The planned rollout of Lenacapavir – an injection used for pre-exposure prophylaxis (PrEP) to prevent HIV infection – by the department of health in early 2026 is not only a game-changer for prevention but will also enable couples to conceive and carry their babies safely. One of the key benefits of PrEP is that it can be safely used by HIV-negative partners in sero-different relationships (where one partner is HIV-positive and the other HIV-negative) to support safe conception and breastfeeding without transmitting the virus to their babies. According to the 2021 South African PrEP provision guidelines, PrEP is “the use of antiretroviral drugs by HIV-negative people before potential exposure to HIV to prevent the acquisition of HIV.” Both oral and injectable PrEP are safe to use during pregnancy and breastfeeding.
In sero-different relationships, PrEP is recommended as a safe conception strategy to protect the HIV-negative partner and prevent transmission to the child. PrEP can be applied in two main scenarios: Scenario one: An HIV-negative female with an HIV-positive male partner takes PrEP for safe conception and continues during pregnancy and breastfeeding while she remains at risk of HIV exposure. This aligns with pillar 1 of the Vertical Transmission Prevention (VTP) guidelines, which focus on the primary prevention of HIV transmission among women of childbearing age.
Scenario two: An HIV-negative male with an HIV-positive female partner takes PrEP for safe conception, while the HIV-positive female continues on antiretroviral therapy (ART) during pregnancy and breastfeeding to prevent vertical transmission. This aligns with pillar 3 of the VTP guidelines, which focuses on preventing vertical transmission. PrEP can also be used by couples who are both HIV-negative but are at high risk of contracting HIV.
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The introduction of Lenacapavir, a six-monthly injectable, supports the recommendations of the 2022 National Antenatal Care (ANC) HIV Sentinel Surveillance, which highlighted the need to strengthen HIV prevention efforts among HIV-negative women attending antenatal care. The surveillance study, conducted by the National Institute for Communicable Diseases (NICD), monitored HIV prevalence and estimated PrEP coverage among pregnant women (aged 15–49) attending 1,595 public antenatal clinics between February and April 2022. Secondary analysis of the 2022 ANC survey revealed that 31% of HIV-negative pregnant women were at substantial risk of HIV acquisition.
Among them, 4% reported having an HIV-positive partner, while 68% did not know their partner’s HIV status. PrEP remains an essential HIV-prevention tool for women with HIV-positive partners or those who don’t know the HIV status of their partners.
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