South Africa launched the most promising new HIV prevention tool in years. Spotlight asks whether we can successfully deliver lenacapavir without the trusted pathways decimated by cuts to aid from the US.

When 29-year-old Keegan Daniels* visited a public hospital outside Cape Town earlier this year to be placed on medication to prevent HIV infection, he says he wasn't sure what to expect, but it definitely wasn't to be reprimanded, lectured and told that anal sex "is abnormal".

Oral pre-exposure prophylaxis (oral PrEP) refers to antiretroviral tablets taken to prevent HIV infection. When used as prescribed, oral PrEP has been shown to reduce the risk of HIV infection from sex, including in men who have sex with men (MSM), by about 99%, according to a 2022 meta-analysis.

During the short consultation, Keegan claims the doctor, who appeared unfamiliar with prescribing PrEP, chastised him for addressing him as "sir" rather than "doctor", and made assumptions about his sexual orientation.

"I am gay, but when he told me I was 'homosexual' instead of asking me, I felt as if I was there to be shamed instead of helped," says Keegan, who identifies as a gay man.

Keegan tells Spotlight that he sought out oral PrEP after an experience that left him worried about his HIV risk. As a man who has sex with other men, he is also part of a population disproportionately...