Injectable PrEP in Singapore: Cabotegravir, Lenacapavir & Long-Acting HIV Prevention

HIV prevention has evolved rapidly over the past decade. Today, Pre Exposure Prophylaxis (PrEP) is one of the most effective ways to prevent HIV infection.

For many people in Singapore, HIV PrEP traditionally involves taking a daily oral medication, such as Truvada or Descovy.

However, new long-acting injectable PrEP medications are now transforming HIV prevention worldwide. These treatments allow individuals to receive protection through periodic injections instead of daily pills.

Interest in injectable PrEP in Singapore has increased as long-acting HIV prevention medications such as Cabotegravir (Vocabria) and Lenacapavir (Sunlenca) continue to be studied and introduced globally.

In this guide, we explain:

• What injectable PrEP is
• How new long-acting medications work
• Differences between oral and injectable PrEP options
• Whether injectable PrEP may become more widely available in Singapore

What is PrEP?

Pre Exposure Prophylaxis (PrEP) is a preventive medication taken by HIV-negative individuals to reduce the risk of acquiring HIV.

When used correctly, PrEP can reduce the risk of HIV infection from sexual exposure by more than 99%.

PrEP works by maintaining antiviral medication in the bloodstream. If HIV enters the body, the medication prevents the virus from establishing infection.

PrEP is commonly recommended for individuals who may have increased HIV exposure risk, including:

• Men who have sex with men (MSM)
• Individuals with multiple sexual partners
• People with HIV-positive partners
• Individuals who want an additional layer of protection alongside condoms

For many years, PrEP has primarily been available as oral tablets taken daily or on-demand. Today, long-acting injectable PrEP is emerging as a new alternative.

What is Injectable PrEP?

Injectable PrEP refers to HIV prevention medications that are administered as long-acting injections by a healthcare professional rather than daily pills.

These medications remain in the body for extended periods, allowing individuals to receive continuous HIV protection for weeks or months at a time.

Depending on the medication, the injection may be given:

• Intramuscularly (into a muscle)
• Subcutaneously (under the skin)

Two new long-acting medications currently available globally and in Singapore are:

• Cabotegravir (Vocabria)
• Lenacapabir (Sunlenca)

Both represent important advances in HIV prevention technology.

Cabotegravir (Vocabria): The First Injectable PrEP

The first widely studied injectable HIV PrEP medication is Cabotegravir, marketed internationally as Vocabria or Apretude.

Cabotegravir is a long-acting integrase inhibitor that blocks HIV replication by preventing viral DNA from integrating into human cells.

How Cabotegravir PrEP is Given

Cabotegravir PrEP is administered as an intramuscular injection, usually into the gluteal muscle.

The typical dosing schedule involves:

1. Optional oral lead-in medication
2. Initial injection
3. Second injection after 4 weeks
4. Maintenance injections every 2 months

This schedule allows individuals to maintain HIV protection without needing to take daily medication.

Effectiveness

Large international clinical trials have shown that cabotegravir injections are highly effective for HIV prevention, and in some studies even more effective than daily oral PrEP due to improved adherence.

Lenacapavir: A Long-Acting Subcutaneous PrEP Option

Another promising long-acting HIV prevention medication is Lenacapavir.

Lenacapavir works through a different mechanism. It is a capsid inhibitor, meaning it disrupts the protective shell of the HIV virus and interferes with viral replication.

Unlike cabotegravir, lenacapavir is administered as a subcutaneous injection, meaning the medication is injected just beneath the skin rather than into muscle.

Potential Advantages

Lenacapavir is particularly exciting because studies suggest it may require dosing only once every six months.

This extremely long duration of action could:

• Reduce the need for frequent clinic visits
• Improve medication adherence
• Expand access to HIV prevention

Research into lenacapavir for PrEP continues to evolve, and it may represent the next generation of long-acting HIV prevention.

Injectable PrEP vs Oral PrEP

Many individuals searching for injectable PrEP in Singapore want to understand how these new treatments compare with traditional oral PrEP medications.

