Overview:
A twice-yearly injection can dramatically reduce the risk of HIV. But the Black Americans who could benefit most from long-acting PrEP remain among the least likely to get it.
First, the good news: scientific progress over the last two decades has fundamentally transformed an HIV-positive diagnosis from a death sentence to a chronic but manageable condition, like diabetes or high blood pressure. Medications like pre-exposure prophylaxis, or PrEP, can nearly eliminate the risk of acquiring the virus.
That includes lenacapavir, a new, remarkably long-acting version of the drug that requires just two injections a year.
Now, the bad news: the HIV epidemic still persists, with almost 40,000 new diagnoses occurring each year. Yet the people who would most benefit from long-acting PrEP — Black Americans, who make up just 12% of the U.S. population but accounted for nearly 40% of new HIV diagnoses in 2023 — aren’t taking it.
Experts say the reasons PrEP, particularly the long-acting options, hasn’t broken through in the Black community are familiar, including disparities in health insurance, access to healthcare and simple lack of awareness of the drug.
The gap in use is so persistent that one of the nation’s leading scientists called it out at a global symposium in July.
The Same Bevy of Barriers
“Inequity in lenacapavir provision by race, ethnicity, and age mirrors very closely inequities we’ve seen in more established modalities,” Aaron Siegler, professor of epidemiology at Emory University in Atlanta, told attendees of the AIDS 2026 meeting in Rio de Janeiro, Brazil.
“So, within just 6 months of release, we are seeing the same inequities that we have seen,” since PrEP in pill form hit the market 14 years ago, he said. “So clearly, there are system factors at play here.”
Those patterns hold across nearly every demographic breakdown of PrEP users.
Most were men, including 91% of oral PrEP users, 86% of cabotegravir users, and 85% of lenacapavir users. As with oral PrEP, lenacapavir uptake was lowest among Black and Hispanic people; each group’s usage rate was at around 17%.
But HIV activists and public health experts are using a growing set of tools to boost the use of long-acting PrEP among Black people at risk of acquiring HIV. If they’re successful, experts say, they can help slow the number of new cases in Black America.
The data tells part of the story.
Black men had the highest rate of new HIV diagnoses among all U.S. men, as did Black women compared to all women of all races or ethnicities. At the same time, young Black people accounted for almost half of new HIV cases among youth ages 13 to 24.
When it comes to PrEP use, the data isn’t much better. Black Americans accounted for just 15% of PrEP users in 2024, even when they met clinical guidelines, according to AIDSVu.
Though it’s relatively new, lenacapavir has already shown promising results. Recent data released by the manufacturer indicate that twice-yearly lenacapavir injections reduced the number of new HIV cases by 96%. But that efficacy has not translated into equitable access.
Perhaps because it only recently hit the market, only 1% of all PrEP users were taking lenacapavir as of December 2025, six months after it became available. People aged 24 years and younger also used lenacapavir less (8%), a rate that’s about 22% lower than older cohorts, including those 45 years and older.
Dr. Pamela Foster, provost and vice president for academic affairs at Tougaloo College in Jackson, Mississippi, said it’s important for health care providers to pay attention to the barriers that prevent potential patients from accessing the treatment, “particularly in populations who are most affected by HIV in the U.S.”
Foster, a preventive medicine specialist, previously taught medicine at the University of Alabama and specializes in HIV and inequities. These barriers, she said, largely stem from cost — including high medical copays — and a persistent lack of access.
“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.”
Spreading the Word
Still, the first and arguably most important step is getting the word out about long-acting PrEP.
The PrEP Locator is a national directory of clinics providing HIV pre-exposure prophylaxis in the U.S. It seeks to give patients access to a national, integrated service that includes both public and private practice providers.
Dr. Aaron Siegler and colleagues at Emory University created the locator in 2016 and expanded it earlier this year. The site now allows users to find locations that offer injectable PrEP as well as daily oral medication, and it extends the U.S. Centers for Disease Control and Prevention’s National Prevention Information Network of health care providers database.
Emory University’s Rollins School of Public Health, ViiV Healthcare, and Gilead Sciences, Inc., have made the PrEP Locator available.
Alongside that access tool, the pharmaceutical industry is also investing in public awareness.
ViiV Healthcare has launched “Do It For Future You,” a multichannel digital campaign anchored by a new website, ForFutureU.com.
The ad campaign — aimed at cities like Atlanta, an HIV hot spot, and Los Angeles, which hosts the U.S. Conference on HIV/AIDS this fall — is designed to encourage discussions about HIV prevention or treatment options, including long-acting injectables, between individuals and their health care providers.
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Bithiah Lafontant, ViiV Healthcare’s head of enterprise communications, says the underlying message is clear: the choices at-risk people make today can shape their tomorrow.
“We are at a critical juncture in the fight to end the HIV epidemic,” she says. While HIV is now a manageable condition, Lafontant says, “key gaps in care remain, particularly for the Black community, and are compounded by persistent societal stigma.”
Breakthrough drugs like long-acting PrEP are important tools, but “won’t see progress unless the people that need them most can access them,” she says. That won’t happen until people “feel comfortable starting a conversation with their health provider about the options that can best fit their life and work for them.”
That often means getting past the stigma of HIV.
“Stigma thrives in the shadows,” Lafontant said. “So by putting culturally relevant, uplifting messages directly into public spaces, we bring these conversations into focus in a positive, forward-looking way,”
