What South Africans need to know about the new once-a-month HIV prevention pill

South Africans are seeing headlines about a once-a-month HIV prevention pill called alimatravir, but the medicine remains investigational and is not yet available to the public.

What is alimatravir?

Alimatravir is an investigational oral medicine being studied as a form of pre-exposure prophylaxis (PrEP). PrEP is medication taken by HIV-negative people to reduce their risk of contracting HIV. Unlike the daily oral PrEP currently available, alimatravir is designed to be taken once a month.

Is it available in South Africa?

No. The medicine is still being evaluated in Phase III clinical trials to determine whether it is safe and effective. Before it can be used in South Africa it would need approval from the country’s medicines regulator, the South African Health Products Regulatory Authority (SAHPRA).

Does it replace existing prevention options?

Not at this stage. Daily oral PrEP remains one of the effective prevention options when taken as prescribed. Other prevention options mentioned include condoms, post-exposure prophylaxis (PEP), voluntary medical male circumcision and regular HIV testing. Long-acting injectable PrEP has also emerged internationally as another prevention option, with access varying between countries. If approved, the monthly pill would add another choice rather than replace existing methods.

Why this matters for South Africa

South Africa has one of the world’s largest HIV epidemics. According to UNAIDS, millions of South Africans are living with HIV, while thousands of new infections are recorded every year. Health experts in the reporting have said expanding the range of prevention options is essential because different medicines suit different people and lifestyles. A once-a-month pill could make prevention more practical for some individuals who struggle with daily dosing, though experts caution more evidence is needed before the medicine could become part of routine programmes.

Why Aspen Pharmacare’s role was highlighted

An agreement announced by Aspen Pharmacare and US pharmaceutical company MSD aims to expand access to the investigational medicine across Africa if it is approved by regulators. Aspen said it plans to manufacture, market and distribute alimatravir on the continent. The companies framed the deal as a way to strengthen Africa’s ability to manufacture advanced medicines closer to where they are needed, a point underscored by lessons from the COVID-19 pandemic about dependence on imports.

What happens next

The outcome of the ongoing Phase III clinical trials will determine whether alimatravir can be submitted to regulators for approval. If trials are successful, regulatory authorities, including SAHPRA, would assess the evidence before deciding whether the medicine can be used in South Africa. Until then, health authorities encourage people at risk of HIV infection to continue using proven prevention methods and to speak to healthcare providers about whether existing PrEP options are appropriate for them.