the highest number of initiations, with 26,357 people having started lenacapavir.
It was followed by: KwaZulu-Natal with 11,941, North West with 4,479, Western Cape with 4,446, Mpumalanga with 4,294 and Eastern Cape with 3,606
The figures mean Gauteng alone accounts for almost half of all reported initiations across the six provinces.
Women make up the majority of recipients, with the Department of Health reporting that 71% of those initiated are female, mostly pregnant and breastfeeding mothers.
The department said it continues to work with provincial health departments, healthcare workers and implementing partners to monitor uptake, availability of commodities, quality of services, follow-up and safety.
From launch to tens of thousands of users
The speed of the rollout is notable because South Africa only officially launched its national lenacapavir programme in June.
At the launch, Ramaphosa said 360 public facilities across six provinces and 24 high-burden districts were ready to provide the injection. Government set an ambition of reaching close to one million people by the end of 2027, with a longer-term target of reaching three million people over three years.
With more than 55,000 people already initiated, the programme has reached about 5.5% of the one-million-person target in its first three months.
The current pace, however, should not be treated as a straight-line forecast for future uptake. The programme is still in its early phase, and expansion, demand, supply and service capacity can all affect how quickly the number grows.
Why is lenacapavir different?
The biggest change for users is the frequency of prevention.
Rather than taking PrEP tablets every day, lenacapavir is administered twice a year. The World Health Organization recommends it as an additional HIV prevention choice, alongside combination prevention approaches.
WHO says offering more PrEP choices can increase uptake because people can choose a prevention method that suits their preferences and circumstances.
The organisation has described lenacapavir as the first twice-yearly injectable PrEP product and highlighted its potential to address barriers associated with daily pills, including adherence, stigma and access to healthcare.
The drug’s introduction in South Africa has also attracted international attention. Following the national launch, WHO praised South Africa for moving from policy to implementation and described the rollout as an important milestone in the country’s HIV response.
SA was among the early adopters
South Africa’s rollout came after the country included lenacapavir on its National Essential Medicines List and after the South African Health Products Regulatory Authority (SAHPRA) approved it.
WHO reported in December 2025 that SAHPRA had become the first African regulatory authority to approve lenacapavir, following the medicine’s regulatory review.
The Department of Health’s own clinical review also considered evidence from the PURPOSE-1 and PURPOSE-2 trials. The PURPOSE-1 trial involved adolescent girls and young women, while PURPOSE-2 included men and gender-diverse people. The department’s review found a large reduction in new HIV infections with lenacapavir compared with daily oral PrEP in the available trial evidence.
What the 55,000 figure tells us
It is important to note that the 55,123 initiations do not mean that 55,123 people have been newly protected from HIV infections, nor do they by themselves demonstrate how many new infections the programme will prevent.
What the figure does show is the speed at which the new prevention option has been taken up through the public health system.
In a little more than three months, tens of thousands of people have already started a prevention method that requires only two injections a year.
The demographic breakdown is also significant: with women accounting for 71% of initiations and pregnant and breastfeeding mothers making up most of that group, early uptake is concentrated among women accessing maternal and other public health services.
The Department of Health says it will continue monitoring uptake, medicine availability, service quality, follow-up and safety as the rollout progresses.
For now, 55,123 initiations in roughly three months suggest that South Africans are making use of a new HIV prevention choice at considerable speed.
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