Below is a simplified comparison of current and emerging PrEP options.

PrEP Medication	Type	How It is Taken	Dosing Frequency	Key Features
Truvada	Oral tablet	Taken by mouth	Daily (or event-based)	Most widely used PrEP globally
Descovy	Oral tablet	Taken by mouth	Daily	Newer formulation with improved kidney and bone safety
Cabotegravir	Intramuscular injection	Injection into muscle	Every 2 months	Long-acting injectable PrEP
Lenacapavir	Subcutaneous injection	Injection under skin	Potentially every 6 months	Next-generation long-acting PrEP candidate

This comparison highlights how HIV prevention is evolving from daily tablets to longer-acting treatment options.

Oral PrEP Options Available Today

Although injectable PrEP is gaining attention globally, oral PrEP remains the most widely available HIV prevention treatment option today.

Two commonly used oral medications include Truvada and Descovy.

Truvada for PrEP

Truvada is one of the most established and widely used PrEP medications worldwide.

It contains two antiviral medications:

• Tenofovir disoproxil fumarate (TDF)
• Emtricitabine (FTC)

Advantages of Truvada

• Extensive long-term safety data
• Proven HIV protection exceeding 99% when taken correctly
• Widely available internationally
• Often one of the most cost-effective PrEP options

Because of its long track record and effectiveness, Truvada remains a cornerstone of HIV prevention globally.

Descovy for PrEP

Descovy is a newer oral PrEP medication that contains:

• Tenofovir alafenamide (TAF)
• Emtricitabine (FTC)

Descovy was designed to reduce the amount of tenofovir circulating in the bloodstream, which may result in less impact on kidney function and bone density.

Advantages of Descovy

• Lower systemic tenofovir exposure
• Improved kidney and bone safety profile in some individuals
• Smaller tablet size

However, Descovy is currently not approved for HIV prevention in individuals exposed via receptive vaginal sex or injection drug use, which may affect eligibility in certain populations.

Is Injectable PrEP Available in Singapore?

Interest in injectable PrEP in Singapore continues to grow as awareness of long-acting HIV prevention increases.

While medications such as cabotegravir and lenacapavir are being studied and introduced globally, access to injectable PrEP may vary depending on regulatory approvals and clinic availability.

At present, oral PrEP remains the most widely accessible and practical HIV prevention option for most individuals in Singapore.

For many patients, starting oral PrEP provides immediate protection while long-acting options continue to develop.

Who Should Consider PrEP?

PrEP may be suitable for individuals who:

• Have multiple sexual partners
• Have a partner living with HIV
• Prefer an additional layer of protection beyond condoms
• Want greater control over their sexual health

A healthcare consultation can help determine whether oral daily PrEP, even-based dosing or future injectable options may be most appropriate.

The Future of HIV Prevention

The development of long-acting injectable PrEP medications represents one of the most exciting advances in HIV prevention.

As new antiretroviral therapy such as cabotegravir and lenacapavir become more widely available, individuals may eventually have several HIV prevention options, including:

• Oral daily PrEP
• Event-based PrEP
• Long-acting injections

This expanded range of options may help improve adherence, increase access, and ultimately reduce HIV transmission worldwide.

Getting Started with PrEP in Singapore

If you are considering PrEP, the first step is to consult a healthcare provider experienced in HIV prevention.

A typical PrEP consultation may include:

• HIV testing
• Screening for sexually transmitted infection
• Kidney function testing
• Discussion of the most suitable PrEP option

Once started on PrEP, patients typically attend follow-up visits every three months to ensure ongoing safety and effectiveness.

Key Takeaways

• Injectable PrEP is an emerging HIV prevention method using long-acting injections.
• Cabotegravir is administered as an intramuscular injection every two months.
• Lenacapavir is given as a subcutaneous injection and may offer protection for up to six months per dose.
• Oral PrEP options such as Truvada and Descovy remain highly effective and widely used today.
• Individuals in Singapore interested in HIV prevention should consult a healthcare provider to determine the most suitable PrEP option.