The groundbreaking results of a recent study have raised hopes for the end of AIDS in South Africa by 2032. The study, conducted by a team led by Linda-Gail Bekker, head of the Desmond Tutu Health Foundation in South Africa, focused on the use of lenacapavir, a revolutionary anti-HIV shot taken every six months. The results were nothing short of astonishing – not a single teen girl or young woman who used lenacapavir contracted HIV.
Lenacapavir works by inhibiting the replication of the HIV virus, preventing it from entering immune cells and spreading throughout the body. This breakthrough has immense implications for the fight against HIV, particularly among the most vulnerable populations in East and Southern Africa – teen girls and young women aged 15 to 24 years old. These groups have the highest risk of contracting the virus, with approximately 122 new infections occurring each day in South Africa alone.
The potential impact of lenacapavir on slowing down new HIV infections in this high-risk population is significant. The results of the study have sparked hope that, with widespread access to this drug, the spread of HIV could be dramatically reduced, ultimately leading to the end of AIDS in South Africa by 2032.
However, amidst this groundbreaking discovery, challenges loom large on the horizon. The recent decision by the US Congress not to reauthorize the American government’s AIDS fund, Pepfar, has cast a shadow over the future of HIV treatment and prevention efforts globally. The absence of reauthorization means that the funds earmarked for HIV treatment and prevention are no longer guaranteed to be allocated as before, leaving the fate of critical programs uncertain.
The Trump administration’s policies on foreign aid have further complicated the situation, with delays and uncertainties surrounding the disbursement of funds to implementing partners. The looming threat of a freeze on Pepfar prevention funding could have devastating consequences for global HIV prevention efforts, jeopardizing the progress made thus far.
As the world grapples with the dual challenges of groundbreaking scientific advancements and political uncertainties, the fate of HIV prevention and treatment hangs in the balance. The potential of lenacapavir to end AIDS in South Africa by 2032 offers a glimmer of hope, but the road ahead is fraught with obstacles that must be navigated with urgency and determination.
Approximately four out of every 10 new HIV infections in the country are among adolescents, despite the fact that they make up only about 8% of the total population. This alarming statistic underscores the urgent need for effective prevention strategies targeted at this vulnerable group.
Recent studies presented at the Croi conference have shown promising results for lenacapavir, a new medication for HIV prevention. Research conducted by Katherine Gill revealed that lenacapavir works as well in 16 and 17-year-olds as it does in young women between 18 and 25 years old. This data is crucial for medicines regulators to consider registering lenacapavir for use in adolescents.
Another study on lenacapavir as pre-exposure prophylaxis (PrEP) showed that the medication is almost as effective for gay and bisexual men, as well as transgender individuals, as it is for young women. These findings have led to a significant development in HIV prevention efforts.
Following these positive results, Pepfar and the Global Fund for Aids, TB, and Malaria have signed a product supply deal with Gilead Sciences, the manufacturer of lenacapavir, to purchase enough of the drug for two million people over the next three years. This initiative aims to distribute the medication in countries supported by these donors, including South Africa.
Challenges in Funding and Implementation
Despite the progress made in securing the drug supply, there are challenges ahead. The recent changes in US government funding policies have raised concerns about the future of HIV prevention projects. The decision to limit funding for PrEP to pregnant and breastfeeding women could exclude key populations at higher risk of HIV infection.
Experts warn that this approach is unscientific and could hinder efforts to reduce new infections among vulnerable groups such as transgender women, gay and bisexual men, injecting drug users, sex workers, and non-pregnant young African women. The need for inclusive and comprehensive prevention strategies is crucial in the fight against HIV.
While the Global Fund remains committed to the lenacapavir deal, the funding cuts from the US government may require other stakeholders to step in and support the initiative. The South African government, along with philanthropic foundations, may need to contribute to ensure the availability of the medication for those in need.
Next Steps in Approval and Cost Considerations
Despite the funding challenges, the approval process for lenacapavir is progressing. The drug is expected to receive approval for HIV prevention in the United States by June 19, with a recommendation from the World Health Organization shortly thereafter. South Africa’s application is part of a joint review process involving the European Medicines Agency, the WHO, and the South African Health Products Regulatory Authority.
Cost considerations for lenacapavir remain a key factor in the implementation of HIV prevention programs. A modeling study presented at the Croi conference suggests that the medication would be cost-effective for South Africa if sold at a price range of $117 to $225 per person per year. Further analysis and review by the National Essential Medicines List Committee are needed to determine the actual cost-effectiveness of lenacapavir in the country.
