The provinces are Gauteng, KwaZulu-Natal, the Eastern Cape, Mpumalanga, North West and the Western Cape, according to the health department’s list of clinics. The Northern Cape, Limpopo and the Free State will get jabs next year when cheaper generic versions of lenacapavir (LEN) become available and South Africa starts rolling out the shot on a larger scale.

At least one generic drugmaker, Hetero in India, has applied to register its product with the South African Health Products Regulatory Authority (Sahpra), CEO Boitumelo Semete-Makokotlela told Bhekisisa. Semete-Makokotlela says this will be a priority review that will be completed in 180 working days (around eight months), so by the end of January 2027.

Lenacapavir is almost foolproof in protecting HIV-negative people against the virus and only has to be taken twice a year.

If enough HIV-negative people take the shot — between 1-million and 2-million HIV-negative people need to take LEN at least once per year between now and 2043 — Wits modelling scientists predict that South Africa could stop new infections fast enough to end Aids as a big public health problem in 18 years’ time.

That, they say, could result in South Africa’s approximately 140,000 new HIV infections in 2025 being reduced to about 65,000 per year so that the rate of new infections decreases to 0.1% or below.

But to achieve this, the country needs between 18-million and 36-million LEN doses in total over the period 2026 to 2043.

So far, South Africa has received only two LEN deliveries — 37,920 doses (via two consignments on March 30 and April 2) and 19,800 doses on April 7 — of the branded version of the medicine made by Gilead Sciences, paid for with a grant from the Global Fund to Fight Aids, TB & Malaria.

The fund says the third delivery of 57,600 doses is expected to land at OR Tambo on June 15, which would bring the total number of delivered doses to 115,320. In total, the fund has promised the country just under 1-million branded doses (974,450) — enough to phase in and keep 456,360 people on the medication — over two years. These doses only come to between 3% and 5.5% of the total number of doses the country needs to end Aids by 2043.

Samples of each Global Fund consignment have to be quality tested before distribution to the health department’s provincial depots. Because South Africa doesn’t yet have accredited labs to conduct quality testing, LEN’s maker, Gilead Sciences, sends samples to its lab in Cork, Ireland, a process which it says takes about a month. The first batch has been cleared and the April 7 delivery is currently undergoing testing.

Activists are unhappy about the time quality testing takes, arguing Gilead should apply for exemption from Sahpra for this process or accredit a South African lab to do the testing.

Once generics become available in 2027, the health department says it will start to buy LEN with its own budget on a much larger scale. How much it plans to buy has not been announced.

Meanwhile, the South African National Aids Council asked local drug companies to submit proposals to make LEN locally. According to the council’s CEO, Thembi Xulu, a committee is now evaluating the proposals and will submit a shortlist of companies that can either make LEN from start to finish or perform aspects of the manufacturing process to Gilead for consideration for generic licences by the end of June.

LEN is not yet available in the private sector — Gilead has not registered a private sector price in South Africa — and will likely only become available at private facilities once generics have hit the market.

So how does the jab work, how do you know if you need it, and where can you find it? We’ve got you covered with 13 questions and answers.

If enough HIV-negative people take the shot … South Africa could stop new infections fast enough to end Aids as a big public health problem in 18 years’ time

1. How does LEN work?

HIV needs to replicate to survive. But, like other viruses, it can’t stay alive on its own. So in humans it hijacks a type of immune cell called a CD-4 cell and worms itself into its DNA, forcing the cell to make copies of the virus instead of itself.

LEN is called a capsid inhibitor, which means it messes with HIV’s shell around its genes — called a capsid — in a way that makes it hard for the virus to get into someone’s CD-4 cells. LEN is injected into the fatty layer of an HIV-negative person’s tummy once every six months and is near perfect in preventing someone from getting the virus through sex. The injection leaves a small supply of medicine, called a depot, under the skin that slowly releases the drug over six months. (That’s why the medicine only needs to be taken once every six months.)

Remember: LEN only prevents HIV infection; it doesn’t prevent someone from getting any other sexually transmitted germ.

2. Is LEN an HIV vaccine?

No. Scientists haven’t yet come up with an HIV vaccine. LEN works differently from vaccines, and there’s an important implication: unlike vaccines, which often give lifelong protection because they train the body’s immune system to fight infections, LEN only works for as long as someone takes it, because it instead blocks HIV from entering someone’s cells.

That’s why the medication is called pre-exposure prophylaxis medicine, or PrEP — a drug that is taken before someone is exposed to a germ like HIV, so that if the bug enters their body later it cannot easily infect them.

An easy way to think about LEN is to compare it to contraception: if you take a daily contraceptive pill and don’t use it each day, your chances of falling pregnant increase. Or if you take a three-monthly contraceptive injection, you’re only protected from pregnancy for that period. LEN works in the same way: it only protects you while you take it. If you want protection from HIV infection for longer than six months, you need to take another injection.

