South Africa plans to begin rolling out the twice-yearly HIV prevention injection lenacapavir in June. A report by Physicians for Human Rights warns the US funding cuts that dismantled community health systems may make that impossible.

Why it matters: Scientists estimate that if one to two million South Africans receive lenacapavir annually, the country could end AIDS as a major public health threat within eight years. The jab exists. The question is whether the infrastructure to deliver it still does.

What lenacapavir does

Lenacapavir is a long-acting injectable that prevents HIV infection with a single shot every six months. Clinical trials showed 96% efficacy. South Africa’s Medicines Control Council approved it for prevention use, and the national rollout is scheduled for June 2026.

The drug replaces the daily PrEP pill, which required consistent daily use and had low adherence rates, particularly among young women in rural areas.

What PEPFAR funded

The US President’s Emergency Plan for AIDS Relief contributed roughly 17% of South Africa’s HIV budget. That sounds modest, but the funding was concentrated in specific services: community-based testing, field recruitment for prevention programmes, and mobile clinics in 27 of the country’s 52 health districts.

When the Trump administration ended most PEPFAR funding in February 2025, those services collapsed. USAID-funded projects closed entirely. CDC-funded programmes continued on bridge funding that expires in June 2026.

The damage

According to the Physicians for Human Rights report, PEPFAR and USAID funding to 70% of supported healthcare facilities has stopped. Over 8,000 health workers lost their jobs. Gender-based violence programmes linked to HIV prevention were terminated entirely.

“For lenacapavir to work, you need a delivery platform,” the report states. “The community health worker networks, the mobile testing units, the demand-creation campaigns. Those systems have been almost completely dismantled.”

The US position

The Trump administration ceased PEPFAR funding as part of broader foreign aid cuts. Officials cited allegations of corruption in aid distribution and the need to redirect spending domestically. The administration has also accused South Africa of “white genocide,” a claim rejected by the South African government and independent human rights organisations.

What happens next

South Africa’s Department of Health has said it will fund the lenacapavir rollout from the national fiscus, but health economists warn this requires roughly R2.1 billion annually, money that is not currently budgeted. The National Treasury is expected to address the funding gap in the Medium-Term Budget Policy Statement in October.

The Global Fund has indicated willingness to provide bridge financing, but the scale of the infrastructure loss means even with funding, rebuilding the community health networks will take 12 to 18 months.