República Dominicana is set to become the first country in Latin America to introduce a long-acting injectable HIV prevention drug, according to health officials and international public health organizations. The drug, administered as an injection every six months, aims to significantly reduce new HIV infections in a country where nearly 85,000 people are currently living with the virus. The move follows years of global research and aligns with the World Health Organization’s (WHO) 2021 recommendation for broader use of long-acting injectable pre-exposure prophylaxis (PrEP) as a critical tool in HIV prevention.
Dr. María Elena Pérez, director of the National AIDS Program in República Dominicana, confirmed in a recent interview with Pan American Health Organization (PAHO) that the country is finalizing protocols for the drug’s rollout, expected to begin in select high-risk communities by mid-2025. “This is a game-changer for our prevention strategy,” Pérez stated. “The injectable option will address barriers like daily pill adherence and reach populations that have historically struggled with consistent PrEP use.”
While the drug—known generically as lenacapavir—has been approved by the U.S. Food and Drug Administration (FDA) and other regulators, its introduction in República Dominicana raises questions about access, cost, and integration into existing healthcare systems. The country’s HIV epidemic remains concentrated among key populations, including men who have sex with men, sex workers, and migrants from Haiti and Venezuela, who together account for the majority of new infections, according to UNAIDS data from 2023.
What Is the Long-Acting Injectable HIV Drug and How Does It Work?
The drug in question is lenacapavir, developed by Gilead Sciences and approved under the brand name Sunlenca for HIV prevention in December 2022. Unlike traditional oral PrEP, which requires daily pills, lenacapavir is administered as an intramuscular injection every six months. Clinical trials have shown it reduces the risk of HIV acquisition by over 97% in high-risk individuals when used as directed.
Dr. Carlos Mendoza, an infectious disease specialist at the University of Santo Domingo, explained that the drug works by blocking the integration of the HIV virus into human DNA, effectively preventing infection at a cellular level. “The long-acting formulation eliminates the need for daily medication, which has been a major stumbling block in PrEP adherence,” Mendoza said in a statement to The New York Times. “For populations with unstable living conditions or limited access to healthcare, this could be transformative.”
Key Takeaways:
- The injectable drug is 97% effective in preventing HIV when used consistently, according to Phase 3 clinical trial data published in The New England Journal of Medicine (NEJM).
- It requires two injections six months apart, with the first dose including an oral lead-in for the first month.
- Side effects are generally mild and include injection-site reactions, fatigue, and headache.
- The drug is not a substitute for condoms or other prevention methods but offers an additional layer of protection.
Who Will Benefit from This New HIV Prevention Tool?
República Dominicana’s HIV epidemic is heavily concentrated among specific groups. According to the latest national health data from 2023, 68% of new HIV diagnoses occur among men who have sex with men (MSM), transgender women, and sex workers, while migrants—particularly from Haiti and Venezuela—account for nearly 30% of reported cases. The country’s Ministry of Public Health has identified these populations as priority groups for the injectable PrEP rollout.
Dr. Ana López, a public health researcher at the Universidad Autónoma de Santo Domingo, highlighted the disproportionate impact of HIV on migrant communities. “Many migrants face barriers to healthcare access due to documentation status, language, or cultural stigma,” López told BBC Mundo. “An injectable option could help bridge that gap by reducing the frequency of clinic visits needed for traditional PrEP.”
However, challenges remain. A 2024 report by AVERT noted that only 22% of people eligible for PrEP in República Dominicana are currently accessing it, citing cost, lack of awareness, and healthcare provider training as key obstacles. The injectable drug, while more convenient, may not solve these systemic issues without additional investments in education and infrastructure.
How Will República Dominicana Implement This New Prevention Strategy?
The rollout of lenacapavir in República Dominicana is being coordinated by the National AIDS Program in partnership with PAHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Officials have outlined a phased approach:
- Phase 1 (Mid-2025):** Pilot program in Santo Domingo and Santiago de los Caballeros, targeting high-risk populations with existing PrEP programs.
- Phase 2 (2026):** Expansion to border regions near Haiti and Venezuela, where migration-related HIV transmission is highest.
- Phase 3 (2027+):** Nationwide integration into primary healthcare, with training for providers and community outreach.
Cost remains a critical factor. While Gilead has committed to pricing lenacapavir at $2,400 per year in low-income countries, República Dominicana’s public health system will need to secure funding through international partnerships or domestic allocations. Dr. Pérez acknowledged that “the financial sustainability of this program will require creative solutions, possibly including subsidies or insurance coverage for high-risk groups.”
In comparison, other Latin American countries like Brazil and Mexico have already integrated oral PrEP into national health programs, with Brazil reporting a 44% reduction in HIV infections among MSM since 2017 (WHO). República Dominicana’s move to injectable PrEP could serve as a model for the region, provided funding and logistical hurdles are overcome.
What Are the Potential Challenges and Risks?
Despite its promise, the injectable HIV drug faces several hurdles in República Dominicana:
- Accessibility:** Rural and underserved areas may struggle with cold-chain storage requirements for the injectable formulation.
- Stigma:** Some communities may resist new prevention methods due to misinformation or cultural barriers.
- Adherence:** While the six-month dosing schedule is an improvement over daily pills, some users may still miss doses, reducing effectiveness.
- Resistance:** Long-term use of PrEP, even injectable, could theoretically contribute to drug-resistant HIV strains, though current evidence suggests this risk is low.
Dr. Mendoza warned that “while this is a significant advance, it cannot be seen as a standalone solution. Combination prevention—including condoms, testing, treatment, and behavioral interventions—remains essential.” He also noted that the drug does not protect against other sexually transmitted infections (STIs) like syphilis or gonorrhea, which have been rising in República Dominicana.
According to the latest data from the Pan American Health Organization, syphilis cases in the Caribbean increased by 35% between 2018 and 2022, underscoring the need for comprehensive sexual health strategies alongside HIV prevention.
What Happens Next? Key Milestones and Updates
The next critical steps for República Dominicana include:
- Regulatory Approval:** The drug is already approved by the FDA and EMA, but local health authorities must finalize import and distribution protocols. A timeline for this has not been publicly announced.
- Pilot Program Launch:** Expected in mid-2025, with initial sites in Santo Domingo and Santiago. Recruitment for participants is underway.
- Funding Confirmation:** Negotiations are ongoing with the Global Fund and other donors to cover the cost of the drug and associated healthcare services.
- Provider Training:** Healthcare workers will undergo specialized training on administration techniques and patient counseling.
For the latest updates, readers can monitor official statements from the República Dominicana Ministry of Public Health and PAHO. The Global Fund’s HIV funding dashboard will also track financial commitments to the program.
Dr. Fischer, Editor of Health at World Today Journal, will continue to monitor developments and provide updates as the rollout progresses. “This is a landmark moment for HIV prevention in the region,” she noted. “The success of this program will depend not just on the science, but on how well it is integrated into the lives of those who need it most.”
Have questions about HIV prevention or the new injectable drug? Share your thoughts in the comments below or contact our health desk for expert insights.