Highly effective prevention drug arrives in South Africa, which has the highest HIV burden in the world

SECUNDA, South Africa – Growing up seeing the devastating effects of HIV in her family and community in South Africa inspired Olwam Plaatjee to start using preventive HIV medications three years ago.

“Sometimes they would lose weight, get sick and have to go to the clinic, and I didn't want that for myself,” she told The Associated Press. “I watched the people I lived with take (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 have signed up for clinical trials of lencapavir, a highly effective, twice-a-year injectable prevention drug that addresses the shortcomings of daily oral prevention pills.

Despite night sweats and other side effects, she continues to take the drug after South Africa became one of the first countries in the world to introduce it this month.

President Cyril Ramaphosa told the stadium crowd at the launch of the drug's rollout that lencapavir marked a “turning point” in South Africa, which bears the highest burden of HIV globally.

But health advocates say the country deserves many more doses given South Africa's central role in the work that brought the promising drug to the world.

South Africa has doses for almost half a million people

More than 80 lakh people in South Africa are suffering from this virus. The hope is that lencapavir will help prevent new infections in the country, which range from 140,000 to 170,000 annually.

“If South Africa can provide it equitably and on a larger scale, it could make a meaningful contribution to reducing new HIV infections,” said Leila Mansour, a senior scientist at the AIDS Program Research Center at the University of KwaZulu-Natal in South Africa.

Clinical trials in South Africa and Uganda evaluated the efficacy of lencapavir, which was developed by Gilead Sciences. An important study in Johannesburg concluded that a six-month injection showed 100% effectiveness in protecting against HIV.

“This was an unprecedented discovery,” said Dr Nkosi Ndlovu, a senior physician at the Wits RHI research institute.

Now the South African government has secured enough doses to cover 456,000 people for a year, funded by a $29 million Global Fund grant. After that, Health Minister Aaron Motsoaledi said that South Africa aimed to finance its program independently with the help of donors.

The government hopes to reach 30 lakh people

However, some South African civil society organizations describe the rollout plan as inadequate, and claim that at least 2 million doses per year are needed to significantly impact new infection rates.

Ramaphosa has vowed to reach 3 million South Africans over the next three years, but has not given details.

There are concerns about access for South Africans despite the country's contributions that have made lencapavir possible, said Tian Johnson, a health strategist at the African Alliance, a Johannesburg-based health advocacy group.

“Our communities participated in the research, our clinics hosted the trials, and our scientists helped prepare the data,” Johnson said. “Yet we are still waiting for Gilead to determine how much product we will receive, when it will arrive, and how quickly access can be expanded.”

Gilead has committed to granting a voluntary manufacturing license to a South African company after granting six licenses to other countries last year, the health minister has said. This allows affordable generic drugs to be made for lower-middle income countries at $40 per capita annually, down from the original price of $28,000.

He said the drug would be manufactured in South Africa after a committee was formed to identify a suitable company.

South Africa focuses on vulnerable groups first

The first batch of 37,920 doses is being distributed to 360 health facilities in six provinces with high HIV rates.

South Africa is initially focusing on high-risk groups, including injection drug users, sex workers, transgender people, adolescent women aged 15 to 24 and women who are pregnant or breastfeeding.

But reaching them can be difficult. Many of their favorite places to receive HIV care had to close due to deep cuts in US aid by the Trump administration.

“Key populations, sex workers, people who use drugs, typically do not use public clinics because of challenges such as long lines and staff attitudes,” said Belinda Thibela, international policy and advocacy coordinator for the Health Global Access Project.

“So that means we're going to lose them unless the government acts fast and makes sure they put resources into reaching those people,” Thibela said.

South Africa's health minister has said patients from 12 closed US-backed clinics have been transferred to existing government facilities, and efforts are underway to train staff and create private space.

“What we've lost is the privacy where they were going to these clinics that are so special to them, where they feel very safe,” Motsoaledi said. “So we are trying to train our doctors to take over.”