Our anti-HIV jab will be rolled out in six weeks. But

South Africa stands at a critical juncture in its HIV prevention strategy. The country is preparing to roll out lenacapavir (LEN), a groundbreaking injectable HIV prevention therapy administered every six months, within weeks—yet faces a significant threat from reduced US funding that could undermine the entire initiative.

Lenacapavir represents a paradigm shift in HIV prevention. Unlike daily oral PrEP (pre-exposure prophylaxis), the injectable formulation offers superior adherence prospects and has demonstrated near-perfect efficacy in clinical trials. For a nation where HIV prevalence remains among the world's highest, this technology promised to reach populations where traditional prevention methods have struggled: sex workers, young people, gay and bisexual men, and transgender communities most vulnerable to infection.

## How Will US Funding Cuts Impact Rollout Plans?

A new research report based on in-depth interviews with healthcare providers, peer counsellors, and frontline workers in Cape Town and Johannesburg reveals the harsh reality: lenacapavir deployment will be "heavily affected" by the Trump administration's funding reductions to South Africa. The timing could not be worse. The country's Department of Health had positioned LEN as a cornerstone of its revised HIV strategy, targeting high-burden populations with culturally informed delivery mechanisms.

The funding cuts ripple through multiple channels. Direct reductions in PEPFAR (President's Emergency Plan for AIDS Relief) support undermine procurement capacity, training infrastructure, and community health worker programmes essential for equitable distribution. South Africa cannot absorb these gaps through domestic budgets alone—the country's health sector remains constrained by competing demands and limited fiscal space.

Researchers documented how health workers anticipated bottlenecks: supply chain disruptions, inability to establish injection sites in vulnerable communities, and reduced capacity for the counselling and monitoring that lenacapavir requires. A sex worker in Johannesburg noted the cruel irony—the drug exists, rollout timelines are set, yet external funding shocks could postpone access by months or years.

## Which Communities Face the Greatest Risk?

The populations most likely to benefit from lenacapavir face the greatest jeopardy. Young people (15-24) in high-transmission areas, particularly in KwaZulu-Natal and Gauteng, depend heavily on donor-supported prevention programmes. Sex workers and LGBTQ+ communities, already marginalised in healthcare access, risk being deprioritised in a resource-constrained rollout. This creates a perverse outcome: those with highest epidemiological need receive lowest protection.

South Africa's health department must now navigate impossible choices. Prioritisation frameworks that were inclusive may contract to urban centres and wealthier provinces. Mobile clinics serving townships may operate at reduced frequency. Training programmes for community health workers could stall, leaving distribution infrastructure incomplete.

The broader investment case deteriorates. Pharmaceutical companies eyeing African markets assess policy stability and funding reliability. A rollout failure damages South Africa's reputation as a progressive public health innovator and may discourage future HIV innovation investment across the continent.

---

#