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Ending HIV: Why Long-Acting Injectable PrEP Matters 

Our chance to turn a medical miracle into actual protection for our communities.

By Bennett Klein, Senior Director of Litigation and HIV Law (he/him)

I burst through the closet door in 1979. It was a time when being gay was viewed as deviant and a deficit. It was also a time of joy and exuberance. We were building a movement for our liberation and dancing away the nights at the discotheques.  

It wasn’t long until the AIDS epidemic hit our community. In its early years, a diagnosis meant facing almost certain death, often within a year. People experienced painful and debilitating opportunistic diseases, with mysterious and frightening names like “pneumocystis pneumonia” and “Kaposi’s sarcoma.” Cleve Jones, who created the AIDS Memorial Quilt, recalls that in San Francisco “it was not unusual to see people collapse and die in the street.” Young people watched entire friendship networks disappear.  

People with HIV faced virulent discrimination. Prominent cultural figures called for quarantines and even tattoos marking people as HIV-positive. Children with HIV were barred from schools – families who fought back experienced violent backlash, even arson. Doctors, dentists, and health care providers routinely refused treatment. In 1991, 45% of Americans said they would avoid shopping at a grocery store whose owner had AIDS. Nearly half the public falsely believed HIV could spread through a sneeze or a cough. 

Over 700,000 Americans have died from HIV – more than all American casualties in foreign wars combined. For those who survived the 1980s, the idea that we would one day have a medicine that prevents HIV transmission by close to 100% once seemed unfathomable. Yet that’s exactly what PrEP is: an extraordinary medical breakthrough. 

But there’s a problem. More than a decade after PrEP was first approved by the FDA, too few people who are vulnerable to HIV are currently taking it. Even in a state as advanced in HIV prevention as Massachusetts, CDC data from 2023 indicated that only 35% of people eligible for PrEP had an active prescription. And the racial disparities in PrEP access are glaring. Far fewer Black and Latino men and transgender women who could benefit from PrEP are prescribed it compared to white people. 

Now we have something that could change everything. In June 2025, the FDA approved the first-ever PrEP medication that is 100% effective with just twice-yearly injections (Yeztugo/Lenacapavir).  

Think about what this means. No daily pills to remember. No monthly pharmacy runs. No visible bottles that might out someone’s status or sexual practices to family, roommates, or employers. Just two shots a year for full protection against HIV. And we are getting closer to a once-a-year shot. 

But here’s the catch: access to this extraordinary prevention tool isn’t guaranteed. Cost barriers, insurance prior authorization requirements, and other health care coverage gaps stand between people and protection.  

We cannot let cost and access barriers keep another generation from the protection they need and deserve. The 110,000 panels of the AIDS Memorial Quilt – each representing a life lost – demand that we do better. 

For several years, GLAD Law has advanced legislative efforts to broaden access to PrEP, such as an immediate short-term supply at a pharmacy without a prescription and the prohibition of cost-sharing or prior authorization requirements in insurance plans. Now, with a federal government hostile to public health, state-based protections are imperative. This is our chance to turn a medical miracle into actual protection for the communities most affected by HIV. 

The people we lost in the 1980s and 1990s would have given anything for the HIV prevention tools we have today. We owe it to them – and to the people still at risk – to make sure everyone has access. 

Learn more about GLAD Law’s work on PrEP accessibility and find a provider near you at GLADLaw.org/PrEP.