SECUNDA, South Africa (AP) — Growing up witnessing the devastating effects of HIV in her family and community in South Africa pushed Olwam Plaatjie to start using preventive HIV medications three years ago.
“Sometimes they’d lose weight, they would get sick and have to go to the clinic, and I didn’t want that for me,” she told The Associated Press. “I’d see the people I live with taking (antiretroviral) pills for HIV every day, and I knew I wouldn’t be able to handle that life.”
The 19-year-old is one of thousands of South Africans who signed up for clinical trials of lenacapavir, a highly effective, twice-yearly injectable prevention drug that addresses the drawbacks of daily oral prevention pills.
Despite night sweats and other side effects, she is continuing with the medication after South Africa this month became one of the world’s first countries to introduce it.
President Cyril Ramaphosa told a stadium crowd at the launch of the drug’s rollout that lenacapavir is a “turning point” in South Africa, which carries the highest burden of HIV globally.
But health advocates say the country deserves many more doses after South Africa’s central role in the work that brought the promising drug to the world.
South Africa has over 8 million people living with the virus. It is hoped that lenacapavir will help curb new infections in the country, which range from 140,000 to 170,000 annually.
“If South Africa can deliver it equitably and at scale, it could make a meaningful contribution to reducing new HIV infections,” said Leila Mansoor, a senior scientist at the University of KwaZulu-Natal’s Center for the AIDS Program of Research in South Africa.
Clinical trials in South Africa and Uganda evaluated the efficacy of lenacapavir, which was developed by Gilead Sciences. A crucial study in Johannesburg concluded that a six-month injection demonstrated 100% effectiveness in protecting against HIV.
“It was a groundbreaking finding,” said Dr. Nkosi Ndlovu, senior clinician at the research institute Wits RHI.
Now South Africa’s government has acquired doses sufficient to cover 456,000 people for a year, funded by a $29 million Global Fund grant. After that, Health Minister Aaron Motsoaledi said South Africa aims to fund its program independently, with help from donors.
Some South African civil society organizations, however, call the rollout plan inadequate, asserting that at least 2 million doses per year are necessary to significantly affect new infection rates.
Ramaphosa has vowed to reach 3 million South Africans over the next three years, but hasn’t given details.
There are concerns about access for South Africans despite the country’s contribution that made lenacapavir possible, said Tian Johnson, health strategist for the Johannesburg-based health advocacy group African Alliance.
“Our communities participated in the research, our clinics hosted the trials and our scientists helped produce the data,” Johnson said. “Yet we are still waiting for Gilead to determine how much of the product we receive, when it arrives and how quickly access can expand.’’
The health minister has said Gilead committed to granting a voluntary manufacturing license to a South African company following the granting of six licenses to other countries last year. That allows cheaper generics to be made for lower-middle-income countries for $40 per person annually, down from the original $28,000 price tag.
The drug would be manufactured in South Africa after a committee is established to identify the appropriate company, he said.
The first batch of 37,920 doses is being distributed across 360 health facilities in six provinces that have high HIV rates.
South Africa is initially focusing on high-risk groups, including injectable drug users, sex workers, transgender people, adolescent women aged 15 to 24 and pregnant or nursing women.
But it can be difficult to reach them. Sweeping U.S. aid cuts by the Trump administration forced many of their preferred locations for receiving HIV care to close.
“Key populations, sex workers, people who use drugs, they don’t normally use public clinics” because of challenges like long lines and staff attitudes, said Bellinda Thibela, international policy and advocacy coordinator for the Health Global Access Project.
“So it means that we’re going to lose them unless the government acts fast and ensures that they put the resources to reach those people,” Thibela said.
South Africa’s health minister has said patients from the 12 U.S.-supported clinics that shut down were transferred to existing government facilities, and efforts are underway to train staff and create private spaces.
“What we have lost is that confidentiality, where they were going to these clinics that are very special to them, where they feel very safe,” Motsoaledi said. “So we are trying to train our doctors to take over.”
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