A Brief History of a Revolutionary Idea

In 1981, a rare form of pneumonia and cancer started appearing in otherwise healthy young men. By 1983, HIV—the virus that causes AIDS—was identified. What followed was decades of loss, activism, and scientific struggle. HIV/AIDS devastated the LGBTQ+ community, especially gay and bisexual men, as well as Black and brown communities across the globe. It laid bare the ugly truths about who society deemed disposable and ignited one of the most powerful public health advocacy movements in modern history.

By the late 1990s and early 2000s, medical advancements had transformed HIV from a fatal diagnosis into a manageable chronic condition for those with access to treatment. But prevention—true prevention—remained elusive. Condoms, clean syringe programs, and behavioral interventions were the primary tools. Still, transmission rates persisted, and stigma remained entrenched.

Then came PrEP.

Pre-exposure prophylaxis, or PrEP, emerged in clinical trials as a groundbreaking intervention: a daily pill that could drastically reduce the risk of HIV transmission for those at high risk. It was approved by the FDA in 2012 under the brand name Truvada, produced by Gilead Sciences. For many, it was the long-awaited breakthrough. For others, it was a source of controversy and debate.

Today, with the FDA’s approval of Yeztugo—a twice-yearly injection boasting 99.9% effectiveness—PrEP enters a new era. The road to this moment, however, is as much about science as it is about trust, stigma, access, and resilience. This blog post traces that path, unpacks the controversies, and highlights why Yeztugo might just be the most important advancement in HIV prevention since antiretroviral therapy itself.

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The Origins of PrEP: Science Meets Social Resistance

The concept behind PrEP is simple: if an antiretroviral drug can suppress HIV in someone who is already infected, could it protect someone who is not? The first major study to test this theory was iPrEx (2010), which found that daily use of Truvada among men who have sex with men (MSM) reduced the risk of HIV infection by more than 40%, and even higher with consistent use.

When the FDA approved Truvada for PrEP use in 2012, headlines hailed it as a “miracle pill.” But not everyone was cheering.

Criticism and Backlash

• Moral panic: Critics dubbed PrEP the “party pill,” alleging it would lead to increased promiscuity and unprotected sex. These fears echoed the same stigma that haunted early conversations about HIV itself.
• Medical gatekeeping: Some healthcare providers hesitated to prescribe PrEP, citing concerns about resistance or long-term effects. In many cases, bias and homophobia played an unspoken role in limiting access.
• Cost barriers: Truvada initially cost over $1,500 per month, limiting access to those with comprehensive insurance. It was not until 2021, after generics entered the market, that costs began to decrease significantly.

Despite these challenges, communities most affected by HIV—including Black gay men, transgender women, and sex workers—pushed for broader education, access, and normalization of PrEP as a tool of self-care and survival.

Personal Story Spotlight: Jamal’s Journey

Jamal, a 29-year-old Black gay man from Atlanta, described the day he started PrEP as “the day I took control of my own health for the first time.” But accessing it was not easy. After being turned away by two doctors, he found a clinic through a local LGBTQ+ center. “They treated me with respect,” he said. “They told me I was doing something brave, not something wrong.”

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Scientific Advancements and Expanding Options

As real-world evidence confirmed its effectiveness, PrEP options began to evolve.

From Truvada to Descovy

In 2019, Gilead’s newer drug Descovy was approved for use as PrEP in cisgender men and transgender women. Though it had similar efficacy to Truvada, Descovy boasted fewer side effects related to kidney function and bone density. Yet, it too came with a hefty price tag and limited applicability—excluded, for example, in people assigned female at birth due to insufficient study data.

Apretude: The First Long-Acting Injectable

In 2021, the FDA approved Cabotegravir (Apretude), the first long-acting injectable PrEP drug, which required a shot every two months. This was a significant development for individuals who struggled with daily adherence, whether due to unstable housing, stigma, or simply life circumstances.

Still, Apretude had its own hurdles: four shots a year, a required oral lead-in period, and high cost made it inaccessible to many.

Enter Yeztugo: A Twice-Yearly Game Changer

Announced in June 2025, Yeztugo—a twice-yearly injectable form of lenacapavir—promises to revolutionize HIV prevention. With 99.9% effectiveness, it is not only more protective than previous formulations but dramatically simplifies adherence.

