HIV prevention is entering a new stage. In the past, the conversation was most often built around condoms, testing, PEP, daily PrEP or the U=U approach. Today, there is growing discussion about long-acting prevention — methods that do not require taking tablets every day.
It sounds like a breakthrough. But it is important to talk about it without hype. A new tool does not, in itself, solve questions of access, price, confidentiality, logistics, stigma or inequality between capitals and regions. This is especially true in Central and Eastern Europe and Central Asia, where HIV prevention often depends not only on medical recommendations, but also on funding, political will, the role of communities and the system’s ability to see people’s real needs.
Long-acting prevention is an approach in which a medicine works for longer than a daily tablet. In the context of HIV, this most often refers to injectable forms of PrEP — pre-exposure prophylaxis for people who do not have HIV but may have an increased need for protection.
In 2025, particular attention focused on lenacapavir — an HIV prevention medicine administered twice a year. In the United States, the medicine, under the name Yeztugo, was approved as PrEP for adults and adolescents weighing at least 35 kg who have a chance of acquiring HIV. In July 2025, WHO recommended lenacapavir as an additional PrEP option for HIV prevention. In the EU, lenacapavir, under the name Yeytuo, received marketing authorisation on 25 August 2025 for the prevention of sexual transmission of HIV-1 in adults and adolescents weighing at least 35 kg who have an increased chance of acquiring HIV.
Important: long-acting PrEP is not a vaccine and it is not HIV treatment. It is one method of prevention for people who do not have HIV. It does not replace testing, does not protect against other sexually transmitted infections and does not remove the need for informed choice.
Why can this be convenient?
For many people, a daily tablet is not simply “a reminder on the phone”. It can be a question of privacy, fear, stigma, daily routine, relocation, unstable housing, work, relationships or access to a healthcare provider.
A long-acting approach can be important for people who find it difficult to take a medicine every day; for those who do not want to keep tablets at home because of the risk of disclosure; for people in migration; for young people; for people who face stigma in healthcare settings; for sex workers; for people who use drugs; for gay men, bisexual men and other men who have sex with men; for trans people; for people in detention settings; and for everyone who needs a prevention tool that better fits their life.
This is the core idea of informed choice — not one universal method for everyone, but the possibility to choose the prevention option that works for a particular person.
But convenience does not mean simplicity
Two injections a year may sound simpler than a daily tablet. But implementing long-acting prevention is a complex process.
Protocols are needed. Procurement is needed. Trained specialists are needed. Regular HIV testing is needed before starting and during the use of PrEP: the label for Yeztugo directly states that a person should be tested for HIV before starting the medicine and before each subsequent injection. Systems for appointments, reminders and support are needed. There must be a clear understanding of what happens if a person misses an appointment, moves to another country, loses insurance coverage or no longer wants to continue this method.
A long-acting medicine is more difficult to “just stop” than a tablet. The official information for Yeztugo states that residual concentrations of lenacapavir may remain in the body for up to 12 months or longer. This does not mean that the tool is “dangerous”. It means that people need honest information about how the medicine works, what to do if an injection is missed, how to switch to another method and why regular testing remains essential.
The research data look very strong, but they must be presented accurately and without exaggeration. According to Gilead, the FDA approval in the United States was based on the PURPOSE 1 and PURPOSE 2 studies: in PURPOSE 1, no new HIV cases were recorded among 2,134 participants in the Yeztugo group; in PURPOSE 2, two HIV cases were recorded among 2,179 participants in the Yeztugo group. EMA also presents these data in its review of Yeytuo and notes that a twice-yearly injection may help people adhere to a PrEP regimen compared with options that require daily use.
But effectiveness in studies is only one part of the story. The second part is whether a person will have real access to this method in the country, city, clinic and system where they live.
A new tool ≠ access
The biggest question today is not only “does the medicine work?”, but “who will actually be able to use it?”
Access is not defined only by scientific results. It is defined by price, registration, national guidelines, budgets, insurance coverage, procurement, logistics, availability of services and whether the system is ready to work with people without judgement.
