Why do women make up 71% of South Africa’s new lenacapavir users? - IOL

Lenacapavir, a six-monthly HIV prevention injection, arrives in South Africa, offering renewed hope to high-risk communities and marking a major milestone in the fight against HIV.

Over 55,000 people have started using lenacapavir, South Africa’s twice-yearly HIV prevention injection, since its national launch in June, and women account for almost three-quarters of those receiving it.

The Department of Health said 55,123 people had been initiated on the jab by September 7, with a total of 71% of recipients being female.

According to the department, most of the women receiving the injection are pregnant and breastfeeding mothers.

Lenacapavir, which is administered twice a year as pre-exposure prophylaxis (PrEP), was launched nationally by President Cyril Ramaphosa and Health Minister Dr Aaron Motsoaledi on June 5.

It is now available through 360 public health facilities across 24 districts in six provinces.

The gender split may be partially linked to the groups that have been prioritised during the rollout.

Before the national launch, South Africa had identified adolescent girls and young women, as well as pregnant and breastfeeding women, among the populations that should be reached with lenacapavir.

Unitaid, which has supported early work around the rollout, quoted Health Minister Motsoaledi as saying South Africa wanted to make lenacapavir available to populations at higher risk of HIV infection, particularly adolescent girls, young women and pregnant and breastfeeding women.

Pregnancy and the period after giving birth are important points at which women can be offered HIV prevention.

There is also growing evidence supporting the use of long-acting HIV prevention options during pregnancy and breastfeeding.

Research presented at the 2025 International AIDS Society conference found that lenacapavir and another injectable PrEP option, cabotegravir, were safe and well tolerated in pregnancy and breastfeeding, supporting their use as HIV prevention options for people at risk.

Another factor is the way lenacapavir is administered.

Instead of taking an HIV prevention tablet every day, which can be time-consuming or lead people to skip a day, people receiving lenacapavir receive an injection twice a year.

The World Health Organization recommends lenacapavir as an additional HIV prevention choice, saying that offering different PrEP options can help people choose a method that suits their preferences and potentially increase effective use of HIV prevention.

For people who find taking a daily tablet difficult, a twice-yearly injection provides an alternative.

That does not mean lenacapavir is replacing other forms of PrEP. The Department of Health has stressed that it is being introduced as part of a PrEP-choice programme, alongside other HIV prevention options.

The emphasis on women also reflects the country's HIV prevention challenges.

UNAIDS reported following South Africa's June launch that women and girls accounted for 59% of new HIV infections in the country in 2024, with adolescent girls and young women aged 15 to 24 accounting for more than 71,000 of those infections.

That helps explain why young women have been identified as an important group for the introduction of long-acting PrEP.

Gauteng has recorded the largest number of lenacapavir initiations, with 26,357 people receiving the prevention injection by September 7.

It is followed by KwaZulu-Natal with 11,941, North West with 4,479, Western Cape with 4,446, Mpumalanga with 4,294 and Eastern Cape with 3,606.

The Department of Health said it was continuing to monitor uptake, medicine availability, quality of service delivery, client follow-up and safety as the programme expands.

The World Health Organization has welcomed South Africa's rollout, describing it as an important milestone in expanding people-centred HIV prevention options.