3. Does LEN give foolproof protection against HIV infection?

Almost. In a July 2024 study among teenage girls and young women, LEN showed perfect protection. But as researchers continued to follow and test participants for HIV after the study results had been published, two more girls got infected.

A second lenacapavir study, of which the results were released in November 2024, revealed that the jab worked almost as well for gay and bisexual men, as well as for transgender people, as it did for young women. The study showed a 96% reduction in new HIV infections among trial participants who took LEN (two out of 2,179 participants got infected). Since the publication of the study, there has been one more infection.

4. Does LEN have side effects?

Yes, all medicines do. The good news is that LEN is generally well tolerated. The most common side effects are pain at the spot where the medicine is injected, small lumps under the skin where LEN forms a small depot, and sometimes swelling and redness or itching. Once in a while, a little bit of fluid may be seen at the spot where someone was injected; this is due to the injection process rather than the medicine itself.

5. Who can take LEN?

You have to be HIV negative and weigh at least 35kg. Early data from the Desmond Tutu Health Foundation shows LEN is also safe for pregnant and breastfeeding women. Sahpra has therefore not excluded them from access but also doesn’t explicitly recommend it for this group in the registration document, as more data is needed. Moreover, the World Health Organisation acknowledges in its guidelines for LEN that, although data is still limited, bad reactions among pregnant women have not been recorded.

Lenacapavir must also not be used together with medicines that may reduce the level of LEN in someone’s body, such as the TB medicine rifampicin; the anti-seizure meds carbamazepine and phenytoin; or the herbal remedy St John’s wort, which some people use for depression or anxiety.

LEN has been registered as a schedule 4 medicine in South Africa, which means you can’t buy it over the counter; it has to be prescribed and injected by an authorised health professional, at this stage, a doctor or nurse.

Remember: You have to take an HIV test each time before you take a LEN injection to make sure you’re still HIV negative.

The health department will get the biggest bang for its buck … if it pays special attention to groups of people who have a bigger chance of getting HIV than the general population

6. Which clinics stock LEN — and how much does it cost?

At this stage, 360 government clinics — in six provinces — stock LEN for free. The provinces with facilities that are handing out LEN are Gauteng (133), KwaZulu-Natal (94), the Eastern Cape (49), Mpumalanga (31), North West (31) and the Western Cape (22), according to the health department’s list of clinics.

The Northern Cape, Limpopo and the Free State will get jabs next year, when cheaper generic versions of LEN become available and South Africa starts rolling out the shot on a larger scale.

Each of the six provinces has between one and seven health districts with clinics that are stocking LEN. Mostly, those are districts with high rates of new HIV infections and facilities that have been doing well with managing prescriptions for a daily HIV prevention pill that state health facilities started to stock widely in 2020.

Bhekisisa used the health department’s list of clinics and compiled these into a searchable PDF document. Find the clinics here. You can also use this searchable map of Wits RHI to find a clinic.

7. Can you get LEN at a private healthcare facility?

Not yet. The company making LEN, Gilead Sciences, told Bhekisisa in October that it is “evaluating private market strategies to expand product availability in South Africa as soon as possible”. Gilead has, however, not yet registered a private sector price for LEN in the country.

Once generic LEN becomes available in 2027, the medicine could eventually be sold privately as well, but, even then, stock may be limited, as the South African government needs millions of doses.

8. How do you ask for LEN at a clinic?

First, you need to look for a clinic on our list that stocks LEN. When you get to the clinic, you need to ask for the clinic’s HIV services; that’s where LEN will be available. In most government clinics the HIV service is given in a separate section of the clinic. The first thing a nurse or counsellor will do is to tell you how HIV prevention medicine works and test you for HIV, because you have to be HIV negative to use LEN. The nurse or counsellor will explain to you that you can choose between LEN and a daily HIV prevention pill.

9. What does your first dose look like?

Like all other doses your first dose will be 927mg of LEN. But it’s too much to fit in one syringe, so people get two jabs, each containing half of the amount.

LEN, however, works over time — it releases itself slowly into someone’s body over six months. That’s why there isn’t enough LEN for HIV protection in someone straight after the first dose.

Along with the first dose, people therefore also need to take four 300mg LEN pills — two on the same day as the injections and two on the day thereafter. That way, there’s enough LEN in their body for full protection against HIV infection by the third day.

You will take the first two of the four pills at the clinic, along with your injection. The nurse will give the other two pills to you to take home to take the next day. It is very important to take them, or there will not be enough LEN in your body quickly enough to protect you from HIV infection.

10. What does a follow-up dose look like?

A follow-up dose of LEN is given around six months — 24 to 26 weeks — after the first dose. You only have two weeks to play with. If you therefore turn up later than 28 weeks after you had taken your first dose, you will have to take the four pills that you had to take along with your first dose again.