As Joseph Walker and Peter Loftus reported in The Wall Street Journal, Yeztugo “solves two of HIV treatment’s longest standing barriers: adherence and accessibility.” By reducing the frequency of doses from 365 pills a year to just two injections, Yeztugo lowers the risk of missed doses and the social burden of having to take a daily pill that could expose one’s HIV status or sexual behavior.

Public Health Potential

With projected sales of $1.6 billion by 2028 and comparisons already emerging against GSK’s Apretude, Yeztugo represents not only a leap forward in pharmacology but also in public health equity. It holds promise particularly for:

• Youth and adolescents at high risk
• Individuals in unstable living situations
• Communities facing high levels of HIV stigma
• People who struggle with daily medication routines due to mental health or lifestyle factors

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The Social Side of PrEP: Stigma, Trust, and Visibility

Even as PrEP’s medical story is one of triumph, its social journey is one of unfinished business. The stigma associated with PrEP—often entangled with racism, homophobia, and slut-shaming—continues to deter people from seeking it out.

Case Study: The “Truvada Whore” Reclaiming

In the early 2010s, some people on PrEP were derisively labeled “Truvada whores.” Rather than shrink, many reclaimed the term. Activists and sex-positive advocates wore it like a badge of honor, launching campaigns and t-shirts declaring their autonomy and unapologetic sexuality. As one advocate said, “If using medicine to protect myself makes me a whore, then call me the smartest whore you know.”

But language only goes so far. Structural access remains a major hurdle.

• Many providers still do not offer PrEP.
• Insurance coverage is inconsistent.
• Rural and Southern U.S. communities, especially among Black and Latinx populations, are underserved.

Intersectional Gaps

Transgender individuals continue to be underrepresented in PrEP research and underserved in implementation strategies. Sex workers and people who inject drugs—both groups disproportionately impacted by HIV—often face criminalization and systemic neglect that make prevention tools like PrEP difficult to access.

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Global Outlook: Beyond the United States

Globally, the rollout of PrEP has been uneven. High-income countries have incorporated it into public health strategies, while many low- and middle-income nations lag due to cost, supply chain issues, and cultural stigma.

The Role of NGOs and Global Partnerships

Initiatives such as PEPFAR (the President’s Emergency Plan for AIDS Relief) and the Global Fund have helped extend access to PrEP in places like Kenya, South Africa, and Thailand. Still, oral daily PrEP remains the dominant form in most global regions, and long-acting options like Yeztugo are unlikely to reach low-income nations without dedicated advocacy and subsidies.

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Looking Ahead: From Pill to Prevention Paradigm

The dream of an HIV-free generation now seems within reach—but only if we do not mistake medical advancement for mission accomplished.

What Comes Next

• Policy and funding: We need robust public funding to ensure Yeztugo is affordable and covered by Medicaid, Medicare, and private insurance.
• Education campaigns: Normalizing PrEP as a basic part of sexual health, like birth control, must continue—especially in schools, clinics, and religious institutions.
• Community-led access models: Queer, Black, brown, and sex worker communities must be at the table, leading the charge for access, implementation, and trust-building.

Ethical Considerations

The success of Yeztugo will depend not just on science but on addressing the fears—legitimate and historic—within marginalized communities. As with the Tuskegee experiments and ongoing medical racism, trust cannot be manufactured overnight. Transparency, community leadership, and cultural humility are essential.

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Conclusion: PrEPared for the Future

Yeztugo’s approval is more than a pharmaceutical milestone. It is a symbolic victory in a long and often painful war—a war fought not just with drugs, but with dignity. PrEP’s evolution from daily pill to biannual injection represents the power of science to simplify lives. But it also reveals what science alone cannot do: erase stigma, repair trust, or guarantee access.

From the trenches of the AIDS crisis to the hope of a needle administered twice a year, the HIV prevention movement has always been about more than medicine. It is about life—full, unashamed, liberated life.

We have the tools. Let us ensure everyone can use them.

If you or someone you love is at risk of HIV, speak to a healthcare provider about PrEP options, including Yeztugo. Support organizations like the PrEP4All Collaboration that fight for access and equity. Share this post to help fight misinformation and stigma. Because no one should have to choose between safety and shame!