A groundbreaking HIV prevention injection, Yeztugo (lenacapavir), recently approved by the U.S. Food and Drug Administration, promises to significantly reduce new infections worldwide, including in Southeast Asia. Experts say this long-acting, twice-yearly shot could help overcome challenges associated with daily HIV-prevention pills, potentially transforming the fight against HIV/AIDS. However, questions about accessibility, cost, and implementation remain—issues of particular concern for middle-income countries like Thailand.
For Thais, HIV remains a chronic social and public health issue. Despite major progress in prevention and treatment, approximately 5,000 new HIV infections occur annually, according to the Department of Disease Control and UNAIDS (UNAIDS Thailand). While daily pre-exposure prophylaxis (PrEP) pills—such as Truvada and Descovy—have been available, adherence is often hindered by stigma, cost, and the burden of taking medicine every day. Yeztugo aims to change that with a simple regimen: two oral doses followed by a subcutaneous injection every six months.
Research supporting the FDA’s approval of Yeztugo included two landmark clinical trials, with one conducted among over 5,000 young women and girls in South Africa and Uganda. Strikingly, none who received the shot contracted HIV during the trial period. Another study involving men and gender-diverse individuals found that the Yeztugo group had only two HIV infections versus nine in the group that took Truvada daily, suggesting that the shot is at least as effective as current gold-standard prevention (Washington Post).
Yeztugo works by targeting the capsid protein of HIV, a structure critical for the virus to mature and infect cells. According to the director of the UCLA Center for Clinical AIDS Research and Education, the injection “blocks the virus from, essentially, setting up shop in the body" by stopping viral replication at its earliest stage. The injection is recommended for HIV-negative individuals at risk of contracting the virus, and a test for HIV status is required before each dose to prevent the development of drug-resistant strains.
The greatest strength of Yeztugo lies in its potential to improve adherence. The medical director of the HIV Clinic at Ward 86, University of California at San Francisco, stated: “Every PrEP option available is almost 100 percent effective if used correctly, but it’s hard to take that pill every day. And it’s hard to stay on that pill for years and years.” For people struggling with homelessness or substance use—groups identified as vulnerable in both the U.S. and Thailand—long-acting injectables could make a meaningful difference.
However, the medication’s cost is a substantial barrier. At over $14,000 per dose ($28,218 annually), Yeztugo’s price is on par with the bimonthly PrEP injection cabotegravir (Apretude) and dwarfs the monthly $30 generic Truvada pill. While most U.S. insurance plans are compelled by federal rules to cover PrEP without copays, public health advocates, like the associate professor of medicine at Johns Hopkins School of Medicine, are worried about the ability of insurance schemes and public health systems outside the U.S. to shoulder such costs. “The more people who know about it, the better…this is a really empowering step,” she said, but acknowledged that affordability could determine the shot’s real-world impact.
In Thailand, external support (including funding from the Global Fund and PEPFAR) and domestic health insurance under the Universal Coverage Scheme have ensured a steady supply of affordable PrEP, especially for key affected populations such as men who have sex with men (MSM), sex workers, and transgender individuals (Thailand Ministry of Public Health). As recently as 2023, Thailand announced plans to expand PrEP access and integrate HIV prevention into community clinics. However, incorporating a high-cost injectable like Yeztugo would require significant negotiation on pricing, adaptation of clinical protocols, and robust monitoring systems.
Cultural and social factors also play a role in how new interventions are adopted in Thailand. Stigma surrounding both HIV and sexual behaviors can limit willingness to seek PrEP or discuss options with health providers—echoing findings from the U.S. Centers for Disease Control and Prevention that only a fraction of eligible individuals globally currently receive PrEP (CDC HIV Prevention). For many Thais, especially youths, privacy, convenience, and reduced contact with healthcare systems could make twice-yearly injections more appealing than daily pills.
Another expert, a professor at the Emory University School of Medicine, described lenacapavir as “groundbreaking,” adding that reduced visits to healthcare settings could lessen the burden for both providers and patients, making it easier to scale up prevention initiatives. Still, the director of the UCLA Center for Clinical AIDS Research and Education warned that high costs, as well as persistent social and structural barriers—ranging from health literacy and insurance access to discrimination—could limit uptake in lower-income groups.
Globally, new HIV infections are falling as prevention, testing, and treatment strategies improve, with UNAIDS reporting a 12 percent decrease in new cases in the U.S. from 2018 to 2022, due in part to wider PrEP adoption. In Thailand, similar declining trends have been observed, though young people and marginalized communities remain disproportionately affected. The introduction of Yeztugo offers new hope for accelerating progress, but as one expert cautioned, “Preventive therapeutics are critical, but vaccines are also going to be necessary for us to really end the HIV epidemic, which I think is the goal of everyone who works in this field.”
Looking ahead, Thailand’s public health officials and civil society organizations must carefully weigh the trade-offs between investing in next-generation prevention options and expanding access to proven, more affordable methods. The emergence of Yeztugo coincides with global budget constraints for HIV services, raising questions about resource allocation and long-term sustainability (Science - Breakthrough of 2024). Researchers and policymakers will watch closely as Thailand and other countries negotiate with manufacturers for price reductions and as real-world efficacy data accumulates.
For Thai readers—especially those at risk, or with loved ones vulnerable to HIV—the most important steps remain getting tested regularly, talking with knowledgeable healthcare professionals about all available prevention options, and engaging with local support networks. As new tools like Yeztugo arrive, staying informed and advocating for equitable access will be key to protecting individuals and accelerating the end of HIV in Thailand.
Key recommendations for Thai readers:
- Monitor updates on Yeztugo’s potential registration and price negotiation in Thailand via the Ministry of Public Health;
- Individuals at ongoing risk for HIV should continue daily PrEP, using affordable generics unless a medical provider offers new options;
- Take advantage of free HIV testing available at government clinics and community health centers;
- Maintain open communication with healthcare providers about prevention methods, side effects, and adherence challenges;
- Support community-led education campaigns to reduce stigma and encourage HIV prevention.
For additional details, readers can consult resources provided by the Department of Disease Control, UNAIDS Thailand, and international health partners to stay updated on prevention options, insurance coverage, and the progress of new medical technologies.