That is because the LEN in your system by then may have dropped below the level you need for protection. Because of that, simply giving the next injection may not restore protective drug levels quickly enough. The oral tablets act as a “reloading” dose to quickly raise lenacapavir concentrations while the long-acting injection begins releasing the medicine again.

Remember, you can only get a follow-up LEN dose once you’ve tested negative for HIV again.

11. Who needs LEN the most?

The health department will get the biggest bang for its buck — read: stop the most new infections — if it pays special attention to groups of people who have a bigger chance of getting HIV than the general population. In easy speak: it costs less money to prevent infections in groups where HIV is common than in populations where HIV is rare, because fewer people would need to take the medication to prevent at least one infection in groups with high rates of new infections.

That doesn’t mean that people who don’t fit into these groups will be turned away from clinics that stock LEN. Rather, it means that the government will make an extra effort to reach these groups:

Teen girls and young women: Around a third of South Africa’s just over 400 daily new infections in 2024 were among women in this age group, even though they make up only about 8% of the total population. Teen girls and young women’s chances of getting HIV are high because their bodies are still growing and the tissue inside their vaginas and cervixes is still soft and thin, making it easier for HIV to pass through. Because of poverty, young women also often end up in relationships with older men, who have the money to help them cover their or their family’s living costs. In such relationships they rarely have the power to ask their boyfriends to use condoms or to be in monogamous relationships.

Sex workers: Sex workers are around nine times more likely to get HIV than the general population.

Gay and bisexual men; transgender people: Men who have sex with men have a 26 times higher chance of getting HIV than the general population. Transgender people are around 13 times more likely to have HIV than the general population. Transgender women in particular have a 20 times higher chance of getting the virus.

Pregnant and breastfeeding women: Pregnant and breastfeeding women have a higher chance of contracting HIV than the general population. Dvora Joseph Davey, an associate epidemiology professor at the University of Cape Town, explains that pregnant women often don’t use condoms because there’s no risk of falling pregnant when they have sex during their pregnancy. There are also biological reasons why pregnant women could be more likely to contract HIV. “When someone is pregnant, there are changes in the cells in the female reproductive system, and the body changes how much of certain proteins it makes, which can cause inflammation,” Joseph Davey explains. “Inflamed tissue makes it easier for HIV to enter someone’s cells because it increases the risk of tearing in the vagina during sex.”

Use Bhekisisa’s dashboard to calculate how our LEN doses can be distributed most effectively.

12. How to stop LEN

When you stop taking LEN, it remains in your system for up to 12 months. But the levels of medicine in your body are too low to protect you against getting infected with HIV. If you do contract HIV during this time, you could develop resistance to treatments from the class of antiretroviral drugs that LEN belongs to, namely capsid inhibitors. To prevent resistance, you need to use other forms of HIV prevention, such as the daily HIV prevention pill or condoms during the year after your last dose, and test for HIV regularly so you monitor your HIV status.

13. Is LEN the only HIV prevention medicine?

Absolutely not. Government clinics have been stocking a once-a-day HIV prevention pill widely since 2020. A monthly pill, known as MK-8527, is in the last stages of being tested, as well as a four-monthly injection using the medicine cabotegravir and a once-a-year LEN jab. A two-monthly cabotegravir shot has been registered in South Africa but is too expensive for the government to buy and is not available in the private sector.

“In the end, people will use what works for them,” says HIV scientist Katherine Gill. “This is why choice matters.”

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

In the 1970s it was gold and commodities, in the 1980s Japanese stocks and junk bonds, in the 1990s the internet, in the 2000s housing and commodities, and in the 2010s, when everyone thought they were being terribly sensible, it was government bonds, whose absurdity became visible only when US 10-year Treasury yields fell to around half a percent and then, in 2022, rose from the dead with a baseball bat.

“So all I’m saying,” Zhao told the RMB Think Summit this week, “is this decade we must have a bubble, and the bubble has to be AI. Why? Because it’s written in the US constitution. We have to have one. We will have one.”

Big question. The argument in favour of the US market, and others around the world being in a bubble, is statistically pretty strong. The most technical measure is something called the Shiller CAPE ratio, developed by Nobel laureate economist Robert Shiller and John Campbell. And it was specifically created to answer the question: is a market overvalued or undervalued?

JPMorgan’s latest market guide puts the S&P 500 Shiller CAPE at about 41 times vs a long-run average of 27.2. What’s more, the S&P 500 price-to-book ratio is at 5.6 vs an average of 3.2.

There is another indication: thumping great IPOs.

On June 11 SpaceX hopes to raise $75bn from investors; AI labs Anthropic and OpenAI are likely to be seeking as much as $60bn apiece. Together, the three giga-IPOs may add as much as $4-trillion to the market value of listed American companies in a matter of months.

