A new era in HIV prevention is on the horizon with the advent of Lenacapavir, a groundbreaking, long-acting antiretroviral drug poised to dramatically reshape the global response to the epidemic, particularly in high-burden countries like South Africa.

Delivered via an injection only twice a year, this treatment offers an unprecedented six months of continuous protection per dose, a significant departure from the current regimen of daily oral pills or bi-monthly injections.

Remarkable efficacy and simplified prevention

Lenacapavir’s potential to simplify adherence and supercharge prevention efforts is underpinned by its remarkable efficacy demonstrated in clinical trials:

• Women: One key trial reported 100% efficacy in preventing HIV infection within the study period.
• Men who have Sex with Men and Transgender Women: Another trial among these key populations showed an efficacy of approximately 96%.

This biannual injectable format could be the answer to one of the biggest challenges in HIV prevention: adherence.

Getting individuals to consistently adhere to prevention options, such as daily oral pre-exposure prophylaxis (PrEP), has historically been a major barrier.

By requiring only two injections a year, Lenacapavir has the potential to overcome this issue, making consistent, long-term protection significantly more accessible.

A critical tool for South Africa

South Africa continues to carry the highest burden of HIV globally, with an estimated 8 million People Living with HIV (PLHIV).

Despite an impressive combination prevention approach which includes comprehensive education, HIV testing, condom distribution, male medical circumcision, and the initiation of over 2 million people on oral PrEP the country still saw approximately 149,000 new HIV acquisitions in 2023.

Worryingly, adolescent girls and young women, along with other key populations, continue to bear a disproportionate burden of these new infections, often due to factors like low condom use and inconsistent adherence to oral PrEP.

Lenacapavir offers a powerful, simplified solution that could dramatically reduce new infections in these vulnerable groups.

Modelling a future free of AIDS

Mathematical modelling underscores the transformative potential of this new drug in the South African context. The projections are ambitious:

“If 2 to 4 million people use Lenacapavir over 12 to 24 months, South Africa could reduce new HIV infections to below 0.1% by 2032.”

This would achieve epidemic control ten years earlier than currently expected.

Lenacapavir has the power to fundamentally change the trajectory of the epidemic, helping to unlock a future where HIV is no longer a public health threat and finally bringing to life the national goal of reaching an AIDS-free generation by 2030.

The convenience and effectiveness of this twice-yearly injection offer a renewed sense of hope in the persistent global fight against HIV.