South Africa has made significant progress in responding to HIV, but the scale of the challenge remains considerable. In 2024, an estimated 7.8 million people were living with HIV and 170,000 people acquired HIV. New prevention options, including long-acting pre-exposure prophylaxis (PrEP) such as lenacapavir, could help accelerate efforts to prevent new infections.
But making a new prevention option available does not automatically make it accessible.
For key populations,* whether HIV prevention works in practice can depend on where services are offered, whether people feel safe and respected when seeking care, whether health workers have the information they need, and whether communities know what prevention options are available to them.
UNDP’s Power of Prevention (PoP) project, supported by the Gates Foundation, provides small grants to community-led organizations working with key populations to strengthen HIV prevention advocacy. Through the project, these organizations are bringing lived experiences and locally generated evidence into policy discussions and advocacy, helping make the case for sustainable financing, more equitable access and health policies, and services that respond to the needs of key populations.
After the first year of implementation, PoP brought grantee organizations together to review progress, share lessons and identify where their approaches could be strengthened. The discussions helped surface common themes across different communities and locations and sharpen priorities for the next phase of advocacy.
Bringing community experience into decisions in the Free State
In the Free State, Rainbow Seeds is using community experience to advocate for better access to HIV prevention and stronger support for key populations. Through community consultations, the organization is gathering perspectives on people’s experiences of prevention services and the barriers they face in accessing and using them.
For Thabiso Marshall Chaka, Programs Director at Free State Rainbow Seeds, the goal is ultimately about ensuring that key populations can benefit fully from the prevention options and health services available to them.
"For me personally, one death is too many. We cannot afford to have anyone in key populations dying or contracting HIV unnecessarily when effective prevention methods like oral PrEP and lenacapavir exist,” he said.
“I want us to reach an HIV-free key population in the province. I also want every available healthcare resource – whether sexual and reproductive health for trans men, trans women or gay men – to be accessible whenever and wherever they need it. When people are supported in their health, they thrive in all aspects of life."
Connecting community preferences with the health system
OUT LGBT Well-being is using community evidence to inform advocacy and support implementation of new HIV prevention options. Its engagement with key populations has highlighted strong interest in long-acting PrEP, alongside questions and concerns about side effects, continuity of supply and how the rollout will work in practice.
“There is immense excitement. In our surveys, participants expressed a strong desire to take lenacapavir,” said Sibonelo Ncanana-Trower of OUT LGBT Well-being.
Ensuring people have clear and reliable information is an important part of translating that interest into uptake. OUT has been using its community networks and digital platforms to address misconceptions about lenacapavir and help people identify where services are available.
“We now run weekly social media campaigns to clarify misconceptions and publish updated lists of verified facilities initiating LEN. This evidence-based outreach directly addresses community hesitation,” said Sibonelo Ncanana-Trower.
OUT is also using weekly social media campaigns to address misconceptions about lenacapavir and share updated information on facilities providing it, helping communities navigate new prevention options as they become available.
Turning community evidence into action
In the Northern Cape, the Shaine Griqua Advice and Development Centre is using community-led monitoring, advocacy dialogues and outreach to identify barriers to HIV prevention and bring them directly to health authorities. Its work has also included training for key population representatives and community mobilization around HIV prevention.
Through its monitoring, the organization identified practical problems, including expired oral PrEP remaining in facility storerooms, limited community information about its availability and low levels of PrEP awareness. These concerns were escalated to district and provincial health authorities, helping open opportunities for the organization to conduct community health talks directly in healthcare facilities.
“Community-generated data paves the way for strategic interactions with key stakeholders, including the government and the private sector. It provides the empirical evidence we need to advocate effectively for HIV prevention services,” said Shaine Griqua.
The organization’s consultations have also highlighted why choice matters. Community members described challenges with taking a daily pill, stigma linked to oral PrEP being mistaken for HIV treatment and concerns about taking medication while experiencing food insecurity. These experiences are helping strengthen advocacy for wider access to long-acting prevention options.
From individual voices to collective action
At the same time, the PoP Community of Practice is bringing organizations working with different key populations together to compare what they are seeing on the ground and identify common priorities. These discussions are helping grantees see where their challenges overlap and where coordinated advocacy could have greater impact.
As PoP moves into its next phase, the focus will be on turning these shared insights into more targeted engagement with decision-makers, while strengthening the role of key populations in shaping HIV prevention policies and services.
Ultimately, the promise of new prevention technologies will depend on how well they respond to the realities of the people who need them. PoP is helping ensure those realities – and the voices behind them – are part of the decisions shaping the future of HIV prevention in South Africa.
* Key populations is a term for population groups that are particularly vulnerable to HIV and frequently lack adequate access to services. They include gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people.
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