The anti-HIV jab that Buhle Sikade trusts — free soon for 456,000 South Africans

For the past three years, Buhle Sikade, 22, has been using an injection – called lenacapavir (LEN) – that gives her almost foolproof protection against getting HIV through sex. About 456,000 other HIV-negative people in SA will be able to get the medicine from 360 government clinics for free from 1 April.

LEN is taken once every six months and injected into the fat under the skin on someone’s tummy.

Sikade moved from Willowvale in the rural Eastern Cape to Masiphumelele, a township near Kommetjie in the Western Cape, in 2016. She and her brother came to stay with her aunt to look for jobs and “better opportunities”.

It was in Masiphumelele, where one in four adults has HIV, that Sikade heard about a study for young HIV-negative women like her, which would test if LEN would keep them HIV-negative.

She joined the trial, Purpose 1, which kicked off in 2022, from the start. When the results of the study were announced in 2024 – not a single one of the 2,134 women who got LEN contracted HIV – she continued to use it, because the company which makes LEN will supply it free to all study participants who need it until the medicine becomes available free in state clinics on 1 April.

These clinics will stock free supplies of LEN.

The health department told Bhekisisa the country’s first LEN shipment, funded by the Global Fund to Fight Aids, TB and Malaria, will arrive in mid-February, after which samples will be quality-tested by our medicines regulator. Stock will be dispatched to depots and clinics to be ready for the country’s launch in April.

Why take LEN

Sikade decided to join Purpose 1 because her age group – women between 15 and 24 years – puts her at a high chance of getting HIV.

Around a third of SA’s just over 400 daily new infections in 2024 were among women in this age group, even though they make up only about 8% of the total population.

Teen girls and young women’s chances of getting HIV are high because their bodies are still growing and the tissue inside their vaginas and cervixes is still soft and thin, making it easier for HIV to pass through.

Because of poverty, young women also often end up in relationships with older men, who may have the money to help them cover theirs or their family’s living costs. In such relationships they rarely have the power to ask their boyfriends to use condoms or to be in monogamous relationships.

But, says Sikade, who is now a life skills counsellor helping children to make good choices, there’s also a high chance of getting raped in Masiphumelele — and contracting HIV that way.

Because rape is a violent act, the tissue in someone’s vagina or anus often tears, making it easier for HIV to enter a person’s system, increasing their chances of getting HIV if the perpetrator is HIV-positive.

And that’s where the protective power of LEN lies.

A ‘chemical condom’

“It’s like a powerful ‘chemical condom’,” explains Linda-Gail Bekker, who heads up the Desmond Tutu Health Foundation, and is the chief scientist for the ongoing Purpose 1 study.

“Unlike latex condoms,” Bekker says, “LEN doesn’t require a user to negotiate for permission from their sexual partners to use, and only has to be taken twice a year, as opposed to each time they have sex.”

How LEN works

So far, Sikade has had six doses – two per year. Each dose consists of two injections, because the LEN solution required is too much to fit into one syringe.

When Sikade got her jabs for the first time, she also had to take four pills – two on the day she got the jabs, two on the next day. That way, there was enough LEN in her body for full protection by the third day.

LEN works over time – it releases slowly into someone’s body over six months, that’s why a shot is only needed twice a year.

Modelling scientists from the Health Economics and Epidemiology Research Office at Wits University have calculated that if enough people – between one and two million per year – take LEN just once, new infections would decline fast enough so that SA can end Aids as a public health threat by 2043.

Ending it as a public health threat would mean fewer people are getting newly infected with HIV than the number of people with HIV who are dying, increasingly for other reasons than HIV, for example, old age. DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.