The world's only twice-a-year shot to prevent HIV could stop
transmission — if people can get it
[June 19, 2025]
By LAURAN NEERGAARD
WASHINGTON (AP) — The U.S. has approved the world’s only twice-a-year
shot to prevent HIV, the first step in an anticipated global rollout
that could protect millions – although it's unclear how many in the U.S.
and abroad will get access to the powerful new option.
While a vaccine to prevent HIV still is needed, some experts say the
shot made by Gilead Sciences — a drug called lenacapavir — could be the
next best thing. It nearly eliminated new infections in two
groundbreaking studies of people at high risk, better than daily
preventive pills they can forget to take.
“This really has the possibility of ending HIV transmission,” said Greg
Millett, public policy director at amfAR, The Foundation for AIDS
Research.
Condoms help guard against HIV infection if used properly but what's
called PrEP — regularly using preventive medicines such as the daily
pills or a different shot given every two months — is increasingly
important. Lenacapavir's six-month protection makes it the
longest-lasting type, an option that could attract people wary of more
frequent doctor visits or stigma from daily pills.
But upheaval in U.S. healthcare — including cuts to public health
agencies and Medicaid — and slashing of American foreign aid to fight
HIV are clouding the prospects.
Millett said “gaping holes in the system" in the U.S. and globally "are
going to make it difficult for us to make sure we not only get
lenacapavir into people’s bodies but make sure they come back” twice a
year to keep up their protection.
Gilead’s drug already is sold to treat HIV under the brand name Sunlenca.
The prevention dose will be sold under a different name, Yeztugo. It’s
given as two injections under the skin of the abdomen, leaving a small
“depot” of medication to slowly absorb into the body. People must test
negative for HIV before getting their twice-a-year dose, Gilead warned.
It only prevents HIV transmission — it doesn't block other sexually
transmitted diseases. Some researchers who helped test the shot advise
cold packs to counter injection-site pain.
Global efforts at ending the HIV pandemic by 2030 have stalled. There
still are more than 30,000 new infections in the U.S. each year and
about 1.3 million worldwide.
Only about 400,000 Americans already use some form of PrEP, a fraction
of those estimated to benefit. A recent study found states with high use
of PrEP saw a decrease in HIV infections, while rates continued rising
elsewhere.
About half of new infections are in women, who often need protection
they can use without a partner's knowledge or consent. One rigorous
study in South Africa and Uganda compared more than 5,300 sexually
active young women and teen girls given twice-yearly lenacapavir or the
daily pills. There were no HIV infections in those receiving the shot
while about 2% in the comparison group caught HIV from infected sex
partners.
A second study found the twice-yearly shot nearly as effective in gay
men and gender-nonconforming people in the U.S. and in several other
countries hard-hit by HIV.
Ian Haddock of Houston had tried PrEP off and on since 2015 but he
jumped at the chance to participate in the lenacapavir study and
continues with the twice-yearly shots as part of the research follow-up.
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This photo provided by Gilead Sciences shows packaging for the
company's HIV prevention medication, Yeztugo, (lenacapvir) at a
manufacturing facility in La Verne, Calif., in June 2025. (Gilead
Sciences via AP)
 “Now I forget that I’m on PrEP
because I don’t have to carry around a pill bottle,” said Haddock,
who leads the Normal Anomaly Initiative, a nonprofit serving Black
LGBTQ+ communities.
“Men, women, gay, straight – it really just kinds of expands the
opportunity for prevention,” he added. Just remembering a clinic
visit every six months “is a powerful tool versus constantly having
to talk about, like, condoms, constantly making sure you’re taking
your pill every day.”
Gilead said the U.S. list price, meaning before insurance, is
$28,218 a year, which it called similar to some other PrEP options.
The company said it anticipated insurance coverage but also has some
financial assistance programs.
Most private insurers are supposed to cover PrEP options without a
co-pay although the Supreme Court is considering a case that could
overturn that requirement. Congress also is considering huge cuts to
Medicaid. And while community health centers still are an option,
the Trump administration has largely dismantled HIV prevention work
at the Centers for Disease Control and Prevention that would
normally get the message to vulnerable populations who'd qualify for
the shot, said Carl Schmid of the nonprofit HIV+Hepatitis Policy
Institute.
Schmid worries the shot won't meet its potential because “we’re
basically pulling the rug out of HIV prevention and testing and
outreach programs.”
Gilead also has applications pending for the twice-yearly shot in
other countries. Last fall, the company signed agreements with six
generic drug makers to produce low-cost versions of the shot for 120
poor countries mostly in Africa, Southeast Asia and the Caribbean.
Gilead plans to make enough shots to supply 2 million people in
those countries, at no profit, until the generics are available,
said company senior vice president Dr. Jared Baeten.
Winnie Byanyima, executive director of UNAIDS, said in a statement
the price is still too high. If it's unaffordable, she said, “it
will change nothing.”
And HIV experts worry the arrangements Gilead has made to reduce
costs in some countries leave out middle-income countries like some
in Latin America.
“Everyone in every country who’s at risk of HIV needs access to PrEP,”
said Dr. Gordon Crofoot of Houston, who helped lead the study in
men. “We need to get easier access to PrEP that’s highly effective
like this is.”
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