South Africa: Activists Call for Greater Access to Newly-Launched HIV Prevention Drug

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South African President Cyril Ramaphosa and Health Minister Aaron Motsoaledi at the official launch of the new injectable drug for HIV prevention, Lenacapavir. Credit: GCIS

BRATISLAVA, Jun 9 2026 (IPS) - As South Africa officially launches the rollout of a groundbreaking HIV prevention drug,  civic groups in the country have slammed the plan, saying it will not reach anywhere near enough people.

President Cyril Ramaphosa on June 5 launched the roll-out in South Africa of lenacapavir, a twice-yearly injectable HIV pre-exposure prophylaxis (PrEP) drug that has been shown to offer almost complete protection against the disease, billing it as a ‘historic event’.

But activists say there is nothing to celebrate, warning the targets set in the rollout are too low, and the volumes of the drug provided by the pharma firm behind its development, Gilead, are tiny.

“In an ideal world, South Africa would not be rolling out lenacapavir as a small pilot. We would be treating it as an epidemic-ending intervention. The objective should be to get millions of people onto lenacapavir as quickly as possible, not a few hundred thousand over several years,” Tian Johnson, founder and strategist of the Pan-African health justice advocacy group, African Alliance, told IPS.

“South Africa has the world’s largest HIV epidemic. We also helped generate the scientific evidence that made lenacapavir possible. An appropriate response would therefore be a national scale-up plan linked to epidemiological need, not constrained by artificial scarcity created by patent monopolies, donor allocations, and supply decisions made outside the country,” he added.

South Africa has the world’s highest burden of HIV, with around 8 million people living with HIV. In 2024 it recorded 170,000 new infections, accounting for roughly 13% of the 1.3 million new cases globally that year.

Lenacapavir has been shown in trials to provide almost complete protection against HIV acquisition. It has been praised not just for its effectiveness but also for its potential for very high adherence, as it is an injection given only every six months.

Civic groups say that if rolled out in a timely manner and with greater volumes, it could avert up to 52,200 new infections per year in South Africa alone.

They also point to modelling which has shown that around 2 million people in South Africa need to be taking lenacapavir annually for it to have a real impact on the number of new HIV infections.

But the government’s rollout is expected to reach only around 450,000 people over the next two years. Moreover, only just under 38,000 doses have so far arrived in the country.

Activists blame adversarial US policy and effective monopolies on the drug’s supply for this and say it has highlighted concerns over who has real control over efforts to end the epidemic in the country.

The Global Fund to Fight Aids, TB and Malaria (GF) and the United States President’s Emergency Plan for Aids Relief (PEPFAR) have historically been central to funding South Africa’s HIV response.

But days after Donald Trump entered the White House early last year, PEPFAR slashed around half of its funding for HIV in South Africa – what is left of it is due to run out this month.

So far, the Trump administration is refusing to fund lenacapavir for South Africa as the two countries lock horns politically and ideologically.

This means that the doses to be used in South Africa over the next 18 months to two years will be funded by the Global Fund and are expected to be only sufficient for 456,000 people.

Meanwhile, since Gilead is currently the only manufacturer of lenacapavir and generics are not available on the market yet, there is no alternative path available to secure more doses for the rollout.

Currently the cost of Lenacapavir is about USD 28,000 per person a year in the U.S., but Gilead has issued six licences to companies to manufacture generics, which will be available to 120 low- and middle-income countries. These are expected to become available in 2027, potentially for as little as USD 40 per person per year.

Earlier this year , it was announced the South African government was working to identify a local company to manufacture lenacapavir. Once identified, that company would then be recommended to Gilead for a voluntary licence to produce the drug.

In 2024, Gilead granted such licences to six generic manufacturers across India, Egypt and Pakistan to produce and supply the drug ⁠to 120 low- and middle-income countries. At the time, critics pointed out that no South African ​drugmakers were included.

Gilead has said it is open to adding another licence for local manufacturing in Sub-Saharan Africa. But activists warn that any final decision on a licence will rest with the company.…