South Africa launched a national public health rollout of lenacapavir, the twice-yearly injectable medication for HIV prevention known commercially as Sunlenca, in 2026, in what health officials described as a landmark moment in the country’s long struggle against a disease that has devastated South African society since the AIDS epidemic emerged in the late 1980s. South Africa has the world’s largest HIV-positive population – approximately 7.8 million people – and despite significant progress in expanding antiretroviral treatment access over the past two decades, new HIV infections have continued at a rate that public health experts say makes elimination goals unachievable without new prevention tools that overcome the adherence challenges of daily oral pre-exposure prophylaxis. Lenacapavir, which requires only two injections per year, was shown in the landmark PURPOSE 1 trial in sub-Saharan African women to provide 100 percent efficacy in preventing HIV infection – a result that stunned the HIV research community and that South Africa’s health authorities determined warranted the fastest possible path to public deployment.

The South African lenacapavir rollout in 2026 follows the drug’s approval by the South African Health Products Regulatory Authority and the negotiation of an access agreement with Gilead Sciences, the US pharmaceutical company that developed the drug, that provides for generic manufacturing licenses to several suppliers in low- and middle-income countries to allow production at prices that make broad public deployment financially sustainable. The rollout faces logistical challenges: lenacapavir must be administered by a healthcare worker rather than self-administered like daily oral PrEP, which creates a requirement for clinic visits twice yearly that may pose access barriers for populations in rural areas with limited healthcare infrastructure. South Africa’s public healthcare system, strained by decades of under-investment, brain drain of medical personnel, and the ongoing burden of treating its large HIV-positive population with antiretrovirals, must scale up its injection administration capacity and community healthcare worker networks to reach the populations at highest HIV risk who are most likely to benefit from a twice-yearly rather than daily prevention regimen. The public health stakes are high: if lenacapavir can be deployed at sufficient scale to reach the populations driving new HIV infections – adolescent girls and young women, men who have sex with men, sex workers – the trajectory of South Africa’s epidemic could change fundamentally in ways that more than a decade of daily oral PrEP deployment has not achieved. South Africa’s role in hosting African tourism and its position as Africa’s most developed healthcare system makes it a natural first mover for continent-wide lenacapavir rollout strategies.