Companies do not usually rush to list when valuations are miserable, but blockbuster IPOs are often seen as signs that a bull market is nearing its peak. The most extreme example was the 2020/2021 listing surge that came just before a bear market. Those earlier IPO booms in the late 1990s and before 2008 were also followed by large slumps.

There are other suggestions too, but these are not quite as clear. The S&P 500 is trading at a forward p:e of about 21.2, but that is not much above its five-year average of 19.9 and 10-year average of 18.9, according to FactSet. Analysts are also forecasting a very punchy 22.6% earnings growth for calendar 2026, which means the valuation case depends heavily on those earnings actually arriving.

This is usually the stage of the dinner party at which someone reaches for the word “bubble”, drops it into the conversation with the solemnity of a small bomb, and everyone nods because it feels both sophisticated and safe.

Zhao’s argument is that this is precisely the danger.

“When everything becomes so obvious in our business, it is not,” he said. “When everybody thinks that something is so clear, so obvious that it’s going to happen, always question that.”

He began not with Nvidia, OpenAI or the great GPU hoarding operation of our time, but with oil, which is not usually where an AI conversation begins unless someone has taken a wrong turn at a commodities conference. His point was that the world had just been through a familiar cycle of certainty.

At the onset of the latest war-related oil scare, investors and economists rushed to conclude that higher oil prices would inflict serious damage on global growth; Goldman Sachs, Zhao noted with some evident enjoyment, lifted its recession probability sharply. And yet the world economy did something irritating: it refused to co-operate.

Manufacturing data in the US, Europe and China improved at the very moment when the consensus expected deterioration. The reason, Zhao argued, was that the world had changed under everyone’s feet. Oil still matters, but not in the same way. The oil dependency of the US, China and Europe had fallen dramatically over the past quarter century, and in real terms the oil shock was far less severe than the nominal oil price suggested. “What does AI have to do with gasoline prices?” he asked. “Not much.”

Zhao’s broader point was that investors are often most confident when the relevant facts have already been absorbed by the market and when the economy has quietly adapted to the thing everyone is still fearing. The oil scare looked obvious, and therefore it was suspect. The same, he suggested, may now be true of the AI bubble scare.

I think we’re in the AI boom, but we’re not yet in the bubble. But we will go there

Chen Zhao

This may be the best counterargument to Zhao. The argument goes like this: even if AI is real, perhaps especially because AI is real, the market has begun to capitalise not just the profits that exist, but the profits that might exist after a trillion-dollar infrastructure buildout, a reshaping of corporate work, and a wholesale remaking of the software economy. That may happen. It may also happen at returns that do not justify today’s prices. Investors have lost fortunes before by being right about the technology and wrong about the stock.

Zhao did not deny this danger. In fact, he explicitly said the AI bubble will probably arrive. His argument was simply that this is not yet what the evidence shows.

For him, the defining feature of a bubble is not enthusiasm, not large capital spending, not even high valuations in isolation. “Bubble has to be in price,” he said. “And when you’re talking about price, you’re talking about how much you are willing to pay per unit of profits.”

That distinction matters. In the late 1990s, Zhao argued, the US stock market was rising even as corporate profits were already under pressure. Investors were not merely paying high prices for good earnings; they were paying higher and higher prices for companies with little or no earnings at all. “Nobody cared, even though profit actually was contracting,” he said of the internet boom. “The narrative at the time … was that if you have a negative EPS, your stocks usually trade at higher multiples than if you had a positive EPS. If you have negative EPS, you’re investing for the future. If you are profitable … you are stupid.”

Zhao said the current market is behaving very differently. Corporate profits, he said, are still growing strongly, and the market is punishing companies that miss expectations rather than rewarding them for being visionary and loss-making. “If you think about stock market behaviour today,” he said, “any company that underperforms its profit expectation is usually punished severely. People just dump the stocks. So in other words, I think the stock market is still acting very rationally, still very much careful about profits.”

Chip company Broadcom’s recent 15% sell-off is a nice little flare in the night sky: the company still had strong AI chip demand, but its guidance failed to give investors an even bigger sugar rush, triggering a sharp fall.

The market may be expensive, narrow and somewhat excitable, but it has not yet abandoned the profit motive. It’s looking a bit tired, but hasn’t yet gone full Roman banquet.

Zhao’s second distinction is between a market driven by earnings and one driven by multiple expansion. In the dot-com bubble, stock prices rose because investors were willing to pay more for the same, or worse, profits. Today, he argued, the advance has been far more closely linked to earnings growth.

“This time around the bull market was completely, absolutely, totally driven by profit because there’s no multiple expansion,” he said. “Look at the Nasdaq 100, same story. The p:e ratio actually came slightly down where profit just went through the roof … Back in the 1990s, no profit, but all multiple expansions. That’s a key difference.”

