Accessing PrEP shouldn’t feel like a privilege. It should be basic healthcare. But as the HIV prevention landscape evolves, stark global and national divides are leaving many gay men without options—and without protection. From cutting-edge injectable treatments in the U.S. to stalled rollout in Canada and devastating funding cuts around the globe, the fight for HIV prevention is far from over.

This is where things stand—and what gay men need to know.

A Six-Month Injectable Option Approved in the United States

In a groundbreaking move, the FDA approved Yeztugo (lenacapavir) in June. This new injectable PrEP treatment offers protection for six full months with just one shot—making it the first and only HIV prevention method requiring only two doses per year.

Lenacapavir’s approval followed strong results from Gilead’s PURPOSE 1 and 2 trials, which demonstrated near-total effectiveness in preventing HIV transmission. The World Health Organization quickly called the development a “major milestone” in the global fight against HIV.

For gay men in the United States, especially those who struggle with daily pill adherence or stigma around PrEP, this marks a significant leap forward.

Canadian Gay Men Left Behind

Canada is once again playing catch-up.

While Apretude (cabotegravir) has been approved and available in Canada since 2024, the only long-acting injectable PrEP option currently offered is administered every two months—a far cry from the ease and convenience of a six-month solution.

What’s worse: most provincial health plans and private insurance in Canada do not cover Apretude, making it financially inaccessible to the vast majority of Canadians who would benefit. The only full public coverage is through the Non-Insured Health Benefits (NIHB) program, which supports First Nations and Inuit individuals. Quebec has recently taken the lead, becoming the first province to reimburse Apretude under its public drug plan (RAMQ).

For everyone else, the options are limited. Most are still relying on Truvada or generic daily pills—formulations that don’t work for everyone and come with issues of adherence, side effects, or stigma.

The Global PrEP Crisis Is Escalating

Just as the U.S. made a leap forward in prevention, a political decision has threatened decades of global progress.

Earlier this year, the Trump administration dismantled USAID, slashing or eliminating more than 80 percent of foreign aid programs—including massive support for HIV prevention via PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief). According to UNAIDS, the ripple effects could result in over 10 million new HIV infections and three million deaths by the end of the decade.

As Reuters reports, many African countries that had been relying on U.S. support to roll out PrEP are now halting services entirely. Clinics have closed. Distribution has stopped. High-risk populations—including gay men, sex workers, and trans people—are again without protection.

The World Health Organization has identified eight countries that could run out of antiretroviral medications completely, and many more are expected to follow.

In a bitter twist, the Trump administration issued a waiver to allow funding for HIV treatment among pregnant and breastfeeding women—but explicitly excluded LGBTQ+ communities from receiving prevention support. As THEM reports, queer people are being left out of life-saving health care by design.

Advocacy and Resistance

The good news? People are fighting back.

Across North America, community health organizations and LGBTQ+ clinics are doing what governments won’t—helping gay men access PrEP through advocacy, education, and subsidies. In Canada, grassroots pressure is growing on provincial governments to expand coverage of Apretude and prepare for the possible future rollout of lenacapavir.

Globally, new coalitions and fundraising initiatives like Fund Our Futures are stepping up to raise emergency funds for HIV prevention in the hardest-hit regions.

UNAIDS has also issued a public call to Gilead urging the company to reduce the cost of lenacapavir—currently listed at over $28,000 USD annually. Independent researchers estimate it could be produced for less than $40 per person per year.

What Gay Men Need to Know Right Now

If you’re in the U.S., talk to your provider about accessing Yeztugo (lenacapavir). While it’s still rolling out, some sexual health clinics are already preparing to offer the injection.

In Canada, check with your pharmacist or local LGBTQ+ health center to see if you’re eligible for Apretude through NIHB, RAMQ, or private insurance. If not, advocate. Call your MPP. Contact your public health authority. The system won’t change unless we force it to.

And globally, donate, support, or amplify organizations working to restore HIV prevention efforts where they’re most needed. HIV is a global issue—and so is our responsibility.

The Bottom Line

A six-month injectable PrEP option now exists. That’s huge. But the road to equitable access remains bumpy, especially for Canadians, low-income populations, and gay men worldwide.

This isn’t just about healthcare. It’s about autonomy, justice, and survival. Whether you’re navigating your own PrEP access or fighting for others, don’t stop pushing. We’ve come too far to let politics, pharma, or red tape turn back the clock.