South Africa: Did US Aid Cuts Break Precisely the Things We Need Most for the Lenacapavir Rollout?

With a new six-monthly injection, South Africa last week launched the most promising new HIV prevention tool in years, but much of the infrastructure that made HIV prevention services accessible to high-risk groups has been dismantled over the last year. Spotlight asks whether we can successfully deliver this breakthrough technology without the trusted pathways decimated by cuts to aid from the United States.

When 29-year-old Keegan Daniels* visited a public hospital outside Cape Town earlier this year to be placed on medication to prevent HIV infection, he says he wasn't sure what to expect, but it definitely wasn't to be reprimanded, lectured and told that anal sex "is abnormal".

Oral pre-exposure prophylaxis (oral PrEP) refers to antiretroviral tablets taken to prevent HIV infection. When used as prescribed, oral PrEP has been shown to reduce the risk of HIV infection from sex, including in men who have sex with men (MSM), by approximately 99%, according to a 2022 meta-analysis.

During the short consultation, Keegan claims the doctor, who appeared unfamiliar with prescribing PrEP, chastised him for addressing him as "sir" rather than "doctor", and made assumptions about his sexual orientation.

"I am gay, but when he told me I was 'homosexual' instead of asking me, I felt as if I was there to be shamed instead of helped," says Keegan, who identifies as a gay man.

Keegan tells Spotlight that he sought out oral PrEP after an experience that left him worried about his HIV risk. As a man who has sex with other men, he is also part of a population disproportionately affected by HIV. According to the World Health Organisation (WHO), men who have sex with one another are up to 26 times more likely to acquire HIV than the general population. This is largely driven by biological risk factors associated with anal sex combined with other social and structural vulnerabilities faced by this group.

A SHOT OF HOPE | A breakthrough years in the making finally reaches SA clinics. We give you the rundown on lenacapavir, and a glimpse of what comes next for HIV treatment.

-- Spotlight (@spotlightnsp.bsky.social) June 5, 2026 at 9:31 AM

The consultation became increasingly uncomfortable, Keegan says, when the doctor began discussing the importance of marriage as a method to prevent HIV and the risks associated with anal sex.

"He may not have meant it that way, but it felt like a judgement," Keegan says.

His experience highlights long-standing concerns from activists, researchers and healthcare providers about discrimination experienced by members of marginal gro