For now, his case is that a boom should not be confused with a bubble simply because it is large, concentrated and noisy. The first half of the internet buildout, as he notes, was real; the madness came later, when legitimate excitement was inflated into a doctrine of permanent exemption from arithmetic. AI may follow the same path, but “may” is doing a lot of work in that sentence.

The market today does have bubble-like features: heroic expectations, magnificent valuations, dangerous concentration and a new-issue calendar that looks as if Wall Street has decided subtlety is for Europeans. But it also has something the late-1990s market increasingly lacked: actual profits growing at actual companies, with actual investors still punishing actual disappointment.

The question is whether we have already crossed from boom into bubble. Zhao’s answer was no: not yet, not while profits are still doing the pulling, not while valuations can still be argued against bond yields, not while disappointment is still punished, and not while the market remains, in his words, “very much careful about profits”.

“The question today is, are we in the bubble or not? That’s the key issue. I don’t think so. I think we’re in the AI boom, but we’re not yet in the bubble. But we will go there.”

The bubble may come. Indeed, if Zhao is right, it almost has an appointment. But his warning to investors is that calling it too early may be another version of the same error he sees everywhere: mistaking the obvious for the truth.

In this episode of AgriView, filmed during the Agbiz Congress 2026 in Gqeberha, Wandile Sihlobo takes viewers inside the critical conversations on this year’s programme, exploring issues that will shape the future of South African agribusiness. From logistics reform and trade diversification to economic diplomacy and municipal performance, these are the discussions occupying industry leaders as they seek to unlock sustainable growth for the sector.

With agricultural exports up 11% in the first quarter of 2026 and record harvests expected across several commodities, South Africa has significant opportunities ahead. But sustaining growth will require efficient ports, functioning railways, better local infrastructure, and expanded access to global markets.

Join Wandile as he unpacks the key themes, debates and policy priorities driving the Agbiz Congress 2026 agenda — and what they mean for farmers, agribusiness and the broader South African economy.

Reducing the rate of new infections is not an easy task. The most effective measure is to make as many as possible of the roughly 8-million people who are living with the disease non-infectious. The good news is that most people with HIV become non-infectious once they are stable on antiretroviral treatment. The bad news is that the growth of South Africa’s HIV treatment programme has slowed. The pool of infectious people thus seems set to remain relatively large.

For people who are not living with HIV, the most effective form of protection over the years has been the correct use of condoms. Condoms also have the benefit that they protect against other sexually transmitted infections.

But condoms aren’t the only game in town. Voluntary medical male circumcision substantially decreases men’s risk of contracting HIV, something that also provides indirect protection for women.

And then there are antiretrovirals (ARVs) taken to prevent HIV infection. Landmark studies published in the 2010s showed that taking a tablet that contains the antiretroviral medicines tenofovir and emtricitabine could reduce someone’s risk of contracting HIV to near zero. Such tablets are commonly referred to as oral pre-exposure prophylaxis, or oral PrEP. For several years now, these HIV prevention tablets have been widely available in South Africa’s public health-care system, although uptake has been muted. Modelling work from Thembisa, the country’s leading mathematical model on HIV and TB, suggests that only a few hundred thousand people are taking the tablets.

The long-acting revolution

One challenge with HIV prevention pills is that not everyone can, or wants to, take them every day. For some, taking ARVs, or being seen to take ARVs, still comes with an accompanying dose of stigma. For others, remembering to take a pill every day can be tricky. Ultimately, the incentives for healthy people without HIV to take prevention medicines simply aren’t as compelling and immediate as they are for people who already have the virus in their bodies.

As in some other areas of medicine, one solution to this treatment adherence challenge is simply to make it more convenient to take the treatment. Many women, for example, prefer three-monthly contraceptive injections or three-yearly implants to a regular pill. There is some evidence that similar preferences apply to HIV prevention medicines.

So-called long-acting therapies do what the name suggests — act over longer than standard periods. They could take many forms, from slow-release tablets to injections that leave a depot under the skin that slowly releases drugs into the bloodstream, to small implantable devices that are typically left in the arm for several years.

The first long-acting HIV prevention option to take the world by storm was an injection. It made headlines in 2020 when a pivotal study found it to be more effective than the daily prevention pills – the difference being largely due to better adherence, rather than differences in the ARVs used. This jab, containing the antiretroviral drug cabotegravir, provides two months of protection against HIV infection at a time.

Two years later, the World Health Organisation recommended the jab, called CAB-LA, for HIV prevention, and it was registered for use in South Africa. But rollout beyond an implementation science setting stalled when the prices that manufacturer ViiV Healthcare was willing to sell it for were deemed unaffordable by the South African government.

