MBABANE- More than 11 000 people started pre-exposure prophylaxis (PrEP) in the first quarter of 2026, signalling growing demand for HIV prevention options as Eswatini expands access to long-acting medication.
A total of 11 359 people-initiated PrEP between January and March 2026, the highest quarterly figure recorded across the five quarters reviewed by the Ministry of Health and the National Emergency Response Council on HIV and AIDS (NERCHA).
The figure represents an increase of 3 093 initiations, or just over 37 per cent, compared to the 8 266 people who started PrEP during the corresponding quarter in 2025.
The figures were presented by Dr Bongani Masango, Director of HIV Response and Coordination, during a meeting where NERCHA was in dialogue with the Editors’ Forum held at Emafini, where journalists were briefed on developments in the country’s HIV response.
The meeting also heard that Eswatini is making progress in reducing HIV-related deaths, with the country now recording about 3 000 such deaths, representing a decline of more than 50 per cent across all age groups.
PrEP is an HIV prevention medicine taken by people who are HIV-negative to reduce their risk of acquiring the virus.
Eswatini now has four PrEP options; daily oral pills, monthly injectable cabotegravir (CAB), twice-yearly injectable lenacapavir (LEN) and the monthly dapivirine vaginal ring for women.
The latest figures show that the sharpest growth has been recorded in injectable PrEP, particularly lenacapavir.
Lenacapavir only began appearing in the national data during the October to December 2025 quarter, when 213 people initiated the drug. By January to March 2026, the figure had jumped to 2 881 initiations.
According to the Ministry of Health and NERCHA data, the increase in national PrEP uptake was largely driven by lenacapavir. Cabotegravir has also recorded steady growth, increasing from 828 initiations in the first quarter of 2025 to 2 022 during the first quarter of 2026. Oral PrEP remains the most widely used option in absolute numbers, although its proportion of total initiations has declined as injectable options have become available.
Oral initiations stood at 7 119 in the first quarter of 2025 before falling to 5 911 in the third quarter. The figure subsequently recovered to about 6 280 and remained around that level in the final two quarters reviewed. The dapivirine ring recorded the lowest and most inconsistent uptake, ranging between 144 and 319 initiations per quarter.
Dr Masango said the increasing availability of PrEP should not be interpreted as a replacement of condoms, particularly because PrEP protects against HIV but not other sexually transmitted infections (STIs).
He raised concern that the growing availability of PrEP appeared to be accompanied by reduced condom use among some people, with STI figures continuing to rise. “STIs continue to grow because people no longer use condoms because of the availability of PrEP,” Dr Masango said.
The concern comes against the backdrop of international guidance which stresses that PrEP and condoms serve different prevention purposes.
The World Health Organization (WHO) states that condoms should be offered alongside PrEP because PrEP prevents HIV, but does not protect against other STIs or unintended pregnancy. WHO also says condoms remain among the most effective methods of preventing most STIs when used correctly and consistently.
The rapid growth in PrEP uptake nevertheless represents an important development in Eswatini’s HIV prevention response, particularly as the country offers people a wider range of prevention choices.
Health officials stressed that the growth of injectable PrEP should be viewed as an expansion of choice rather than evidence that existing methods are becoming obsolete.
For people who find it difficult to take a pill every day, long-acting options may make it easier to maintain HIV prevention.
The introduction of lenacapavir has been particularly significant because it requires only two injections a year. WHO recommended lenacapavir as an additional long-acting PrEP option in 2025. The growing demand has, however, raised questions about whether the country has sufficient supplies to meet uptake.
A question from the floor asked whether Eswatini had enough PrEP doses, whether people were willing to access the services and whether sensitisation efforts were reaching the masses, particularly amid reports of shortages in some African countries.
Dr Masango assured the forum that Eswatini had adequate stocks. “We have enough stock as a country,” he said. He explained that government had anticipated the possible demand for injectable PrEP and established pilot centres around the country before the rollout.
“Before we started the injectable PrEP, we set up pilot centres around the country to gauge the uptake,” he said. He said the pilot programme helped government understand the likely demand and plan accordingly.
The assurance comes as some African countries have reported supply constraints during the rollout of lenacapavir.
A May 2026 report by Sci Dev net reported that demand for the twice-yearly HIV prevention injection was outpacing supply in parts of Africa and that stocks in some countries had been depleted during the early rollout.
More recent, reporting by aidsmap in July also noted that demand for lenacapavir was outstripping supply in some instances across Africa.
Dr Masango attributed Eswatini’s relative resilience to government investment in the national HIV response. He said the country was among those less severely affected when the US Government withdrew funding from NGOs earlier this year because government had already invested in procuring treatment and was not as heavily dependent on external funding.
The meeting also focused on findings from the HIV Prevention Indaba Study and the role of the media in strengthening positive social and cultural values that support sustainable HIV prevention.
The increased uptake of PrEP presents an opportunity for the country to strengthen HIV prevention, but health officials face the parallel challenge of ensuring that new prevention technologies do not undermine other measures.
With more than 11 000 people initiating PrEP in a single quarter, the figures point to growing acceptance of biomedical HIV prevention.
However, the continued rise in STIs, as highlighted by Dr Masango, suggests that the expansion of PrEP must be accompanied by renewed messaging around condoms, regular STI testing and comprehensive sexual health services.
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