Lenacapavir rollout must go beyond policy to deliver real access, experts say
Lenacapavir has the potential to transform HIV prevention in South Africa, but experts say the breakthrough injection will only succeed if it is backed by a health system that is accessible, integrated and responsive to people’s realities.
Speaking during the Rural Health Advocacy Project webinar, Beyond Policy: Lenacapavir and Real Access to Sexual and Reproductive Health Services, public health experts said scientific innovation alone will not reduce new HIV infections unless long standing barriers such as stigma, poor access to healthcare and fragmented services are addressed.
Opening the discussion, the webinar introduced lenacapavir, a long-acting injectable HIV prevention medicine administered just twice a year. As South Africa begins rolling out lenacapavir, the discussion explored its potential to transform HIV prevention, particularly for rural communities that continue to face barriers such as transport costs, healthcare worker shortages and limited access to healthcare services.
Jacqueline Pienaar, a psychologist and public health specialist supporting the National Department of Health’s rollout of lenacapavir, said while South Africa has the infrastructure and experience to introduce the injectable prevention method, implementation remains the biggest challenge.
“We need to remember that having the infrastructure is not the same as being implementation-ready,” she said.
Pienaar argued that prevention services should be taken to communities rather than expecting healthy people to travel to clinics. She called for lenacapavir to be integrated into sexual and reproductive health services, allowing people to access HIV prevention alongside contraception, pregnancy care and other routine health services.
“The innovation here is not just the injection itself. It is how we choose to deliver it,” she said.
Dr Zoe Duby, Senior Scientist at the South African Medical Research Council, said adolescent girls, young women and pregnant and breastfeeding women remain among those at greatest risk of HIV infection. She said lenacapavir could reduce the burden of taking a daily prevention pill, but warned that it would not overcome deeper challenges such as stigma, misinformation, gender inequalities and unfriendly healthcare services. Success, she said, should be measured not only by the number of injections administered, but by whether people continue using HIV prevention during periods when they are most at risk.
Associate Professor Sakhumzi Mfecane from the University of the Western Cape said HIV prevention efforts cannot succeed without actively involving men. Drawing on his work in rural communities, he said many men only visit health facilities when they are seriously ill, making clinic based prevention strategies unlikely to reach them. Instead, programmes should be designed around the realities of people’s lives and communities, rather than expecting communities to adapt to interventions. “We need to meet men where they are,” he said, adding that men and women should have equal opportunities to access HIV prevention while recognising that some groups remain at greater risk of HIV infection.
The speakers agreed that lenacapavir presents an opportunity to rethink HIV prevention in South Africa. Rather than creating another standalone HIV programme, they said the rollout should strengthen person centred healthcare by expanding access, reducing stigma and ensuring prevention reaches the people who need it most.