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

Why It Matters

Missing the mobile male workforce leaves a critical gap in South Africa’s HIV prevention strategy, undermining efforts to curb new infections and transmission to partners.

Key Takeaways

• Lenacapavir offers near‑100% efficacy with two annual injections.
• Rollout targets adolescent girls, pregnant women, trans people, sex workers.
• Adult male workers in construction, mining, transport remain unaddressed.
• Clients of sex workers drive ~42% of new South African infections.
• Workplace‑based testing models boost male uptake in hard‑to‑reach groups.

Pulse Analysis

Lenacapavir’s arrival marks a milestone for South Africa’s HIV response. The injectable, requiring only two shots a year, achieved almost perfect protection in trials, prompting the health ministry to launch a June rollout aimed at groups with the highest incidence: adolescent girls and young women, pregnant or breastfeeding women, transgender individuals, sex workers, men who have sex with men, and people who inject drugs. By concentrating resources on these populations, the program hopes to curb the epidemic’s most vulnerable segments while leveraging the drug’s long‑acting profile to improve adherence.

Yet the strategy overlooks a hidden driver of transmission: adult men employed in highly mobile, male‑dominated industries such as construction, mining, and transport. Studies show these workers often rotate between sites, live in hostels where casual sex and sex work are common, and are less likely to test or seek treatment. They act as a "bridging population," linking high‑prevalence groups like female sex workers—who have HIV rates around 62%—to low‑prevalence partners. Modelling indicates that clients of sex workers account for roughly 42% of new infections, and migrant men’s partners face a tenfold increase in risk, underscoring the need to address this cohort.

Policymakers can close the gap by integrating prevention services into workplaces. The Test@Work model, proven in the UK, delivers opt‑in HIV testing, PrEP, and post‑exposure prophylaxis during routine health checks, achieving high uptake among men who rarely visit clinics. Expanding the national framework to explicitly name male clients of sex workers and older men in age‑disparate relationships would align resources with transmission dynamics. By meeting men where they work and live, South Africa can enhance the impact of lenacapavir and move closer to ending new HIV infections.