By Mia Malan and Ida JoosteAlmost 55,000 people in South Africa have already had a shot that protects them against HIV for six months at a time, the health department says. Lenacapavir, or LEN, has been available through the health department since June. The injection gives near-perfect protection against HIV and, because it lasts for six months, people only need to return to a clinic twice a year. For now, LEN is available at 360 government clinics — about one in 10 — across six provinces. The Free State, Limpopo and the Northern Cape don’t yet have it. That should start to change when cheaper generic versions become available in 2027. The health department plans to use some of its own budget, along with a grant from the Children’s Investment Fund Foundation through the Global Fund, to buy more LEN and expand the number of clinics that offer it. And South Africa needs to scale up fast. Modelling shows that between one-million and two-million people would need to use LEN each year between now and 2043 for the injection to make a big enough dent in new HIV infections to help end Aids as a public health threat. For now, the health department is focusing particularly on people who have a higher chance of getting HIV: teenage girls and young women aged 15–24, sex workers, transgender women, gay and bisexual men and other men who have sex with men, and pregnant and breastfeeding women. People who use government clinics and want HIV prevention medicine can choose between a daily prevention pill and the six-monthly injection. Both are free.Getting LEN involves a little more than just one jab. At the first appointment, a health worker gives two injections, either in the stomach or buttocks. The person also takes two LEN tablets that day and another two the next day. If they return for their next injections on time — 24 to 28 weeks after the previous injection — they don’t need to take the tablets again.But what is it actually like to use LEN — and why are people choosing it over a daily pill?We spoke to four people from groups the roll-out is particularly trying to reach: a sex worker, a student, a pregnant woman and a transgender woman. Here, in their own words, they explain why they chose LEN, what getting the injections felt like and whether they’ll be back for their next shots.Precious Mafanga got her LEN shot at Delft Community Health Centre near Cape Town. She switched from a daily HIV prevention pill to the injection. Picture: (Mia Malan) Precious MafangaI’m 39, a mother of four, a wife and a sex worker.I live at Ikhwezi Hostel in Langa. I’m also a peer educator with Tholwana e Molemo, where I help other sex workers with their health and other needs.In our work, time is money. We rent rooms for R500 a day, so sometimes we’re chasing minutes. On a good day, it’s one client after another. As soon as he leaves, it’s “next!” You can easily make more than R1,500.But on a bad day, you might not even make enough to pay the rent. Then there’s pressure to agree when a client offers you more money for sex without a condom. You pay the rent and start all over again the next day.I got my LEN injections at Delft Community Health Centre near Cape Town in June and spent a few hours at the clinic.While I was waiting, my phone kept ringing. Clients were calling and I wanted to leave to see them. But I stayed and got my injections.Before LEN, I took the daily HIV prevention pill for four or five years. It wasn’t easy. You have to remember to take it every day.With LEN, I don’t have that worry. The medicine stays in my body for six months, so I only have to go to the clinic twice a year.As a peer educator, I help link other sex workers to clinics where they can get HIV prevention medicine without being judged. When US funding cuts disrupted outreach services, many of our sisters stopped taking their daily prevention pills. Some later tested positive for HIV.That’s why LEN is so important for us.But we still hand out condoms because LEN doesn’t prevent pregnancy or other sexually transmitted infections.I’ve sent my eldest child’s partner to get LEN. And now that I know younger people can get it too, I’m sending my 17-year-old.I wish people understood our work as sex workers. We’re not selling our bodies. We’re selling a service. We’re exchanging sex for money.Because if I sold my body to a client, I wouldn’t have a body anymore.Siviwe Gaika had to visit Kwazakhele Community Health Centre in Gqeberha three times before getting her LEN jab. She had to wait four hours in line. “I prepared myself for the waiting period,” she says. “I know that’s how clinics operate.” Picture: (Mia Malan) Siviwe GaikaI’m 24 and live in New Brighton, a township in Gqeberha. I’m studying towards a law degree at Nelson Mandela University. It’s my second degree; I already have one in social sciences from Rhodes University. I also run the social media accounts for Advocates for the Prevention of HIV and Aids.Before LEN, I wasn’t using HIV prevention medicine because the only option