HIV: 76,922 South Africans on biannual injections, and nurses trained with cooking oil

As of October 8, 2026, 76,922 people in South Africa had started lenacapavir, a preventive HIV treatment injected only twice a year, according to Foster Mohale, spokesperson for the Department of Health, as cited by the South African media outlet Spotlight on October 23, 2026. The rollout began on June 5, 2026, in 360 public facilities across six provinces; Gauteng alone accounts for 36,733 initiations across 133 centers.

The stakes are significant. The country recorded approximately 140,000 new infections in 2025. According to models cited by Spotlight, reaching 1.4 to 2.1 million initiations per year by 2030 would prevent between 32,200 and 51,700 infections annually. By mid-2025, nearly 350,000 people were taking prevention in the form of a daily pill, according to Thembisa estimates.

A thick solution, a kitchen trick

Behind these figures lies a very practical learning process, as recounted by Spotlight. Nurses must first complete the mandatory NIMART course, which authorizes them to initiate antiretroviral treatment. Then comes the practice: the product is so viscous that they practice drawing it up using cooking oil. A pharmacist from the Wits RHI institute taught them a faster method—keeping the vial upright and drawing air first. They also learn to inject slowly to avoid leakage, with the support of videos and more experienced colleagues.

Keitumetse "Tumi" Senokwane, a nurse of twenty-six years and site manager, and researcher Catherine Martin describe a skill set that cannot be learned from a manual. The first consultation lasts about an hour and a half; subsequent ones take an hour or less.

Patients have chosen

The LEN4PrEP study, conducted by Wits RHI at two health centers in Tshwane, recruited 1,544 participants between November 2025 and June 2026, with follow-up until June 2027. Among the 1,538 who indicated their preference, 85.8% chose the injection, 13.7% chose the pills, and 0.5% chose nothing at all. The reason can be summed up in one word: convenience, as the injection eliminates the daily pill and frequent clinic visits. Among those who started, about half of the women prefer the buttock, and 51% of men prefer the upper arm. A clinical trial involving 2,140 participants noted nodules at the injection site in about 64% of them.

"People want options that fit into their lives," summarized Professor Saiqa Mullick of Wits RHI during a conference held in Johannesburg in September 2026. The South African ministry indicates that feedback from the initial sites will be used to refine training and national recommendations—a body of expertise that other countries on the continent, facing the same epidemic, will be watching closely.