As the fight against HIV continues, the availability and affordability of innovative prevention strategies like lenacapavir will be critical in reducing new infections and improving the health outcomes of vulnerable populations.
Could Lenacapavir Revolutionize HIV Prevention?
As of the end of 2024, South Africa has seen a significant uptake of the daily HIV prevention pill, known as oral PrEP, with approximately 1.78 million HIV-negative individuals having used it at least once. This makes it the largest programme of its kind in the world, with about 70% of users being women between the ages of 15 and 34.
While the daily pill has proven effective in reducing the risk of HIV infection when taken consistently, studies have shown that adherence can be challenging for many individuals, especially young women. Additionally, many users do not continue taking oral PrEP for an extended period.
This is where lenacapavir comes into play. This long-acting injectable medication offers a more convenient dosing schedule, with injections needed only every six months compared to daily pills. A recent study comparing lenacapavir to daily pills found that many young women, particularly those aged 16 to 17, preferred the injectable form due to its “worry-free” and discreet nature.
One participant expressed their preference for lenacapavir, stating, “Taking pills every day…sometimes there is that one day you will forget. So, the six-month intervals are not a problem…I will only go twice in a year for the PrEP injection and after that I will be free.”
The Potential Impact of Lenacapavir on HIV Incidence
A cost-effectiveness analysis presented at Croi suggests that widespread use of lenacapavir could significantly reduce new HIV infections in South Africa over the next 20 years. By providing between one and four injections to each eligible individual, the medication could decrease new infections by 27–41%, potentially ending the HIV epidemic as a public health threat by 2032, a decade earlier than previously projected.
Ending the HIV epidemic as a public health threat means reaching a point where the number of new infections is lower than the number of individuals dying from HIV-related causes. In 2024, South Africa recorded approximately 178,000 new infections and 105,000 HIV-related deaths.
To achieve this goal, between two and four million HIV-negative individuals would need to receive lenacapavir injections annually over the next eight years. This ambitious target could significantly impact the trajectory of the HIV epidemic in the country.
The Future of HIV Prevention in South Africa
As international funding for HIV prevention programmes in East and Southern Africa faces uncertainty, the future of biomedical prevention hangs in the balance. The potential discontinuation of PrEP programmes could have dire consequences, with many at-risk individuals losing access to crucial prevention tools.
Bhekisisa spoke with experts who expressed concerns about the potential impact of funding cuts on HIV prevention efforts. The importance of continued government support for HIV prevention, including the introduction of innovative medications like lenacapavir, was emphasized as a crucial step towards ending the HIV epidemic.
As South Africa navigates the challenges of HIV prevention and treatment, the role of innovative medications like lenacapavir could play a significant role in reshaping the country’s approach to HIV prevention and ultimately ending the epidemic.
This article was produced by the Bhekisisa Centre for Health Journalism. Subscribe to their newsletter for more updates on health-related news.
The sun was setting over the horizon, casting a warm golden glow over the landscape. The air was filled with the sound of birds chirping and the gentle rustling of leaves in the breeze. It was a peaceful evening, perfect for a leisurely stroll through the countryside.
As I walked along the winding path, I couldn’t help but marvel at the beauty of nature all around me. The fields were a vibrant green, dotted with colorful wildflowers swaying in the wind. The trees stood tall and proud, their branches reaching up towards the sky. And in the distance, I could see the silhouettes of rolling hills, bathed in the last rays of the sun.
I took a deep breath, inhaling the fresh, crisp air. It was invigorating, filling me with a sense of calm and contentment. I felt at one with the world around me, connected to the earth and all its wonders.
As I continued my walk, I came across a babbling brook, its clear waters glistening in the fading light. I sat down on a nearby rock and closed my eyes, listening to the soothing sounds of the water as it flowed over the smooth stones. It was a moment of pure serenity, a chance to escape the hustle and bustle of everyday life and simply be in the present moment.
As the sun dipped below the horizon, painting the sky in shades of orange and pink, I felt a sense of gratitude wash over me. Gratitude for the beauty of the natural world, for the peace and tranquility it offered, and for the opportunity to experience it all firsthand.
And as I made my way back home, the stars began to twinkle in the night sky, a reminder of the vastness and wonder of the universe. I felt small and insignificant in comparison, but also a part of something much greater than myself.
As I settled in for the night, I knew that I would always cherish this evening walk through the countryside. It was a reminder of the simple joys and profound beauty that surrounded me every day, if only I took the time to notice. And I made a promise to myself to make more time for moments like these, to connect with nature and find peace in its embrace.
