South Africa Launches Revolutionary HIV Prevention Program Despite US Funding Cuts

Breaking New Ground in HIV Prevention

South Africa has launched a groundbreaking HIV prevention program using a twice-yearly injection that is nearly 100% effective at preventing the virus. On Friday, President Cyril Ramaphosa and Health Minister Aaron Motsoaledi stood before a crowd at Lilian Ngoyi Stadium in Secunda, Mpumalanga, and launched lenacapavir as a national HIV prevention programme. South Africa, home to roughly 8 million people living with HIV – the largest such population on earth – became the ninth African country to formally roll out the drug.

This revolutionary injection, known as lenacapavir, represents a potential game-changer in the global fight against HIV. Lenacapavir gives us something we have never had before in HIV prevention: a twice-yearly option that might be significantly easier to fit into people's lives. Scientific modeling suggests that if one to two million people receive the injection between now and 2043, AIDS could cease to be a major public health problem in South Africa.

The timing is critical. There are around 8 million people living with HIV in South Africa and every week around 1000 adolescent girls and young women become newly infected with HIV. The country faces particular challenges among young women, with more than 800 adolescent girls and young women aged 15-24 becoming infected with HIV every week.

Innovative Funding Model Emerges

The program's launch comes amid significant geopolitical tensions that have reshaped HIV funding in South Africa. Excluded from US lenacapavir supply and stripped of PEPFAR funding, South Africa launched the twice-yearly HIV prevention injection on Friday using Global Fund money and a generic licensing framework. Ramaphosa framed it as a declaration of health sovereignty.

The Global Fund redirected $29 million in existing allocations to provide approximately 500,000 person-years of lenacapavir access in 2026 and 2027 at a negotiated price of roughly $60 per person annually. The Children's Investment Fund Foundation contributed alongside government appropriations to assemble R1.3 billion for the rollout. Additionally, the South African government allocated R410 million over the medium term to offset research funding withdrawn by the United States.

China has stepped in to fill some gaps, announcing a two-year $3.49 million funding partnership to expand HIV services across South Africa. This diverse funding approach reflects South Africa's determination to maintain its HIV response despite international political pressures.

Overcoming Supply and Access Challenges

The rollout faces significant logistical hurdles. The health department plans to make the twice-a-year anti-HIV jab, lenacapavir, available at over 300 government clinics in health districts — with high rates of new HIV infections — between April 2026 and March 2028. For the first phase of its roll-out — between April 2026 and 2028 — the department will buy the branded version of lenacapavir, made by the pharmaceutical company Gilead Sciences, with R513-million ($29.2-million) from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The current supply covers only about 456,000 people over two years, far short of the one to two million people scientists believe need access to meaningfully impact the epidemic. Unitaid, in partnership with Wits RHI and the Gates Foundation, negotiated voluntary licenses from Gilead Sciences, the California-based manufacturer that produces lenacapavir under the brand name Sunlenca – where it retails in the United States for $42,250 per two-dose course. Under the license terms, generic versions from manufacturers in India, Egypt, and Pakistan are expected to reach the market by 2027 at approximately $40 per person annually.

A Model for Global Health Independence

South Africa's approach demonstrates how countries can navigate complex international funding landscapes while maintaining critical health programs. Domestic resources account for around 74% of South Africa's HIV response, which demonstrates the political will and commitment of the country's leadership to end the AIDS pandemic. This domestic commitment provides a foundation for weathering international funding disruptions.

The lenacapavir launch represents more than just a new medical intervention—it signals a shift toward health sovereignty and innovative partnership models. As generic versions become available and local manufacturing capabilities develop, South Africa is positioning itself to potentially supply not just its own needs but those of neighboring countries facing similar challenges.

The success of this program could provide a blueprint for other nations seeking to maintain essential health services while reducing dependence on volatile international funding streams. With proper implementation and adequate supply, lenacapavir could mark the beginning of the end of South Africa's HIV epidemic—and offer hope for similar transformations across the continent.