HIV PREVENTION3 AUG 2026#Aids2026: Bhekisisa analysed SA’s first LEN roll-out data. Here’s what it foundSouth Africa accounts for over half of all lenacapavir (LEN) users in Africa, with health department data revealing…Mia MalanLinda PretoriusKaren Harkema11 min read

South Africa has more than half of all Africans using the world’s newest HIV prevention injection. But the real story lies beyond the headline numbers. Bhekisisa analysed the health department’s first six weeks of roll-out data to reveal who’s choosing LEN, whether it’s bringing new people onto HIV prevention and if the country has enough doses to keep up with demand Just over half of everyone in Africa using the once-every-six-month HIV prevention injection, lenacapavir (LEN), through national roll-out programmes lives in South Africa.

Health department data presented at South Africa’s exhibition booth at the International Aids Conference in Rio de Janeiro on Tuesday shows 31 297 of the continent’s roughly 60 000 LEN users are in South Africa. The health department started rolling outthe jab at 360 government clinics — about 8% of South Africa’s public clinics — across six provinces on 5 June. Since then, 98.5% of HIV-negative people offered a choice between a daily HIV prevention pill and LEN have chosen the twice-yearly injection.

Just over two-thirds of South Africa’s LEN users are in Gauteng and KwaZulu-Natal, the two provinces with the most clinics offering the injection (129 in Gauteng and 94 in KwaZulu-Natal).Together, the provinces are home to almost half of South Africa’s population. Health Minister Aaron Motsoaledi toldBhekisisahis department had worried that people might be reluctant to use the injection because some associate jabs with Covid vaccines. “After the Covid pandemic, there was vaccine hesitancy and some people confuse LEN with a vaccine,” he says.

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“But our data tells us South Africans are realising lenacapavir’s value.” LEN is not a vaccine.It’s a medicine for HIV-negative people that prevents HIV by stopping the virus from entering the body’s cells. One injection protects someone for six months, after which they need a follow-up jab to stay protected. Ten African countriesare rolling out the jab with funding from the Global Fund to Fight Aids, Tuberculosis and Malaria and the United States government.

Some,including Zambia and Eswatini, started as early as November and are seeing up to 85% of users returning on time for their second injection, country representatives reported at a conference session. People need to return for their follow-up injectionwithin two weeks from the date of their six-month appointment. If they miss that window, they have to take four lenacapavir tablets — two on the day of the injection and two the next day — alongside the jab, just as first-time users do.

The tablets make sure there is enough medicine in the body to protect against HIV within three days. Studies have shown that LEN provided complete protectionagainst HIV for young women in clinical trials and near-perfect protection for other groups, including gay and bisexual men and transgender people, who have a higher chance of getting HIV than the general population. Because South Africa started rolling out LEN only on 5 June, the first users will be due for their second injections on 6 December.

The health department therefore doesn’t yet know how many people will return for their follow-up shots. But early results fromLEN4PrEP, an implementation study led by Wits RHI that started in November, show that, of the relatively small number of participants who should have returned for their second injection, 85% have come back on time for their follow-up dose. The study is being conducted at two Tshwane government clinics and a mobile clinic that serves the surrounding communities.

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