JOHANNESBURG (FN) — South Africa will begin rolling out a groundbreaking HIV prevention injection in 2026—but only a fraction of those in need will get it, while local manufacturers and communities accuse pharmaceutical giant Gilead of sidelining them in the global race to fight the disease.
Health Minister Aaron Motsoaledi on Tuesday praised lenacapavir, the world’s first twice-yearly HIV prevention jab, as a “milestone” for the country hardest hit by HIV. Yet, he also acknowledged that just 456,000 people will receive it during the first two years—barely scratching the surface of the nearly 8 million South Africans living with HIV.
The rollout will be funded by a 29.2 million Dollars grant from the Global Fund and a further 5 million Dollars from NACOSA, a local HIV/AIDS advocacy group. But even before the first dose is given, criticism is mounting over the limited access, exclusion of local pharmaceutical companies from licensing deals, and foreign control over supply chains.
“About half a million people will be able to begin using lenacapavir, thanks to this support—but demand will likely outstrip supply at first,” said Motsoaledi. He noted that data shows targeting vulnerable populations in high-burden districts will prevent the most infections, but civil society groups argue it shouldn’t come down to triage.
The minister also issued a warning: foreign aid cannot be relied on forever. Early 2025 cuts by USAID and other U.S. government programs severely damaged South Africa’s HIV and TB response. “We can’t afford to depend on inconsistent donors,” Motsoaledi said. “We need control over our own health destiny.”
That control, critics argue, is being undermined by Gilead Sciences’ licensing decisions. Despite South Africa hosting clinical trials for lenacapavir, no local drugmakers were included in the company’s voluntary manufacturing licenses granted to firms in Egypt, Pakistan, and India.
“This is not the principle of ubuntu,” said Sheila Mbele-Khama of the South African National AIDS Council. “You came here, you used our data, our bodies, and now you exclude us? That’s exploitation, not partnership.” She added that a quarter of new HIV infections occur in countries barred from making generics.
Gilead’s South African director, Wendy Cupido, defended the company’s decision, stating that local manufacturers lacked the technical capacity to produce sterile injectables. She added that Gilead remains open to further licensing if quality standards are met—but activists say that answer rings hollow in the context of a health emergency.
Meanwhile, the price drop from 28,000 thousand Dollars to 40 Dollars per person per year for the Global South has done little to quell frustration. Critics argue that what looks like corporate benevolence is actually strategic image management, especially after the U.S. government secured 2 million doses for poorer nations—a move some see as an attempt to repair damaged diplomatic trust.
UNAIDS South Africa director Eva Kiwango welcomed the 34 million Dollars investment but emphasized that without immediate access and local control, lenacapavir’s potential could be lost. “This is not a cure, but it could be a revolution in prevention,” she said. “Only if everyone—not just the privileged few—can access it.”
