Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
You may be thinking of STD tests and bloodwork that is done every 3-6 months depending on your risk level to ensure that you're still HIV negative and that your kidneys are functioning normally, as kidney issues is a rare but serious side effect, especially for Truvada.
Now, what I believe is correct is that most people on PrEP would love to have a vaccine instead of needing a daily pill or even 2-6 injections per year as long as they remain sexually active.
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.
Why haven't other countries stepped up to address this pressing need? I'm sure every other western nation could easily chip in collectively to cover the roughly $34B budget USAID had. Or do they just not care about these millions of people apparently sentenced to death?
The problem is money doesn't build supply lines overnight. Nor does it hire experts both locally and globally and get them there. Much of the data collected on patients by USAID can't just be handed over to another government for a myriad of privacy issues. Patients then have to know that their old clinic no longer exists and they have to go to a new one (is it in the same village anymore?). In the meantime viral counts go up, people get sick, infect their partners or newborn children. You can't just "pick it up later" without causing real harm.
> or do they not care
Do we not? Why can't we care, why is it now someone else's problem because Musk is still mad Mandela was let off of Robin Island?
Condoms? They break. More frequently than you might think.
Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).
Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.
A vaccine is the only real option for dealing with HIV for good.
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 20-39 prime reproductive age cohort for those seeking it. It also decreases the risk of ovarian cancer by 42–77% (https://doi.org/10.5468/ogs.2018.61.5.542).
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person (HN Search: lenacapavir - https://hn.algolia.com/?q=lenacapavir).
US Government Overhauls Teen Pregnancy Program to Focus on Marriage and Starting Families - https://www.nytimes.com/2026/07/22/us/politics/teen-pregnanc... | https://archive.today/ - July 22nd, 2026
Teen birth rates hit another historical low in 2025, CDC says - https://www.npr.org/2026/04/09/nx-s1-5777587/teen-birth-rate... - April 9th, 2026
Private Money Saves Colorado IUD Program As Fight Continues For Public Funding - https://kffhealthnews.org/health-industry/private-money-save... - August 27th, 2015
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors
- people need to make the right decisions to take HIV vaccines
We are comparing two tools, not tools versus discipline.
In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.
They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.
An effective vaccine that lasts years would be much more convenient.
Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!
My argument is simply that new tools are great, but it's not what's going to solve the HIV problem. Distribution, cost, access, stigma, etc are the larger problems to deal with. (We need to solve all the reasons why people aren't using the existing tools)