PrEP in 2026: What Long-Acting Injections Mean for HIV Prevention

HIV prevention is changing fast. In 2026, gay and bisexual men have more PrEP options than ever before. Daily pills are no longer the only choice. Long-acting injections can now protect against HIV for months at a time. Some need just two shots a year.

The World Health Organization (WHO) called this shift a turning point. In July 2025, the WHO recommended lenacapavir as a new PrEP option. The European Medicines Agency followed with a positive opinion in late 2025. This article explains what these new tools are, how well they work, and what they mean for you.

What is PrEP again?

PrEP stands for pre-exposure prophylaxis. It is medicine that HIV-negative people take to stay HIV-negative. When used correctly, PrEP lowers the risk of getting HIV through sex by about 99 percent. That figure comes from the U.S. Centers for Disease Control and Prevention (CDC).

For years, PrEP meant one thing: a daily pill. In the Netherlands, this is usually tenofovir/emtricitabine. It works very well. But daily pills are not for everyone. Some people forget doses. Others do not want a pill bottle at home. Others have side effects.

The new injectable options

Two long-acting injectables are now central to PrEP care.

Cabotegravir (brand name Apretude)

Cabotegravir is given as a shot in the buttock. After two starter doses one month apart, users get one injection every two months. That is six shots a year instead of 365 pills.

The HPTN 083 trial, published in The New England Journal of Medicine, tested cabotegravir in gay and bisexual men and transgender women. It was 69 percent more effective than daily oral PrEP. Not because the pill does not work, but because people stuck with the injections better.

Lenacapavir (brand name Yeztugo)

Lenacapavir goes even further. Users get one injection every six months. That is two shots a year.

The PURPOSE trials, run by drug maker Gilead, showed near-total protection. In the PURPOSE 2 study among gay men, bisexual men, and transgender people, lenacapavir was 96 percent more effective than daily oral PrEP at preventing HIV. The U.S. Food and Drug Administration approved it in June 2025.

Why does this matter?

HIV prevention only works if people actually use it. Studies from Aidsfonds and Soa Aids Nederland show that daily pills are hard for some groups. Younger men, men who travel a lot, and men who do not want partners or family to see medication all report problems.

Injections solve some of these problems. You visit a clinic. You get the shot. You leave protected for months. There is no pill bottle. No daily reminder.

This does not mean pills are outdated. Oral PrEP is cheaper, well-studied, and works excellently for people who take it as prescribed. On-demand PrEP (also called 2-1-1 dosing) is still an option for gay men who plan their sex in advance. The point is choice. More options mean more people can find a method that fits their life.

The catch: price and access

Long-acting PrEP is not cheap. Lenacapavir launched in the United States at around 28,000 dollars per year per person. Cabotegravir costs about 22,000 dollars per year. Daily generic oral PrEP, by contrast, can cost less than 100 euros a year in Europe.

Gilead has signed licensing deals to produce generic lenacapavir for 120 low- and middle-income countries. But most European countries are not on that list. In the Netherlands, injectable PrEP is not yet part of standard care through the sexual health clinics (GGD). Health economists at the RIVM are studying whether the cost is justified by the health benefit.

For now, most Dutch users still get oral PrEP through the national PrEP programme. Injectables may become available more widely from 2026 to 2028, depending on price negotiations and health insurance decisions.

What about side effects?

Both drugs are generally well tolerated. The most common side effect is pain, swelling, or a small lump at the injection site. This usually fades within a week.

Some users of cabotegravir reported fever or headache after the first shots. Serious side effects were rare in trials. Long-term safety data is still growing, since these drugs are new.

One important note: if you stop injectable PrEP, the drug slowly leaves your body over months. During this "tail" period, low drug levels could allow HIV to develop resistance if you get infected. Clinicians recommend switching to oral PrEP or getting regular HIV tests after stopping.

PrEP is not the whole picture

PrEP prevents HIV. It does not prevent other sexually transmitted infections. Rates of syphilis, gonorrhoea, and chlamydia are rising in the Netherlands, according to RIVM data from 2024. Condoms still matter. So does regular testing.

New tools help here too. Doxy-PEP, a single dose of doxycycline taken after sex, can lower the risk of bacterial STIs. And anal cancer screening is becoming more common for gay and bi men, especially those living with HIV.

What should you do?

If you already take oral PrEP and it works for you, there is no urgent reason to switch. Daily tenofovir/emtricitabine remains highly effective and affordable.

If you struggle with daily pills, or if oral PrEP is not medically suitable for you, talk to your GP or sexual health clinic about injectable options. In the Netherlands, ask at your GGD PrEP clinic. In Belgium, ask at an aidsreferentiecentrum.

Global HIV prevention is at a difficult moment. US aid cuts have reduced access in many low-income countries. Long-acting PrEP is a scientific breakthrough. Whether it becomes a public health breakthrough depends on price, policy, and access.

The tools exist. The question now is who gets to use them.