Fortunately, a new prevention jab that provides protection for three times as long as CAB-LA was on the way. In 2024, two large studies found that an injection of the antiretroviral drug lenacapavir given every six months was almost 100% effective in preventing HIV infection. These findings would later be hailed as the journal Science’s 2024 scientific breakthrough of the year. It is this “breakthrough” that is being rolled out in South Africa now.

Two often-neglected groups in HIV research, adolescents aged 16 and 17 and women who become pregnant while in a study, were included in clinical trials of lenacapavir. The jab was found to be safe in both populations, which means it can now be offered to adolescents and pregnant women in the South African rollout.

Lenacapavir is injected just under the skin, typically in the stomach area, where it forms a small depot that very slowly releases the drug over time. These depots can form small lumps under the skin. Though harmless and usually not visible, it will be important that people getting the jab know to expect these “subcutaneous nodules”. The other most common side effects seen in the two pivotal studies were pain at the injection site and a skin rash. These reactions and the size of the nodules appear to decrease with subsequent injections.

Prior to their first injection, people will first have to get an HIV test to ensure they aren’t already living with HIV. This is important since treating someone with HIV with just lenacapavir could result in the development of drug resistance. Together with the injection, people starting lenacapavir will also have to take some lenacapavir tablets for two days. Since the depot releases the injected drug very slowly, these tablets are needed to get the drug levels in the body up more quickly so that it can provide full protection as soon as possible. The department of health has published a guideline document setting out how it should all work at the clinic.

In addition to the lenacapavir and CAB-LA jabs, there is also a long-acting vaginal ring that contains the ARV dapivirine. The ring provides one month of protection at a time, with a three-month version also under development. The available evidence, however, suggests that the dapivirine vaginal ring is not as effective at preventing HIV infection as oral PrEP or the two injectable options.

The long road to jabs at clinics

Having the scientific evidence that an injection works is, of course, only one step in that jab’s long journey to the point where people can get it at clinics. An essential next step is regulatory approval, which lenacapavir received from the South African Health Products Regulatory Authority in October 2025. After regulatory approval was secured, the next question became whether a sufficient supply of the product could be procured in South Africa on acceptable terms.

Lenacapavir is currently only being produced and marketed by the pharmaceutical company Gilead Sciences, which holds the critical patents on the product. In the US, lenacapavir is sold for around $28,000 per person per year. The Global Fund, the world’s largest multilateral funder of health in low- and middle-income countries, and the US President’s Emergency Plan for Aids Relief are, however, procuring limited stocks of lenacapavir at a lower price for use in some low- and middle-income countries. It is some of these Global Fund-procured jabs that will be used in the first phases of the rollout in South Africa.

For now, largely due to the limited stocks, the local rollout will target only around half a million people at 360 clinics in areas with high HIV rates, but the plan is to scale up considerably in the next few years.

The South African government will likely start buying lenacapavir from generic manufacturers in 2027 or 2028. Gilead has so far issued licences that will allow six companies to produce lenacapavir and to sell it in 120 different countries, including South Africa.

The Gates Foundation and a partnership including Unitaid, the Clinton Health Access Initiative and Wits RHI have concluded separate deals with generic manufacturers that should see these generics sold for a price of no more than $40 (under R800) per person per year. This is lower than what the government currently pays for oral PrEP, and modelling work suggests it would be affordable for the South African government. Barring any unforeseen hiccups, the pieces are thus in place to facilitate widespread access to lenacapavir in South Africa in the coming years.

For now, none of the generic versions of lenacapavir will be produced in South Africa. But negotiations are under way that may eventually see a local company licensed to produce the jab. Such local production is seen as important for ensuring security of supply, although it is not clear that local companies will be able to compete with Indian generic drugmakers on price.

At the time of writing, neither the lenacapavir nor CAB-LA injections can be purchased at private sector pharmacies in South Africa. Oral PrEP can be purchased for around R300 for a month’s supply. The monthly dapivirine vaginal ring should cost in the region of R500 per ring. (These prices are based on the April 30 2026 Single Exit Price database published by the health department.)

How many people will want the jabs?

One of the big unanswered questions about lenacapavir is how many people will come forward to get the jabs. It is hoped that the department of health will routinely provide detailed numbers on uptake in the coming months and years.

The initial rollout is largely clinic-based, but researchers will also be assessing how well distribution works through mobile clinics. We need not stop there, of course. At the height of the Covid pandemic, public sector users could access vaccines from nurses at private sector pharmacies. With sufficient political will, the same could be done with lenacapavir. No doubt some young people would rather get their jab at the mall than at the clinic.

