180 000 infections in 2024, 47 000 by 2045 — if SA rolls out the twice-a-year HIV prevention jab fast enough

South Africa’s first batch of the once-every-six-months HIV prevention shot, lenacapavir (LEN) —paid for with the country’s grant from the Global Fund to Fight Aids, TB and Malaria— will arrive soon, the health department says, although it’s slightly delayed. Government roll-out is set to start in government clinics within the next couple of months, depending on when the first batch of medicine arrives and by when samples of the first batch have been quality-tested to ensure safe and effective medicine will be distributed. Results published in 2024showed that the twice-a-year injection is almost perfect in stopping someone from getting infected with HIV through sex, leading to it being hailed as“the closest thing to a vaccine”.

(LEN is not a vaccine; rather, it’spreventive medicine, which works for only as long as someone takes it). Ending Aids means new HIV infections, which were around 180 000 in 2024, would have to drop to 65 000 a year, Jamiesonhas calculated,tobring down the rate of new infections, called the incidence rate, from thecurrent 0.32%to 0.1%. From next year, the health department will probablystart buying genericsto add to the branded Global Fund donations and pay for them from its own pocket, with a price tag ofaround $40 a year(about R640 at the current exchange rate).

Exactly when generics will be bought depends on when the manufacturers will have them ready and by when the products will be registered in South Africa. In a recent development, the South African National Aids Council, in collaboration with four government departments, alsoannounced that they were working with Gileadand local pharmaceutical companies to obtain generic licences to make LEN locally. LEN made in South Africa could be available as soon as next year, which will help companies that do get licences from Gilead to master manufacturing processes, says Unitaid.

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Countries will have to make smart decisions, he says. And LEN could be that opportunity. But to make sure the country doesn’t “miss this moment”, says Warren, the government would have to dig deep into its pocketbook for enough extra doses and campaigns that convince people to use it over the coming years to drive LEN’s roll-out.

Exactly how deep would the health department have to dig though and for how much bang? We take a look at what health economists’ modelling predicts.

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