In the United States, the annual price of Yeztugo is estimated at more than USD 28,000, while in Europe, access after authorisation will depend on price and reimbursement negotiations in each country. Gilead has also signed royalty-free voluntary licensing agreements with six generic manufacturers for 120 countries, mainly low- and lower-middle-income countries, and has stated its intention to supply the medicine on a no-profit basis until generic manufacturers are able to fully meet demand. At the same time, the discussion about which countries are included in such mechanisms, and which remain outside them, has already become part of a wider question of equitable access.
For Central and Eastern Europe and Central Asia, this is especially important. In our region, access to HIV prevention is often already unequal: between countries, between cities and regions, between people with and without documents, between those who have insurance and those who fall outside formal systems. If long-acting prevention is available only in selected private clinics or only in large cities, it will not become a tool of equity. It will become another marker of inequality.
HIV prevention works when people are not afraid to ask questions. When they do not have to explain their life to a healthcare provider who judges them. When they can receive information in their own language. When testing is confidential. When a person understands that PrEP is not a “sign of risk”, but a responsible choice to care for oneself.
That is why community-led services, peer support, information platforms, outreach and local organisations need to be part of long-acting prevention implementation from the very beginning. Not after protocols have already been written without people. Not as a “communications add-on”. But as part of the design of access.
This is especially critical in the context of funding cuts. According to early UNAIDS data, in 2025 access to HIV prevention in a number of countries fell sharply because of cuts in international assistance: the number of people receiving PrEP in 62 countries dropped by 38%, from 3.3 million in 2024 to 2.1 million, while condom funding in some places fell by more than 90%. This is an important reminder: innovations cannot compensate for the destruction of basic services.
What questions should be asked now?
The first question is price. How much will long-acting PrEP cost the state, the donor, the insurance system and the person themselves? Will it be free for those who need it? Or will it be available only to those who can pay?
The second is prioritisation. Who will receive access first? Will key communities, people in migration, refugees, people without stable income, people without documents or people with limited access to the healthcare system be among the priority groups?
The third is geography. Will long-acting PrEP be available outside capital cities? Will a person be able to receive an injection in the region where they live, instead of travelling several hours to a large city? Will there be a continuation system if a person relocates?
The fourth is confidentiality. Will a person be able to receive counselling, testing and the medicine without the risk of disclosure? How will their data be protected? Who will have access to information about their visits?
The fifth is informed choice. Are all available options explained to the person: condoms, PEP, daily PrEP, injectable PrEP, testing, U=U, treatment for sexually transmitted infections and harm reduction? Does the person have the right to say: “This does not work for me, I want another method”?
The sixth is the role of communities. Are community organisations involved in planning? Can they help with navigation, support, reminders, explanations and referrals? Is this work funded?
The seventh is sustainability. What will happen in one year, two years, three years? Will the programme start as a pilot that ends quickly? Is there a plan for procurement, training, monitoring and transition between methods?
For Central and Eastern Europe and Central Asia, long-acting prevention can be an important opportunity. But it should not come to the region as an “expensive symbol of progress”. It should come as part of a broader prevention ecosystem.
This means that alongside new medicines, there must be accessible testing, PEP, daily PrEP, condoms, needle and syringe programmes, opioid agonist therapy, HIV treatment, mental health services, legal and social support, navigation for people in migration and services that do not place a person in a situation of shame or fear.
European authorisation does not mean automatic access in every country. EMA can confirm that a medicine is authorised for use in the EU, but actual access depends on national decisions on price, reimbursement, procurement, clinical protocols and the patient pathway. This is where the key conversation for Central and Eastern Europe and Central Asia begins: how to make sure innovation does not remain on paper or in a few consulting rooms in capital cities.
Innovation without access is not equity. Innovation without confidentiality is a risk. Innovation without communities is weak implementation. Innovation without funding is a promise that may never reach people.
Long-acting prevention can change the future of HIV prevention. It can give people more freedom, privacy and choice. It can help those for whom a daily tablet is not the right option. It can become an important part of the HIV response in Central and Eastern Europe and Central Asia.
But the main question is not whether a new tool has appeared. The main question is whether a person will actually be able to use it.
HIV prevention should not be a privilege for those who live in a capital city, have documents, money, insurance and safe access to a healthcare provider. It should be part of the right to health — with respect for privacy, dignity, informed choice and people’s real lives.