Those in control of the rollout will have to think carefully about how they promote and provide the jab. At its core, it is an empowering tool that can help people stay HIV-free, but as the case often is with HIV-linked products, there is a risk of stigma. In addition, even though lenacapavir is not a vaccine, some vaccine scepticism might well transfer over to lenacapavir since it is administered as an injection. As with any large health-care intervention, one will not have to look far to find lenacapavir-related misinformation on social media.

Either way, just having the jab at clinics and hoping people will come get it might not be good enough if we’re hoping to see good uptake. Fortunately, we have several research groups and NGOs in South Africa that have world-class expertise on just this type of issue. Hopefully the government will draw on this unique reservoir as the lenacapavir rollout is shaped and adjusted.

So what’s next?

The rollout of the lenacapavir jab in South Africa will not be the end of our HIV prevention story. Two promising products in the pipeline are a new formulation of lenacapavir that looks like it could provide a full year of protection per shot and a pill containing another antiretroviral that could provide a month of protection at a time. We are keeping a close eye on the development of these products. There are also still hopes that an effective HIV cure or vaccine might one day be developed, although this is a much longer shot than better long-acting antiretroviral formulations.

In the meantime, though, twice-yearly lenacapavir is rightly dominating the headlines.

Modelling suggests that over the next 20 years, an ambitious lenacapavir rollout could reduce new HIV infections by 20%-30%. There can be little doubt that, like condoms and ARVs for people living with HIV, providing lenacapavir at scale makes public health sense.

But thinking of lenacapavir mainly in terms of cost-effectiveness and public health benefits risks obscuring its more immediate and transformative human potential. For many people, especially young women, a discreet and convenient form of HIV prevention that they can control may well make the difference between contracting HIV or not.

As experts often point out, when it comes to products that can prevent HIV, choice — as in the world of contraception — is key. Some products will work for one person, but not for others. As circumstances change, a product that might have once worked may no longer be the best option. Having more than one product in the “toolkit of prevention” makes it easier to find what actually works in people’s lives.

For years, the HIV world has been flush with rhetoric about empowering young women — a group that is profoundly affected by HIV. An ambitious lenacapavir rollout might be the most concrete realisation of those ideals yet. We simply have to get it right.

Disclosure: The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation but is editorially independent — an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

This special briefing is part of a series by Spotlight — health journalism in the public interest. Sign up for the Spotlight newsletter.

This week the all property index was still hovering around the 12,000 mark, down only 7% from the multiyear peaks reached at the end of February before the US attacked Iran.

The sector’s resilience has no doubt been supported by the recent spate of impressive results: most counters have returned to inflation-beating dividend growth, concluded heavily oversubscribed capital raises and made several high-stakes acquisitions.

Corporate action has intensified in recent weeks. In a surprise move, the Public Investment Corporation (PIC), on behalf of the Government Employees Pension Fund, launched a R1.12bn bid to buy 49.7% of small-cap residential developer Balwin Properties with the aim of delisting the company. Balwin founders, including CEO Stephen Brookes, MD Rodney Gray and GRE Africa, which is related to Buffet Investments, will remain invested alongside the PIC through the proposed private ownership structure and retain a majority 50.3% stake.

Balwin is the second small (and highly illiquid) property stock that may go private this year. Market talk is that RMB Holdings will also potentially delist after a buyout agreement with AttBid, an investment vehicle owned by the co-founders of WeBuyCars, Faan and Dirk van der Walt, alongside Atterbury Property Fund.

The Balwin announcement coincided with a colossal R2.8bn capital raise by prolific dealmaker Vukile Property Fund, which announced its intention to enter Italy with the acquisition of three shopping centres for about R2.23bn. In March, it added 50% of the 54,689m² Splau Shopping Centre in Barcelona to its portfolio of more than 20 Spanish and Portuguese shopping centres for about R3.3bn.

Vukile’s retail portfolio, which includes several township malls in South Africa, is fast approaching R60bn, split 66/34 between Europe and South Africa. Management, under CEO Laurence Rapp, has been sniffing around other European countries for some time before settling on Italy as its next offshore investment destination. Vukile will be the first JSE-listed property stock to offer South African investors access to the Italian real estate market.

In another big-ticket deal, Hyprop Investments, which owns Rosebank Mall in Joburg and Canal Walk in Cape Town, is splurging R2.3bn on Galleria Burgas, a 36,700m² shopping centre in the Bulgarian port city of Burgas. The acquisition will bring Hyprop’s mall portfolio in Eastern Europe to five and aligns with its strategy to expand its retail footprint in the region.

Spear Reit, the JSE’s only property stock with 100% exposure to the Western Cape, last month clinched a R960m deal to buy a portfolio of three office blocks spanning 28,500m² in Tyger Valley, Cape Town. That follows a successful R1bn capital raise in April and is Spear’s third big-ticket acquisition since mid-2025. The first two were the R442m purchase of the 19,642m² Watergate Centre in Mitchells Plain and the R455m acquisition of Maynard Mall, a 25,969m² convenience centre in Wynberg.

