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Learning and Teaching by Doing: My Experience With Long-Acting PrEP

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Released: September 03, 2026

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As a healthcare professional, my own experience with injectable PrEP informed much of what I told my patients about long-acting PrEP afterwards. I am grateful for that experience to help my patients make informed decisions about HIV PrEP modalities. Keep reading to learn from my firsthand account of what a typical administration feels like for long-acting PrEP.

Joseph Cherabie
Joseph Cherabie, MD, MSc, FIDSA
My Experience With Long Acting PrEP

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As a member of the LGBT+ community, I was eager to get started on oral pre-exposure prophylaxis (PrEP) as soon as it came to market, to make acquiring HIV one less thing to worry about in my sex life. I continued on oral PrEP until I donated my kidney, after which I wanted to switch to an injectable regimen that was less likely to negatively affect my remaining kidney.

However, I traveled a lot for work and was concerned about my ability to stick with the every-2-month injection schedule of injectable cabotegravir (CAB), so I waited for the every-6-month lenacapavir (LEN) to make the switch.

Initiating LEN for PrEP
At my primary care provider’s office, I was the first person to receive LEN for PrEP, so they had little guidance on how to proceed beyond their experience using LEN for treatment. When it came to choosing my site of injection, I chose my thighs, as I felt that was more discreet than my abdomen, and summer was coming up with some expected pool days. I had received subcutaneous injections before, mainly as vaccines, but the size of this injection was different than those, so this was truly a unique experience for me.

I received both injections after having iced both sites on my thigh for several minutes beforehand. The injections were given over 20-30 seconds each, and I felt the nodules form under the pinched skin the nurse was injecting into. There was a slight burning sensation, and I was grateful for the ice packs to return after.

I iced on and off once I got home, and my nodules (which I was very conscious of) went largely unnoticed by most other people. Eventually, many colleagues and friends asked to feel my nodules, and I was grateful to oblige their curiosity, as this was a new drug and new experience for many. The nodules fully dissipated over the next few months.

Using My Own Experiences to Teach Others
As a healthcare professional myself, my own experience with LEN for PrEP informed much of what I told my patients about long-acting PrEP afterwards. I am grateful to have had that experience to help my patients make informed decisions for their own HIV PrEP modalities. Some people experience more visible nodules than others, so I tell people that, if they choose LEN, they should choose an injection site where they would feel comfortable seeing a potential nodule.

Some people are more sensitive to pain, and so we ice the injection sites before and after, and we offer lidocaine gel. We tell them their pain will likely go away, but we ask them to keep an eye out for red, painful, purulent nodules. There have been reports of leakage from injection nodules, and injection and care instructions have been updated accordingly. Similarly, some people receiving gluteal injections of CAB experience soreness, and we remind them that the pain will likely go away soon.

The Best PrEP, Not the Perfect PrEP
With more options available to individuals, we can better meet people’s wants and needs regarding their PrEP modalities. To me, there is no one modality that is definitively better than another. Rather, the best PrEP modality is the one that works for that individual patient. If a patient experiences an issue with one injectable, then another is available, or we can always move back to oral agents, with longer-acting orals hopefully coming down the pipeline.

In this era of long-acting injectable PrEP, the key to patient satisfaction is open communication, explanation of options, and weighing of priorities to allow for shared decision-making.

Your Thoughts
What questions do you ask to determine if patients are good candidates for long-acting PrEP, or how do you help them decide to stay on oral PrEP? Leave a comment to join the discussion!

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