South Africa’s health minister hails new HIV prevention jab but warns of limited supply

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JOHANNESBURG (AP) — South Africa’s health minister on Tuesday called lenacapavir, the first twice-yearly HIV prevention jab in the world, a “groundbreaking” tool to fight the disease, but warned initial donated supply would be limited to nearly half a million people in the African country with the highest prevalence rate.

This comes just weeks after the U.S. announced plans to buy 2 million doses of the HIV prevention drug for low-income countries.

The initial supply in South Africa is set to begin in April 2026, funded by a $29.2 million Global Fund grant with an additional $5 million allocated by the Networking HIV and AIDS Community of Southern Africa (NACOSA).

Addressing a national healthcare roundtable dialogue in Johannesburg, Minister Aaron Motsoaledi said the Global Funds’ catalytic commitment will deliver around 456,000 lenacapavir initiations over two years, translating into 912,000 doses.

“We plan to roll out lenacapavir initially in about 23 high-incident districts across six provinces, targeting around 360 high-performing public clinics within these areas for phase one implementation,” said the minister.

“About half a million people will be able to begin using lenacapavir, and thanks to this support, but demand will likely outstrip supply at first,” said Motsoaledi, highlighting that research data suggested that prioritizing vulnerable populations in high-burden districts first would result in the highest impact in terms of new infections prevented.

The minister was quick to caution against complacency with the initial investment after South Africa’s health system was significantly hit by the abrupt cuts to funding from USAID and other U.S. government sources in early 2025. These cuts have had a severe impact on HIV/AIDS and tuberculosis (TB) treatment, prevention, and research programs across the country.

Although Motsoaledi expressed gratitude that Gilead had lowered the price from the $28,000, initially touted to $40, per person annually, he said that South Africa aimed to fund its program independently, with long-term funding hinging on lenacapavir’s integration into local systems, such as the essential medicines list.

The World Health Organization in July recommended the six-month HIV prevention jab that’s already approved in the U.S. and Europe, as an additional prevention choice as part of combination approaches. Gilead is expediting registration in 18 high-incidence countries, including South Africa, to deliver lenacapavir until generic versions become available in 2027.

Early in October, Gilead Sciences announced it had executed voluntary, non-exclusive, royalty-free license contracts with six pharmaceutical companies in Egypt, Pakistan, and India to produce and market generic lenacapavir. Despite participating in the clinical trials for the drug in recent years, South African companies were excluded from Gilead Sciences’ voluntary licensing, which has infuriated civil society.

“This is not the principle of ubuntu,” said Sheila Mbele-Khama, in reference to the South African philosophy that values principles such as human dignity and fairness.

Mbele-Khama, speaking on behalf of the South African National Aids Council (SANAC), claimed during the roundtable that one out of every four new HIV infections took place in the 26 nations that Gilead didn’t give licenses to. “You can’t come in the house to ask us to allow you to learn and then you run away, you no longer include us”.

According to Wendy Cupido, country manager for Gilead, the South African manufacturers that were evaluated in 2024 did not satisfy the technical specifications for the production of sterile injectables at that time. She said, though, that Gilead was still willing to look at further voluntary licensing if a South African manufacturer could develop the required capabilities and meet quality standards.

Welcoming the over $34 million in investment into the rollout, UNAIDS South Africa country director Eva Kiwango said at a time when foreign assistance funding cuts could lead to an additional 6 million HIV infections globally by 2029, long-acting injectable medicines were a “fresh option for all people at risk,”.

“It is not a cure or a vaccine, but it could be a game changer if made accessible to all who could benefit,” said Kiwango. “For many, lenacapavir expands choice, strengthens agency, and reduces barriers linked to stigma, disclosure, or daily adherence.”

The roundtable is a two-day event that will conclude on Wednesday.

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