One Shot, Six Months: How Long-Acting HIV Treatments Are Reshaping Life for New Yorkers

There is a ritual familiar to virtually every person living with HIV who has been on antiretroviral therapy: the daily pill. Taken at roughly the same time each day, often with food, sometimes with side effects, and always with the quiet psychological weight of a reminder that a virus is being held at bay. For many people, this routine becomes second nature. For others, it remains a persistent source of stress, stigma, and missed doses.

A new class of medications is beginning to rewrite that experience — not incrementally, but fundamentally. Long-acting injectable HIV treatments now make it possible to maintain viral suppression with injections administered once a month or even once every six months. The implications for New Yorkers living with HIV are significant, and the questions surrounding access, eligibility, and equity deserve a thorough and honest examination.

Understanding the Medications

Two long-acting injectable treatments have emerged as the most clinically significant in this new landscape: cabotegravir with rilpivirine, marketed under the brand name Cabenuva, and lenacapavir, marketed as Sunlenca.

Cabenuva combines two antiretroviral agents — cabotegravir, an integrase strand transfer inhibitor, and rilpivirine, a non-nucleoside reverse transcriptase inhibitor — into a regimen of two injections administered together once a month, or on an every-two-month schedule for eligible patients. It was approved by the FDA in January 2021, making it the first complete long-acting injectable regimen for HIV treatment in the United States. Patients must first demonstrate viral suppression on an oral regimen and meet specific criteria before transitioning.

Lenacapavir operates through a different mechanism. It is the first in a new class called capsid inhibitors, which interfere with the HIV replication cycle at multiple stages. Approved by the FDA in December 2022 for adults with multidrug-resistant HIV, lenacapavir requires an injection only twice per year — every six months — making it the longest-acting antiretroviral currently available. Its current approval is specifically for treatment-experienced patients whose infections have not responded adequately to other regimens, though clinical trials exploring its use in broader populations are ongoing.

Why This Matters Beyond Convenience

It would be easy to frame long-acting injectables as a lifestyle upgrade — a welcome convenience for people who would simply prefer not to take a daily pill. That framing, while not inaccurate, undersells the significance of these medications for many communities.

For New Yorkers living in environments where privacy is difficult to maintain — crowded households, shared living situations, or settings where an HIV diagnosis has not been disclosed — a daily pill bottle carries real risk. It can be seen, questioned, or discovered. The psychological burden of concealment is not trivial, and it contributes to inconsistent adherence in ways that are difficult to quantify but widely recognized by clinicians.

"I had a patient who was sharing a room with three family members who didn't know his status," said Dr. Marcus Webb, an infectious disease physician practicing in Washington Heights. "He was doing everything right, but the stress of hiding his medication was enormous. Switching him to monthly injections changed his life in ways that went well beyond the pharmacology."

For individuals experiencing housing instability, long-acting injectables also eliminate the challenge of keeping medications safe, unexpired, and accessible during periods of transition — a practical advantage that can mean the difference between maintained suppression and a viral rebound.

Eligibility and the Path to Access in NYC

Neither cabotegravir/rilpivirine nor lenacapavir is currently available to all people living with HIV, and understanding the eligibility requirements is essential before pursuing either option.

For Cabenuva, the primary requirements are that the patient be virally suppressed (HIV RNA below 50 copies per milliliter) on a stable oral regimen, that they have no prior treatment failures with either cabotegravir or rilpivirine, and that they do not have certain resistance mutations. A transition period involving oral lead-in doses is typically required before the injections begin. The every-two-month schedule is available for patients who have demonstrated tolerability on the monthly regimen.

Lenacapavir's current FDA-approved indication is more specific: it is designated for treatment-experienced adults with multidrug-resistant HIV who are failing their current regimen. For these patients, it represents a genuinely transformative option. Researchers and advocates are watching closely as trials like PURPOSE 1 and PURPOSE 2 examine lenacapavir's potential as a preventive tool — which, if approved, could eventually extend its reach dramatically.

In New York City, both medications are available through major HIV specialty clinics, including those affiliated with NYU Langone Health, NewYork-Presbyterian, Mount Sinai, and a number of Federally Qualified Health Centers across the boroughs. Patients interested in these options should speak directly with their HIV care provider about whether they meet current eligibility criteria.

The Cost and Coverage Question

Long-acting injectables are expensive. Cabenuva carries a list price that exceeds $22,000 per month without insurance, though most patients access it through commercial insurance, Medicaid, or manufacturer patient assistance programs. ViiV Healthcare, which manufactures Cabenuva, offers a patient assistance program for uninsured and underinsured individuals. Lenacapavir, manufactured by Gilead Sciences, similarly has patient support resources available.

Advocates caution that cost alone does not determine access. Prior authorization processes, step therapy requirements — which may mandate that patients try other regimens before a plan approves an injectable — and administrative delays can create months-long waits even for patients who are clinically ready to transition. Community-based organizations with benefits navigation specialists can be invaluable in helping patients move through these processes efficiently.

Equity on the Horizon

The communities most affected by HIV in New York City — Black and Latino residents, transgender women, people experiencing poverty — are precisely the communities most likely to face structural barriers to accessing these newer treatments. The history of HIV medicine offers a cautionary lesson: innovation does not automatically translate into equity. Antiretroviral therapy was transformative when it arrived in the mid-1990s, but it took years of sustained advocacy before it reached all of the people who needed it.

Advocates are determined not to repeat that pattern. Organizations across the city are pushing for expanded Medicaid coverage of long-acting injectables without burdensome prior authorization, for community health workers trained to navigate patients toward these options, and for clinical trial designs that actively recruit and retain participants from historically underrepresented groups.

What to Do Now

If you are living with HIV and curious about whether long-acting injectables might be appropriate for your situation, the most important first step is a conversation with your current HIV care provider. Bring your questions, your concerns about your current regimen, and any practical considerations — including privacy, housing, and your ability to attend monthly clinic appointments — that might be relevant.

If you do not currently have an HIV care provider, AIDS NYC can connect you with affirming, experienced clinicians across all five boroughs. Visit aidsnyc.org for our provider directory and navigation resources.

The science is moving quickly. The fight to ensure that science reaches every New Yorker who needs it is moving, too — and this community has never waited passively for that work to be done.