from DION HENRICK in Cape Town
Western Cape Bureau
CAPE TOWN, (CAJ News) – AFRICAN health advocates are urging decisive action from the South African government following sharp criticism of a United States–backed donation of lenacapavir (LEN-LA), a twice-yearly HIV prevention injection shown to offer near-complete protection against HIV infection.
The U.S. government, Gilead Sciences, and the Global Fund this week announced the arrival of just 500 donated doses each for Zambia and Eswatini—while excluding South Africa entirely.
Civil society organisations across the continent condemned the move as inadequate and politically motivated, arguing that the donation is designed more to shape markets than to address urgent public-health needs.
Fatima Hassan, Director of the Health Justice Initiative (HJI), called the offer “a symbolic handout” that enables Gilead to claim early African rollout without committing to affordable, large-scale access.
Advocates note that at least 10 million people in Africa require lenacapavir to meet global targets for a 90% reduction in new infections by 2030.
Yet U.S. officials have pledged doses for only 300,000 people worldwide in 2026.
“Protection for 300,000 people is insulting,” said Bellinda Thibela of Health GAP, arguing that millions of doses are needed, particularly after extensive U.S. funding cuts to HIV programmes earlier this year.
According to activists, the United States has slashed nearly 40% of PEPFAR funding, issued stop-work orders for major programmes, and negotiated restrictive bilateral agreements that may curtail services for key populations.
As a result, they report declines in testing, rising infections, and stalled treatment access.
“Deaths and illness now far exceed any benefit these small donations will provide,” said Sibongile Tshabalala of the Treatment Action Campaign (TAC).
The decision to exclude South Africa from the rollout has drawn additional backlash. Advocates attribute this to U.S. political grievances, with Nigeria also reportedly sidelined.
By contrast, Eswatini, which accepted both the 500 doses and separate U.S. funding, remains included.
Meanwhile, China announced a new HIV prevention initiative in South Africa focused on young people and people who inject drugs.
South Africa, which accounts for 14% of global new infections, needs more than two million doses annually.
Current Global Fund allocations will cover only 480,000 people between 2026 and 2028—an amount researchers say will avert just a fraction of annual infections.
Activists argue that Gilead’s strategy, including limited voluntary licenses and delays in filings that would enable generic production, is prolonging the epidemic.
Gilead has also insisted on price secrecy for lenacapavir, a demand critics say will hinder planning for already strained health budgets.
Although LEN-LA has recently been registered by SAHPRA, advocates say Gilead is restricting access in South Africa’s private sector, further limiting availability.
Civil society groups are now calling on the South African government to issue a compulsory license to permit generic manufacturing and ensure sustainable supply for the region.
“It is a public-health emergency,” said Thibela. Others urged South Africa to assert global leadership by demanding expanded licensing and full transparency from donors and manufacturers.
“Lifesaving innovations cannot be held hostage to corporate and political interests,” said Yvette Raphael of the Advocacy for Prevention of HIV and AIDS.
“No HIV prevention effort can succeed while excluding South Africa.”
– CAJ News