I knew about was a daily pill. My life is busy: if I’m not in lectures, I’m studying or working. Taking a pill every day would have been one more thing on an already long to-do list.So when I heard about LEN, I thought, ‘If I only have to go to the clinic and deal with the nurses twice a year, I can do that."I got my shot at Kwazakhele Community Health Centre in Gqeberha, about 20 minutes from where I live. But it took three visits.The first time I went, in June, I was told there wasn’t a nurse trained to give LEN. The second time, staff said the clinic didn’t have a certificate to prescribe it.I went back in early July and finally got my shot. I had to wait about four hours, partly because I didn’t have a clinic file and they had to open one for me. There wasn’t a separate queue for LEN either, so I had to wait in the general queue.The nurse who gave me the injection was patient. She explained how LEN works, that I could choose between the daily pill and LEN, and what side effects I might have.She also got me to set a reminder on my phone to take the two LEN pills I needed the next day.I deliberately took the pills in public because I wanted someone to ask me what I was taking. I was in the library when my alarm went off. One person came over and asked about the pills, so my plan worked.I also recorded myself taking them and posted the video on TikTok. I told people what I was taking and how long it had taken me to get LEN — because four hours is a long time to wait.I told them about the two bumps I got under my skin where I was injected too. I couldn’t wear jeans for about two weeks and took a break from the gym. But the bumps gradually got smaller, and they don’t bother me anymore.That’s been my journey.“Everything has now changed for me. There’s an unborn child, so I have to stay safe for him or her,” says Lindiwe Mqatazana, who got her LEN jab in July. Picture: (Mia Malan) Lindiwe MqatazanaI’m 25 and a waste picker, working on contract for the City of Cape Town.In July, I suspected I was pregnant, so I went to Vuyani Clinic in Gugulethu for a test. When it came back positive, I decided there and then that I wanted to start LEN.There’s an unborn child now, so I have to stay safe for him or her.The nurse explained that LEN is safe for me and my baby. After I tested negative for HIV, she told me I could choose between the six-monthly LEN injection and the daily HIV prevention pill. I chose LEN.I had used the daily pill before, but it made me feel nauseous. I also travel home to the Eastern Cape often. When you’re on the road, it’s easy to forget your tablets.Getting LEN was easy. I went to the clinic early in the morning, so they could see me straight away. From walking in to walking out it took about an hour-and-a-half.The nurses used ice to numb the injection sites for about 10 minutes. My friends are scared of LEN because they think it has to be injected into your stomach. But because I’m pregnant, the nurses injected it into my buttocks. You can choose.I can feel a small bump under the skin on my left buttock, but I haven’t had headaches or other side effects.As young women, we often don’t use condoms. We date. But everything has changed for me now that I’m pregnant.I think I’ll tell people at work about LEN too, because some of them are in danger.Dimpho Tsotetsi. Picture: (Mia Malan) Dimpho Tsotetsi I’m Dimpho Divine Tsotetsi. I’m a trans woman and work as a peer educator. I used to work at a donor-funded transgender clinic, but it closed after US President Donald Trump cut funding for such facilities in 2025.I got my LEN shot on July 1 at Chiawelo Community Health Centre in Soweto. I arrived at 9.15am and got the injections at 10.45am.First, I had to join the general queue to get tested for HIV. Once I tested negative, I could move to a special LEN queue.The nurse gave me two LEN tablets. About 30 minutes later, I got two injections, one on each side of my tummy. I have a small bump under my skin at each injection site. [LEN forms a depot under the skin, which slowly releases the medicine over six months.]The bumps bothered me at first. I normally wear a waist trainer, but it was uncomfortable for about a month. Now I wear it only sometimes and choose looser, flowy clothes. I can still feel the bumps when I wear tight clothes.Before LEN, I took the daily HIV prevention pill for nine years. I struggled to take it consistently. You get pill fatigue. You also have to remember to take your pills with you when you go out or travel.So I’m definitely going back for my second LEN shot after six months. The bumps caused some discomfort, but that’s nothing compared with the burden of taking a pill every day.There’s another advantage for trans people. In our community, some people associate taking HIV prevention medicine with being promiscuous. A partner can find your pills. They can’t find an injection you got at a clinic.LEN makes my life simpler.This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.The Bhekisisa Logo (Supplied)