#Aids2026: three HIV announcements South Africa made in Rio

South Africa returned from the 26th International Aids Conference in Rio de Janeiro last week with three big HIV announcements:

• a new dashboard that tracks the roll-out of HIV prevention medicine;
• a licence for Aspen Pharmacare to make a promising monthly HIV prevention pill; and
• progress towards manufacturing a six-monthly HIV prevention injection, lenacapavir (LEN), in South Africa.

By August 3 close to 36,000 HIV-negative people had taken LEN, according to health department figures — a quarter of them pregnant and breastfeeding women, a group that has a high risk of contracting HIV.

Our team was on the ground and breaks down what the announcements could mean for the country’s HIV prevention programmes.

1. We have a PrEP dashboard

Almost everyone who starts HIV prevention medicine at government clinics where people can choose between a daily pill and a six-monthly injection opts for the injection.

New figures released in Rio show that 98.5% of people choose LEN.

South Africa unveiled a dashboard at its country booth to track the rollout of HIV prevention medicine. HIV-negative people use the medicine, known as pre-exposure prophylaxis (PrEP), to stop themselves from getting HIV.

The health department started rolling out the injection on June 5 at 360 clinics — about one in 10 clinics — in six provinces. Almost all government clinics stock the pill.

The dashboard tracks PrEP use at the 360 clinics where HIV-negative people can choose between the daily pill and the twice-yearly injection, LEN.

The dashboard also breaks down PrEP users by age, gender, province and health district. Moreover, it shows whether the programme is reaching people who have a higher chance of getting HIV — including sex workers, pregnant and breastfeeding women, gay and bisexual men, transgender people and people who inject drugs.

The dashboard also tracks LEN stock, showing the health department how many doses are left at each clinic. For now, South Africa is using doses paid for by the Global Fund to Fight Aids, Tuberculosis and Malaria. But from 2027, the health department plans to buy cheaper generic versions of the medicine.

So far, the data shows that a quarter of LEN users are pregnant or breastfeeding women, and most people who choose the injection are between 25 and 34 years old. By August 3, a total of 35,778 people had received a LEN injection, compared with just 579 who chose the daily pill.

The dashboard, however, has limited data on LEN uptake in the Western Cape because the province uses its own electronic medical record system to track patients. As a result, it cannot show users by age, gender or groups with a higher chance of getting HIV.

Mia Malan spoke to the national health department’s deputy director-general for HIV, Fikile Ndlovu, at the conference about how the dashboard works. Watch the short video below. (It was recorded on July 29, so the LEN uptake figure is lower than the latest figure reported in this story.)

For those without an Instagram account, watch here.

2. SA will make a monthly HIV prevention pill

South Africa’s largest drug maker, Aspen Pharmacare, announced that it has received a licence to make generic versions of a monthly HIV prevention pill, alimatravir (MK-8527), developed by Merck (known as MSD in South Africa).

The pill could help reduce South Africa’s roughly 140,000 new HIV infections each year.

In a first for HIV prevention medicines, Aspen received the licence before the studies needed to prove the pill works had finished.

“We don’t yet know if the medicine will work, so Merck is taking a risk. But, in my opinion, it’s a wise strategic risk,” Mitchell Warren, executive director of the international HIV advocacy organisation Avac, told Bhekisisa in Rio de Janeiro.

The studies are expected to potentially finish in the second half of 2027.

MSD awarded seven licences in total. Besides Aspen, manufacturers in Uganda, Kenya and India also received licences.

Aspen won’t make MK-8527 from start to finish. Instead, it will import the pill’s active ingredient and then manufacture the finished medicine in South Africa, says the company’s group senior executive for strategic trade, Stavros Nicolaou.

If studies show alimatravir works and regulators approve it, Aspen will be able to sell and export the pill to 129 low- and middle-income countries, including all 54 countries in Africa.

So why develop a monthly HIV prevention pill when there’s already a daily pill and a six-monthly injection? Choice. Family planning has shown that the more birth control options people have, the more likely they are to use one. Scientists believe the same could be true for HIV prevention: the more choices people have, the better the chance that one will suit their lifestyle and preferences.

Early data from South Africa’s lenacapavir roll-out support that idea. Bhekisisa analysed the health department’s dashboard figures to see whether offering people a choice between a daily pill and a six-monthly injection was linked to more people starting HIV prevention medicine.

Although the comparison isn’t perfect — the figures come from different numbers of clinics — it suggests that giving people more options may encourage more people to start PrEP. In 2025, before LEN became available, an average of about 2,670 people a week started PrEP by taking the daily pill at just over 4,500 public health facilities.

Since LEN was introduced, an average of about 4,200 people a week have started PrEP at 360 clinics in six provinces, where people can choose between the daily pill and the injection.

Watch this short video from Rio, where Mia Malan explains why having more HIV prevention options could encourage more people to start PrEP.

For those without an Instagram account, watch here.

3. SA is one step closer to making LEN

On a conference panel moderated by Bhekisisa in Rio, the CEO of the South African National Aids Council (Sanac), Thembi Xulu, announced that the country had completed an assessment of local drug makers that could potentially make LEN in South Africa. The list has been submitted to LEN’s developer, Gilead Sciences, to consider them for generic licences.

“We’ve handed the list to Gilead, which will now conduct its own assessment. That includes site visits to determine whether the companies have the technical capacity to make the medicine,” Xulu said.

“The process will take three to six months. After that, we’ll know which companies can help make lenacapavir more accessible, affordable and sustainable for South Africa and the Southern African Development Community (SADC).”

When Gilead awarded six generic licences in 2024, no South African company was included because Gilead only considered manufacturers that could also make the medicine’s active pharmaceutical ingredient (API) — the ingredient that makes the drug work.

But Sanac and the government asked Gilead to take a “developmental” approach, recognising that no South African company can yet manufacture LEN from start to finish.

To identify potential local manufacturers, Sanac set up two committees — an evaluation committee and an adjudication committee — made up of South African and international experts who are independent of government.

The evaluation committee invited applications from companies that could manufacture the injectable form of LEN using imported API, make only the tablets taken with the injection during the first two days after starting LEN, or eventually produce the entire treatment.

The evaluation committee drew up a shortlist, which the adjudication committee used to make the final decision.

Gilead will now decide which companies qualify for generic licences after completing its own assessment, including site visits.

Watch our interview with Xulu, in which she explains what happens next in South Africa’s bid to manufacture LEN locally.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.