A new long-acting HIV prevention injection, Yeztugo (lenacapavir), has earned approval from U.S. regulators and promises to curb new infections globally, including in Southeast Asia. Experts say a biannual shot could overcome adherence hurdles tied to daily PrEP pills, potentially speeding progress against HIV/AIDS. Yet questions about cost, availability, and implementation loom—especially for middle-income countries like Thailand.
In Thailand, HIV remains a serious public health and social issue. Despite gains in prevention and treatment, about 5,000 new infections occur each year, according to the Department of Disease Control and data from UNAIDS in Thailand. While daily PrEP pills such as Truvada and Descovy are available, adherence is often hindered by stigma, affordability, and the burden of daily dosing. Yeztugo aims to change this with a simple regimen: two oral doses followed by a semiannual injection.
Two major clinical trials supported the FDA approval. One study, conducted among over 5,000 young women and girls in Africa, found no HIV infections among those who received the shot during the trial. Another trial involving men and gender-diverse individuals reported two HIV infections in the Yeztugo group versus nine in the daily PrEP group, suggesting competitive or superior effectiveness to current options.
Yeztugo targets the HIV capsid protein, essential for the virus to mature and infect cells. A leader at the UCLA Center for Clinical AIDS Research and Education noted that the injection interrupts the virus’s ability to establish itself in the body, effectively halting replication at an early stage. The injection is intended for HIV-negative individuals at risk, with HIV testing required before each dose to prevent drug resistance.
The major advantage of Yeztugo is improved adherence. A medical director at a prominent San Francisco clinic noted that while all PrEP methods can be highly effective with correct use, taking a pill daily for years poses real challenges. For people experiencing homelessness, substance use issues, or other barriers—groups recognized in both the United States and Thailand—long-acting injectables may offer meaningful benefits.
Cost, however, is a critical obstacle. Priced at more than $14,000 per dose (roughly $28,000 per year), Yeztugo is expensive and mirrors the price of other injectables while far exceeding the cost of generic daily Truvada. In the United States, most insurers are obligated to cover PrEP with minimal to no copay, but affordability remains a concern for health systems in other countries. Advocates caution that real-world impact depends on pricing and coverage adequacy.
Thailand’s public health framework has long supported affordable PrEP through funding from international partners and national insurance under the Universal Coverage Scheme. This ensures access for key populations, including men who have sex with men, sex workers, and transgender individuals. Thailand also aimed to broaden PrEP access and incorporate HIV prevention into community clinics in 2023. Introducing Yeztugo would require pricing negotiations, protocol adjustments, and robust monitoring within the Thai health system.
Cultural and social factors influence adoption of new HIV interventions in Thailand. Stigma around HIV and sexual behavior can deter people from seeking PrEP or discussing prevention options with clinicians. Nevertheless, many Thai youths value privacy, convenience, and reduced health-system contact, which could make a biannual shot appealing.
Medical experts warn that while lenacapavir is groundbreaking, high costs and persistent social and structural barriers—such as health literacy, insurance access, and discrimination—could limit uptake among lower-income groups. A professor at Emory University called the drug transformative, while the UCLA team emphasized that affordability remains a decisive factor for widespread use.
Global trends show declining new HIV infections as prevention, testing, and treatment expand. In the United States, UNAIDS notes a double-digit drop in new cases between 2018 and 2022, partly due to broader PrEP use. Thailand has seen similar progress, yet disparities persist among youth and marginalized communities. Yeztugo offers a potential acceleration in prevention, but experts caution that vaccines and additional tools are still crucial to ending the epidemic.
Going forward, Thai health authorities face the challenge of weighing next-generation prevention against expanding access to proven, affordable options. The Yeztugo development arrives as global HIV program budgets tighten, raising questions about sustainable investment. Researchers and policymakers will monitor pricing negotiations with manufacturers and real-world effectiveness data as Thailand considers pathways to broaden prevention.
For Thai readers at risk or with loved ones affected by HIV, essential steps remain: get tested regularly, speak with healthcare professionals about prevention options, and engage with community networks. As new tools emerge, staying informed and advocating for equitable access will help protect individuals and advance Thailand’s HIV response.
Key recommendations for Thai readers:
- Monitor potential registration and pricing developments for Yeztugo through the Ministry of Public Health.
- Continue using affordable PrEP options unless a healthcare provider advises otherwise.
- Access free HIV testing at government clinics and community health centers.
- Maintain open dialogue with providers about prevention methods, side effects, and adherence challenges.
- Support community-led efforts to reduce stigma and boost prevention awareness.
For more information, readers can consult Thailand’s Department of Disease Control, UNAIDS Thailand, and partners in international health, to stay updated on prevention options, insurance coverage, and the progress of new therapies.