What AIDS 2026 Revealed About the Asia-Pacific Region's Long-Acting PrEP Gap

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Released: September 01, 2026

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Asia and the Pacific Islands account for nearly a quarter of global new HIV infections annually, yet the region utilizes less than 5% of global pre-exposure prophylaxis (PrEP). Keep reading to learn how inadequate translation of scientific progress in long-acting PrEP products into equitable access framed key discussions at the 26th International AIDS Conference (AIDS 2026).

Nittaya Phanuphak, MD, PhD

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Asia and the Pacific Islands account for nearly a quarter of global new HIV infections annually, yet the region utilizes less than 5% of global pre-exposure prophylaxis (PrEP). This stark mismatch reflects a deep structural gap: One of the regions carrying the heaviest burden of the HIV epidemic has the least access to the most effective prevention tools.

Inadequate translation of scientific progress in long-acting PrEP products into equitable access framed key discussions at the 26th International AIDS Conference (AIDS 2026). Of note, Thailand, Malaysia, Vietnam, and the Philippines all contributed to the clinical trials supporting approval of cabotegravir and lenacapavir and the investigational monthly pill alimatravir. Yet speakers and panelists from the region were strikingly underrepresented when it came to discussing access, preparation, and rollout, reflecting funders’ and multilateral agencies’ late and limited engagement in the Asia and Pacific region.

Initiatives for Equity
Despite this underrepresentation, several initiatives are working to secure long-acting PrEP for this region. An abstract by investigators from the Third World Network showed that early and proactive legal and policy strategies by civil societies in India, can prevent unwarranted monopolies and speed generic entry by challenging patents and blocking weak secondary patents. This is a critical lever given India’s role in supplying large-scale generic long-acting PrEP worldwide.

However, civil society support alone is not sufficient to ensure equitable access to PrEP. A report from the International Treatment Preparedness Coalition drew on case studies, including from individuals in Malaysia, to show that government decision-making is what actually converts advocacy into enforceable policies that enable generic competition, drive down prices, and expand access. Together, these findings suggest legal advocacy and political action must move in tandem to be effective.

Equity and Access to Choice
Access strategies must also reflect what communities in the region actually want. Qualitative study findings from India found that long-acting injectable PrEP delivered through community-based organizations was most preferred by men who have sex with men, transgender women, and female sex workers. In comparison, adolescents and young people preferred to receive HIV vaccines at government hospitals, if this option were to become available. These findings underscore the need for differentiated, community co-designed delivery models rather than one-size-fits-all approaches.

Survey data from the Philippines reinforced this need for more than a one-fits-all approach, as 49% of PrEP-eligible clients preferred long-acting injectable PrEP, compared to 22% who preferred oral PrEP (22%). Of those with oral PrEP experience, 65% indicated they would switch to long-acting if given the chance. These findings directly shaped the 2026 donation of 30,000 lenacapavir doses to the Philippines by the US government and the Global Fund.

The Monetary Cost of Equity
UNAIDS Global Price Tag modeling estimates that the region needs $338,000,000 USD by 2030 for PrEP to achieve the global HIV prevention target of a 90% reduction in new HIV acquisitions, relative to 2010. This represents 32% of global long-acting PrEP needs. Nevertheless, donor-driven supply to Asia and the Pacific has been limited and unpredictable. Rather than waiting on constrained bilateral and multilateral funding, the region needs coordinated market-shaping and procurement mechanisms to lower unit costs and secure reliable supply, alongside greater investment in domestic financing.

Your Thoughts
How do these findings on PrEP equity translate to your region and practice? Leave a comment to join the discussion!

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