Kegoratile Aphane did not flinch as the needle pierced her skin, delivering a bright yellow drug hailed as a potential game-changer in the fight against HIV. The 32-year-old became one of the first South Africans — and among the first Africans — to receive lenacapavir, an injection administered twice a year that reduces the risk of HIV transmission by over 99.9 percent, making it functionally similar to a highly effective vaccine.
“I didn’t even feel any pain,” she said with a relieved smile after receiving the two injections that constitute the initial dose.
On Tuesday, five other patients also received lenacapavir at a clinic near Pretoria, as part of an implementation study conducted by the Wits University Reproductive Health and HIV Institute (RHI) and funded by Unitaid, an international health agency promoting equitable access to medical innovations. The study will enrol 2,000 participants and follow them for at least a year to evaluate real-world effectiveness, according to RHI researcher Saiqa Mullick.
A Life-Changing Option
South Africa bears one of the world’s heaviest HIV burdens, with nearly one in five adults living with the virus and 170,000 new infections recorded last year — the highest of any country. Until now, the main prevention option for HIV-negative individuals was a daily oral pill, which posed adherence challenges.
The twice-yearly lenacapavir injection promises to be “life-changing,” said clinic manager Magdaline Ngwato, particularly for young people, sex workers, and LGBTQ individuals seeking discreet protection.
“Now with the injection, it will be fine because you can do it secretly,” Ngwato explained. “Even mothers said they will send their children to come get it. I think we are going to see a lot of HIV-free generations.”
For Aphane, the decision was deeply personal.
“I lost my mom in 2021; she was HIV positive,” she shared. “It’s a very, very painful disease. That’s why I am serious about being safe and trying this.”
Twenty-year-old student Katlego, speaking under a pseudonym, echoed that sentiment. “You never know what the future holds. You might be exposed without knowing. So it’s important to take care of ourselves,” she said.
Looking Ahead
A broader national rollout is planned for next year, starting with 400,000 doses supplied through a deal between Gilead Sciences, the drug’s manufacturer, and the Global Fund to Fight AIDS.
While lenacapavir currently costs around $28,000 annually in the United States, generic versions are expected from 2027 at approximately $40 per year in over 100 countries, thanks to agreements facilitated by Unitaid and the Gates Foundation with Indian pharmaceutical companies.
“This rollout could transform the future for my daughters and grandchildren,” Aphane said. “The more it’s introduced, the more people talk about it, and the more it’s visible everywhere, the more lives it will save.”
