Africa: HIV in South Africa - Why Rolling Out a Groundbreaking New Shot Will Miss a Critical Group of Men

The first shipment of Lenacapavir, a long-acting injectable that prevents HIV with two shots a year, arrived in South Africa from the United States in early April 2026. Clinical trials showed close to 100% efficacy. The rollout, expected to begin in June 2026, prioritises adolescent girls and young women, pregnant and breastfeeding women, transgender people, sex workers, men who have sex with men, and people who inject drugs.

These are the right populations to start with. But one group repeatedly slips through the cracks: adult, employed men in mobile, male-dominated industries, who move between work sites and home, between long-term partners and casual or paid encounters. In epidemiology, they are a "bridging population": people whose sexual networks connect higher-prevalence groups to lower-prevalence groups.

In 2017, UNAIDS named the problem in its Blind Spot report, showing that men across sub-Saharan Africa are less likely than women to test for HIV, less likely to be on treatment, and more likely to die of Aids-related illness. A 2022 meta-analysis of 168 studies confirmed that across sub-Saharan Africa, men remain missing along the HIV care continuum, and South Africa, with the world's largest HIV burden, is a particular concern. South African men are less likely than women to know their HIV status, link to treatment less often, and are 27% more likely to die from HIV.

For decades, South Africa's HIV campaigns have focused on awareness. That work has largely succeeded: in our work on HIV-related risk behaviour and condom use among male construction workers, spanning 2008 to date, nearly all participants understood how HIV is transmitted and what condoms do. The problem is that this knowledge does not translate into consistent behaviour. We are researchers working in the field of HIV/Aids in the South African construction industry since 2008, with a particular focus on the psycho-social aspects of the disease. We focus primarily on site-based construction workers.

Like the military, mining and trucking industries, construction work is highly mobile and male-dominated. Workers move between sites, spend long periods away from long-term partners, and live in worker hostels where shebeens and sex work flourish. These conditions are linked to multiple and overlapping partnerships, long identified as a key driver of transmission.

In our 2023 study, we showed how condom use varies by partner type: participants were far more likely to use condoms with sex workers and casual partners than with long-term partners. A follow-up study of participants repor