South Africa’s HIV Prevention Injection Lags Adoption

South Africa launched the six-month HIV prevention injection known as LEN at 360 government clinics in June, but initial adoption figures indicate the program will fall short of its goals without a deliberate push to increase demand.

Researchers specializing in health economics at the University of the Witwatersrand determined that simply raising awareness does not guarantee usage. Their 2022 survey revealed that only 33% of sexually active adults had ever heard of daily HIV-prevention pills, even though the medications were provided at no cost and stocked across the country.

When outreach teams deployed peer navigators to discuss prevention methods, 46% to 50% of those who engaged immediately began taking medication. In contrast, initiatives relying on broad, untargeted messaging achieved uptake rates of just 21% to 34%. These results highlight three key strategies. First, health authorities must actively educate the public about LEN, emphasizing its six-month protection period and free availability. Second, trusted community members—such as peer educators who share similar backgrounds with potential users—should deliver this information. Finally, the gap between learning about the injection and receiving it must be closed as quickly as possible.

While mass-media campaigns can reach large audiences, they rarely lead to direct action. Less than 5% of survey participants first learned about prevention pills through television or radio. The majority, 84%, heard about them from friends, family, healthcare workers, or targeted social-media campaigns. A combination of broad outreach and localized, personal engagement appears to be the most effective approach.

Generating demand incurs costs. Budget for demand creation is critical. In the projects evaluated, activities such as peer-educator salaries, transportation, and community events represented 14% to 40% of total per-visit expenses. Budgets that prioritize drug procurement alone risk leaving clinics with surplus stock that goes unused.

Measuring success requires more than tracking distributed flyers or social-media engagement. The essential metric is the number of people who learn about LEN and actually receive the injection. Monitoring this conversion rate will help officials allocate resources to methods that successfully move individuals from awareness to treatment.

As of October 5, government health records indicate that just over 71,000 people have received LEN since its introduction. This figure remains far below the one to two million annual users required to reduce new HIV infections and align with the 2043 target of eliminating AIDS as a public health concern.

To accelerate adoption, the government has secured advance purchases of LEN from manufacturers, guaranteeing deliveries through 2025. However, officials acknowledge that long-term sustainability depends on reducing production costs and negotiating better pricing terms with pharmaceutical companies.

The National AIDS Council has set an internal benchmark: by the end of 2024, at least 500,000 people must receive LEN annually to stay on track for the 2043 target. Achieving this will require not only expanded demand strategies but also improvements in clinic efficiency, supply-chain management, and cross-sector collaboration.

Building Demand Through Community Outreach and Accurate Information

South Africa’s Thembisa model estimates roughly 40 million HIV-negative individuals aged 15 and older could benefit from LEN. A 2022 national survey found only one-third of sexually active adults had ever heard of oral HIV-prevention pills, a gap that directly limits interest in the injection. Because awareness is low, officials must generate intentional demand rather than rely on passive exposure. Without a clear strategy, the pool of potential users will remain largely untapped.

In 2022, the Gates Foundation funded several South African groups to trial diverse communication tactics for HIV-prevention pills. Tested approaches included community radio spots, printed flyers and posters, targeted social-media messaging, outreach events, and peer-education sessions. HE2RO evaluated the financial implications of these pilots and interviewed 1,038 young people beginning prevention medication for the first time. Results highlighted that personal, peer-driven interactions outperformed broad, untargeted advertising.