---
title: "Lenacapavir rollout a major HIV milestone but the real test is keeping people protected"
description: "South Africa’s new HIV-prevention medicine offers considerable hope, but we must follow what happens to the people who receive it for maximum benefit."
type: "OpinionNewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "Opinionistas"
author: "Colleen Aldous"
author_url: "https://www.dailymaverick.co.za/author/colleen-aldous/"
canonical_url: "https://www.dailymaverick.co.za/opinionista/2026-09-15-lenacapavir-rollout-a-major-hiv-milestone-but-the-real-test-is-keeping-people-protected/"
published: "2026-09-15T20:01:59"
lang: "en-ZA"
word_count: 1117
---

# Lenacapavir rollout a major HIV milestone but the real test is keeping people protected

> South Africa’s new HIV-prevention medicine offers considerable hope, but we must follow what happens to the people who receive it for maximum benefit.

By Colleen Aldous · Published 15 September 2026, 22:01 SAST

## Content

Lenacapavir is a long-acting medicine that helps prevent HIV infection in people who do not have the virus.

Given as injections under the skin every six months, with tablets taken at the start, it blocks a protein HIV needs to multiply. It offers an alternative to taking a daily HIV-prevention pill, although regular HIV testing and returning for the next dose remain essential.

When someone leaves a clinic after receiving their first dose of lenacapavir, they have taken an important step towards protecting themselves against HIV. Whether that protection continues depends on what happens next. Can they return when the next dose is due? Will the clinic have stock? Will someone help if they develop a worrying symptom? These questions should shape how South Africa judges its rollout.

By 7 September 2026, the Department of Health reported that more than 55,000 people had started the twice-yearly medicine at 360 public facilities in six provinces. That is great progress, but counting people who start a medicine doesn’t tell us anything about how many remain protected over time.

Our ebullience about this rollout has a sound scientific basis. Two large studies, Purpose 1 and Purpose 2, showed that lenacapavir can prevent HIV extremely well. Both Purpose studies compared lenacapavir injections given every six months with daily HIV-prevention tablets. Purpose 1 had three groups, testing the injection against two different tablet options, while Purpose 2 had two groups, testing it against one tablet option. Everyone received an active prevention medicine.

### Matching placebo tablets

Participants also received matching placebo tablets or injections to help keep them unaware of which medicine they were receiving.Understanding what they found also helps explain what the rollout still needs to demonstrate.

Purpose 1 involved adolescent girls and young women in South Africa and Uganda. At the study’s main analysis, none of the 2,134 participants receiving lenacapavir had acquired HIV. Infections did occur in the groups offered daily prevention tablets.

This finding understandably attracted headlines about “100% protection”. It means no infections were recorded in the injection group during the period analysed. It cannot promise that every person receiving the medicine will remain protected under all circumstances.

Purpose 2 studied men and gender-diverse people in seven countries, including South Africa. Two of the 2,179 people receiving lenacapavir acquired HIV, compared with nine of the 1,086 offered daily prevention tablets. Allowing for the different group sizes and time followed, the injection group’s infection rate was 89% lower.

The often-quoted 96% reduction from that study uses a different comparison. Researchers estimated how frequently HIV would occur without any prevention medicine. They did not deliberately leave a randomly selected group unprotected. Participants were assigned by chance to receive either the injection or prevention tablets.

Together, these findings provide strong grounds for offering lenacapavir. They also show why having a choice matters. Daily prevention tablets, commonly called PrEP, work well when taken as prescribed. But some participants in Purpose 1 struggled to take them consistently. A medicine given every six months can ease that burden. The trials support that advantage, they do not show that prevention tablets have stopped working.

The studies’ duration also needs explaining. In the main safety assessment, the middle point of the time participants had received lenacapavir was 43 weeks in Purpose 1 and 39 weeks in Purpose 2. This is roughly nine to 10 months, with some followed for shorter periods and others longer.

### Strong results

Both studies produced such strong results that independent monitoring committees recommended ending the stage in which participants did not know which medicine they were receiving. Participants were then offered lenacapavir openly.

Follow-up could continue, but the original comparison had ended. This was a response to convincing evidence of benefit. It also means those comparisons cannot answer every question about several years of use. Rarer side effects, continued attendance and longer-term outcomes still need to be tracked as access expands.

Safety information should be equally understandable. The trials found no major overall safety concern. Pain, swelling or lumps where the injections were given were common, although most reactions were mild or moderate. Few people stopped because of them.

Some lumps lasted many months. Headache and nausea were also reported. People deserve to know what to expect and where to seek help. A symptom that is manageable medically may still influence whether someone returns.

VigiAccess, the WHO’s public database of adverse events, dated 30 August 2026 contained 1,121 reports involving lenacapavir. These included pain, lumps, discharge and swelling at injection sites, as well as nausea and other symptoms. These reports help identify problems that may need investigation.

They do not prove that the medicine caused each event. Nor can they tell us how common a problem is, because the database does not provide the total number of people who used the medicine. Lenacapavir is also used to treat HIV, so these reports cannot simply be assigned to South Africa’s prevention rollout.

The few infections in Purpose 2 also underline the importance of HIV testing. In both people who acquired HIV while receiving lenacapavir during the main analysis, researchers found a change in the virus associated with resistance to the medicine. Anyone who acquires HIV needs prompt assessment and effective treatment. What, then, should the next government update tell us?

### Second doses

As second doses become due, we need to know how many people receive them on time. For those who stop, the reasons matter. Someone who chooses another prevention method has a different experience from someone turned away because a clinic has run out of stock. We also need to know who is being reached.

The department reports that 71% of recipients are female, describing many as pregnant or breastfeeding. Contact with maternity services may make access easier. The same figures leave questions about people who seldom attend clinics. Pregnancy findings from Purpose 1 are reassuring, but the number of exposed pregnancies was too small to rule out uncommon problems. Following mothers and babies remains important.

And who will pay for continued protection? The initial roughly $29-million Global Fund allocation came from an existing grant. Using that money for lenacapavir means considering what else it would have funded. The government needs a clear plan for future doses, testing, staff and safety monitoring.

The trials give South Africa good reason to act. The rollout must now show that people can continue receiving protection, get help when needed and access the medicine regardless of where they live.

The person leaving the clinic after a first dose should be able to trust that the next stage of their care has already been planned. **DM**

*Colleen Aldous is a clinical scientist, healthcare researcher and professor in the School of Clinical Medicine at the University of KwaZulu-Natal.*