Update of the long-acting injectable HIV pre-exposure prophylaxis (PrEP) drug lenacapavir grew faster upon its release than the injectable PrEP cabotegravir, but it remains a very small overall proportion of overall PrEP use and reveals substantially less relative uptake among Black, Hispanic, and younger people compared with White and older people, according to findings presented at the AIDS 2026 meeting in Rio de Janeiro, Brazil.

“Inequity in lenacapavir provision by race, ethnicity, and age mirrors very closely inequities we’ve seen in more established modalities,” Aaron Siegler, PhD, professor of epidemiology at Emory University in Atlanta, told attendees. “So, within just 6 months of release, we are seeing the same inequities that we have seen for 14 years of oral PrEP. So clearly, there are system factors at play here.”

Pamela Foster, PhD, provost and vice president for academic affairs at Tougaloo College in Jackson, Mississippi, and previously a professor of medicine specializing in HIV and inequities at the University of Alabama, Tuscaloosa, noted the importance of clinicians paying attention to barriers to uptake of new medicines, “particularly in populations who are most affected by HIV in the US,” she said.

“For example, there are still many in the community who don’t know what PrEP is, and secondly, for many the cost of this type of PrEP is too expensive if not covered by insurance,” she said. “Strategies to overcome these barriers need to be elucidated.”

Lenacapavir received FDA approval for PrEP in June 2025, so Siegler and colleagues examined its uptake using national claims data for the subsequent 6 months, from June 2025 to December 2026. The claims data — from clearinghouses, pharmacy benefit managers, hospital systems, pharmacies, and other sources — represent about 80%-90% of prescriptions in the US, and the researchers used an algorithm to remove lenacapavir, cabotegravir, and oral PrEP prescriptions used for HIV treatment or post-exposure prophylaxis.

During that 6-month period, 7134 people in the US used lenacapavir PrEP, compared with 31,868 using cabotegravir PrEP and 533,878 using oral PrEP. Siegler provided additional context for those numbers that suggested slow overall uptake for long-acting injectable PrEP.

“Oral PrEP has had 14 years on the market, cabotegravir about 4, and lenacapavir about half a year at the time of this analysis, and we can see that injectable modalities have a lower-than-expected proportion, even accounting for time on market,” he said.

Most of the PrEP users were men, including 91% of oral PrEP users, 86% using cabotegravir, and 85% using lenacapavir. As with oral PrEP and cabotegravir, lenacapavir uptake was lowest among Black (17%) and Hispanic (17%) people compared with White (61%). People aged 24 years and younger also had lower uptake of lenacapavir (8%) compared with those aged 25-34 years (31%), 35-44 years (31%), and 45 years and older (30%), similarly mirroring the breakdown of proportions for cabotegravir and oral PrEP.

To determine how equitable the use of lenacapavir was, the researchers calculated a PrEP equity ratio that assesses how much different demographic groups are accessing and using PrEP based on their need, which is based on rates of new HIV diagnoses in their demographic group.

“PrEP equity ratios allow us to compare across medication types with very different numbers of users,” where a ratio of 1 represents perfect equity, Siegler explained.

Using men as the reference for sex, the PrEP equity ratio for women was 0.78, showing only modestly lower equity, which Foster found “encouraging.”

“I was surprised by the increased uptake of this medicine for women vs men,” she said. “Initially, PrEP uptake in women was low, probably due to lack of marketing to women.”

Equity was substantially lower, however, for Black (0.17) and Hispanic (0.19) users compared with White users, and for those aged 24 years and younger (0.31) compared with those aged 35-44 years.

Overall uptake of lenacapavir was faster upon its release than cabotegravir was at its release, with more than double the fills in the first 2 months and over five times the fills in the first 4 months, but there were differences in uptake by insurance type and high copay levels, “likely indicating insurance-related barriers may be impeding uptake,” he said. Uptake of lenacapavir among those with a copay above $100 was only 5% compared with 95% paying less than $100, and over half those taking lenacapavir had commercial insurance (57%) compared with those on Medicaid (28%) or with another insurance status (16%). 

“New interventions and policies are needed to make it easier for individuals in the US to access injectable PrEP,” he said. He noted that a US PrEP clinic locator website was just launched a few weeks ago that allows people to search for clinics near them that offer injectable PrEP.

“Such a search did not exist prior to 2 weeks ago, and that is the most basic level of meeting some consumer-level demand,” he said. “This is one step forward, but we clearly need to support this with policies and programs that can support injectable PrEP access.”

Foster noted one strategy she heard recently at a conference from a speaker from the AIDS Healthcare Foundation.

“Practices that have holistic approaches to care, including social workers and caseworkers to remove barriers for medication uptake, including working with pharmaceutical companies for free medication as well as grants which lower costs, work well to overcome barriers to medication uptake,” she said.

The research was funded by the National Institute of Allergy and Infectious Diseases. Siegler reported research funding to his institution from Gilead Sciences, Merck, and ViiV Healthcare. Foster reported receiving no disclosures.

Tara Haelle has covered science and medicine for nearly two decades and is the author of Vaccination Investigation: The History and Science of Vaccines and The Informed Parent: A Science-Based Resource for Your Child's First Four Years. She is based in Dallas.