New HIV Prevention Jab in South Africa: How It Works and Access Points
A new six-monthly anti-HIV injection, known as lenacapavir (LEN), is now being rolled out across South Africa, offering long-acting protection against HIV infection for eligible individuals. The jab is currently available for free at 360 government clinics in six provinces, marking a major step in the country’s HIV prevention efforts.
The provinces where the injection is currently available include Gauteng, KwaZulu-Natal, the Eastern Cape, Mpumalanga, North West, and the Western Cape. The Northern Cape, Limpopo, and Free State are expected to receive supplies next year as production and rollout expand.
The Department of Health says the rollout is supported by international funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, with South Africa already receiving multiple shipments of the medication. These initial deliveries are being used to begin phased distribution through public health facilities.
What is the new HIV prevention jab?
Lenacapavir, commonly referred to as LEN, is a long-acting injectable medicine designed to prevent HIV infection in HIV-negative individuals. Unlike daily HIV prevention pills, the injection only needs to be taken twice a year, making it one of the most convenient prevention methods currently available.
The medicine works as a capsid inhibitor, targeting the protective shell of the HIV virus. By interfering with this structure, LEN prevents the virus from entering and infecting human CD4 cells, which are essential components of the immune system.
Once injected, the medicine forms a slow-release “depot” under the skin that gradually releases the drug over six months, maintaining continuous protection.
Is it a vaccine?
Despite its long-lasting protection, LEN is not an HIV vaccine. Unlike vaccines that train the immune system to recognise and fight infections permanently, LEN only works while the drug remains active in the body. This means users must continue receiving injections every six months to stay protected.
Experts compare its use to contraception: just as pregnancy prevention requires consistent use of birth control, HIV prevention with LEN requires regular dosing to maintain protection.
How effective is it?
Clinical studies show that lenacapavir offers extremely high protection against HIV infection when used correctly. Trials involving young women, gay and bisexual men, and transgender individuals showed a near-complete reduction in new infections among participants who received the injection as scheduled.
However, researchers note that no prevention method is 100% absolute, and rare breakthrough infections have been recorded in ongoing studies.
Who can use the injection?
To qualify for LEN, individuals must be HIV-negative and weigh at least 35 kilograms. Health experts also indicate that early data suggests the injection may be safe for pregnant and breastfeeding women, although ongoing monitoring continues.
However, LEN should not be used alongside certain medications, including:
- Tuberculosis treatment such as rifampicin
- Some anti-seizure medications like carbamazepine and phenytoin
- Herbal remedies such as St. John’s wort
Before receiving the injection, patients must undergo an HIV test each time to confirm they remain HIV-negative.
Where is it available in South Africa?
At present, LEN is available at 360 public healthcare clinics across six provinces. These clinics are part of the government’s early rollout phase, which focuses on prioritising high-risk areas and populations.
Patients cannot purchase the injection over the counter, and it is only available through prescribed public health services. It is not yet widely available in the private sector.
Health officials say private access may only become possible once generic versions of the medicine are approved and registered in the coming years.
How to get the jab at a clinic
To access LEN, individuals must visit a clinic offering HIV prevention services. At the clinic, healthcare workers will explain available prevention options and conduct an HIV test before administering the injection.
Patients are also given guidance on alternative prevention methods, including daily oral HIV prevention pills, allowing individuals to choose the option that best suits their lifestyle.
How the first dose works
The first dose of LEN is not a single injection. Instead, it is administered as two injections, followed by oral tablets over two days to ensure immediate protection begins building in the body.
Patients receive:
- Two injections on day one
- Two tablets taken at the clinic
- Two tablets taken at home the following day
This combination ensures adequate drug levels are reached quickly, with full protection developing within a few days.
Follow-up doses and timing
After the initial dose, users must return for a follow-up injection every six months. There is a short window of flexibility, but missing appointments may require restarting the initial dosing process, including tablets.
Health authorities stress the importance of maintaining regular appointments to ensure continuous protection.
What happens if you stop using it?
If someone stops taking LEN, the medication can remain in the body at low levels for up to a year. However, these levels are not sufficient to protect against HIV infection.
During this period, individuals are advised to use other prevention methods such as condoms or oral PrEP to avoid infection and reduce the risk of drug resistance.
A major step in HIV prevention
Health experts believe that widespread use of long-acting HIV prevention injections could significantly reduce new infections in South Africa. Modelling studies suggest that if enough people use LEN consistently, the country could dramatically lower HIV transmission rates in the coming decades.
However, supply limitations remain a challenge. Although hundreds of thousands of doses have been secured through international funding, experts say millions more will be needed over time to achieve national impact.
Government plans also include expanding local manufacturing and introducing generic versions of the drug in the coming years to improve affordability and availability.
Conclusion
The introduction of the six-monthly HIV prevention injection marks a major milestone in South Africa’s fight against HIV. While still in its early rollout phase, LEN offers a promising, long-term prevention option that could transform how HIV is managed in the country.
For now, eligible individuals are encouraged to visit participating clinics to learn more, get tested, and explore whether the injection is suitable for them.