A Shot of Hope: What the New HIV Prevention Injection Could Mean for Young People and Vulnerable Populations in South Africa

For many young people in South Africa, particularly Black women and LGBTQ+ youth, HIV is more than just a health risk. It is a social injustice rooted in inequality, stigma, and limited access to trusted, youth-friendly healthcare. While oral pre-exposure prophylaxis (PrEP) has been an important prevention tool, daily adherence can be difficult, if not impossible, for those facing discrimination, unstable living conditions, or lack of privacy.

But a new injectable option is offering fresh hope. Lenacapavir, a long-acting antiretroviral drug, was recently approved in the United States for HIV prevention. If made widely available in South Africa, it could be a game-changer, especially for young people who have historically been left behind by the healthcare system.

What Is Lenacapavir and Why Is It Different?

Lenacapavir is a twice–yearly injection designed to prevent HIV infection. It works by interfering with the virus’s ability to replicate in the body. This makes it a promising form of PrEP, offering long-term protection without the need for daily pills or monthly visits.

The World Health Organisation has endorsed lenacapavir as a major breakthrough and urged pharmaceutical companies to lower its cost to ensure affordability for vulnerable populations. In the recent Purpose 1 trial, which included South African participants, lenacapavir showed 100% efficacy in preventing HIV among women aged 16 to 26. In the Purpose 2 trial, it showed 96% efficacy among LGBTQ+ participants.

Why Daily PrEP Is Not Always Practical

While oral PrEP has been a vital option, it does not work for everyone. Stigma, privacy concerns, and life pressures often get in the way.

As Nolethu Ndude, activist and founder of WeMattah, explains:

“Daily pills pose logistical and psychological burdens. Discovery of pills can lead to accusations of infidelity. Real-world effectiveness drops because people simply struggle to take them every day.”

For many, clinic visits for refills clash with work or school schedules. Gender-diverse youth also face the risk of misgendering or discrimination at public clinics, adding to the reasons why they might avoid healthcare spaces altogether.

A Shot That Could Shift Power

Unlike pills, lenacapavir offers privacy, reliability, and autonomy. One injection every six months, often discreetly administered alongside contraceptive care, removes the daily burden of remembering or hiding medication.

Ndude highlights its transformative potential:

“A six-month injection restores autonomy. It eliminates the need for partner approval, and it’s discreet. That’s power, especially for young women and queer youth navigating stigma or unsafe environments.”

Pontsho Pilane, journalist, activist, and author, agrees.

“Lenacapavir could completely shift the HIV prevention landscape, especially for young women, adolescent girls, sex workers and others who face stigma in accessing or using oral prevention. A discreet injection offers privacy, autonomy, and choice, which at its core is progress and feminist.”

HIV in South Africa: The Ongoing Struggle

Despite progress over the last two decades, South Africa still faces one of the world’s highest HIV burdens. According to UNAIDS, young women aged 15 to 24 are three times more likely to be infected than their male peers. LGBTQ+ people, particularly gay men and transgender individuals, also face heightened risk due to structural inequalities.

Carol Lennon, a nurse and outreach worker at Triangle Project, says much of the problem is societal silence.

“HIV is almost 99% preventable, but we don’t speak to the youth about it. Medications like lenacapavir are life-saving. But when research funding ends, our people are often left behind, especially queer communities, who’ve been guinea pigs in HIV trials.”

Access Does Not Always Mean Accessibility

Getting lenacapavir approved in South Africa is just the first step. Making it truly accessible to those who need it most will require targeted policy, community engagement, and investment.

Ndude stresses that structural challenges must be addressed:

“Availability is not the same as accessibility. We need mobile and community-led services that integrate with sexual and reproductive healthcare, like offering contraception and PrEP in the same visit. We must also train providers in LGBTQ+ competent care and tackle myths like ‘PrEP causes infertility’.”

Cost is another major concern. Ndude calls for generic licensing and tiered pricing, as well as support for local production to avoid donor dependency.

“This is an opportunity to decolonise access. African countries like South Africa can lead, not just as testing grounds, but as producers and decision-makers.”

What Needs to Happen Next?

If implemented with care, lenacapavir could radically improve the lives of young people most at risk of HIV. But rollout must be grounded in rights-based, community-driven approaches. Pilane reminds us:

“Scientific approval is critical, but trust and uptake are equally important. We need to engage meaningfully with the people who’ll use these products.”

That means involving youth, sex workers, queer communities, and people living with HIV in policy development, not as afterthoughts, but as partners.

As Ndude puts it:

“Nothing about us without us.”

A Moment of Possibility

Lenacapavir is not just a new medical tool. It is an opportunity to rethink how South Africa approaches HIV prevention. It offers a chance to challenge stigma, centre marginalised voices, and finally make good on the promise of health for all.

But that will only happen if government, pharmaceutical companies, civil society, and communities work together to ensure access, education, and dignity for every young person, no matter who they are or where they live.

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About the Author:

Nadine Dirks is a communications consultant, writer, and intersectional feminist advocate with over a decade of experience in sexual and reproductive health and rights, gender justice, and diversity, equity, and inclusion. Author of Hot Water, she is pursuing her Master’s in Women and Gender Studies at the University of the Western Cape.