In yet another book build, Fairvest raised R900m, above the initial target of R500m. Emira Property Fund, meanwhile, made a cheeky play for Octodec Investments, assembling a 23.5% stake; it had hoped to acquire 34.9% in a voluntary offer to shareholders.

Vacancy metrics are stabilising across the better-quality portfolios

Garreth Elston

Independent property analyst Keilen Ndlovu says the “phenomenal” uptake of recent accelerated book builds — mostly at premiums to market pricing — reflects the extent to which sentiment towards listed property as an asset class has improved, especially among institutional investors, which two years ago were still steering clear of the sector. He says while there was lots of capital to participate in equity raisings in the first quarter, activity was put on hold in March due to the Middle East conflict. It has since resumed as markets stabilised.

Ndlovu notes that recent wheeling and dealing have been supported by stronger balance sheets and a return to inflation-beating earnings growth. The sector has delivered guidance-beating results from late last year into 2026. Earnings have been boosted by lower debt funding costs and increased letting activity, which has led to lower vacancies and higher rentals. In May alone, at least eight counters, including Redefine Properties, Spear, Octodec, Dipula Properties, Collins Property Group, Equites Property Fund, Exemplar Reit and Emira released better-than-expected earnings growth, with most upgrading their numbers for the next six to 12 months.

Sector heavyweight Redefine Properties lifted its guidance for distributable income for the year to August to 6%-7%, up from 5%-6%, after posting a solid set of results for the six months to February. The company, one of the largest mall owners in South Africa, reported a particularly pleasing turnaround in its retail portfolio, with rental reversions on lease renewals turning positive to the tune of 3%.

Spear delivered 6.02% dividend growth — ahead of its 4%-6% guidance — for the year to February and upgraded its growth expectations for its 2027 financial year to 6%-8%. Spear has been a major beneficiary of the real estate rally in Cape Town, where even the office market, which is still subdued in other cities, is starting to see demand outstrip supply in certain pockets. Office vacancies in the Mother City have dropped to a record low of 2.7%, significantly below Joburg’s 13.8%, according to recent figures from the South African Property Owners Association.

Dipula, which owns a portfolio of more than 80 convenience shopping centres that cater mostly to low- and mid-income shoppers, upgraded its earnings growth guidance for the year to August from 7% to 7%-8% on the back of a marked increase in letting activity, which led to a healthy 6% rental reversion.

Still, despite upbeat earnings growth numbers and plenty of support for capital raises, analysts expect some caution to start setting in after last week’s 25 basis point rate hike and a jump in inflation from 3.1% to 4% in April.

Ian Anderson, head of listed property and portfolio manager at Merchant West Investments, says the 34% total return achieved by domestic real estate investment trusts for the 12 months to the end of April (despite the 12% pullback in March) is unlikely to be repeated over the next year. At least 10 stocks, led by Octodec, Delta Properties and Emira, delivered a total return exceeding 45%. But Anderson now expects the next phase of returns to be “more selective”.

He says the easy part of the rerating may now be behind the sector. Still, he believes that funds with resilient retail, logistics and self-storage exposure, disciplined leverage, low vacancies and the ability to raise and deploy capital judiciously are well placed to outperform into 2027.

Garreth Elston, MD of Golden Section Capital, shares the sentiment and believes that the easy money has been made. While the property sector is still holding up well, he says, the picture can change quickly given the potential for a few more months of massive fuel price increases and another interest rate hike.

On the upside, Elston says the latest round of results confirms that the South African listed property sector is delivering “genuine operational improvement”, with distributable income growth running ahead of prior-year comparatives. “Vacancy metrics are stabilising across the better-quality portfolios and management guidance has been upgraded at a meaningful number of counters. The numbers are good.”

He says recent results may be signalling that the sector has likely crossed from a rerating phase into an earnings growth phase. Elston tells the FM that these two environments demand very different investor approaches. “The rerating phase, characterised by wide NAV discounts, depressed sentiment and the structural dislocation of the post-Covid and load-shedding years, rewarded buying cheaply and waiting for multiples to compress. By contrast, the earnings growth phase requires the underlying fundamentals to do the heavy lifting.”

The problem, says Elston, is that earnings growth, while real, is not particularly exciting at current cost bases, and the stocks that were pricing in 35%-45% discounts to NAV have closed much of that gap.

His overall read is that the sector now sits in a zone of “respectable but uninspiring” growth. “The recovery narrative, as a collective sector call, has largely run its course. What follows is a stock-specific, fundamentals-driven phase.”

Elston reckons subsector positioning, with a bias towards industrial/logistics property and necessity-anchored retail over offices and secondary malls, balance sheet quality and hedging discipline will differentiate the winning property stocks from the losers.