Spain Launches Europe’s First Bi-Monthly HIV Injection

Spain has become the first country in Europe to provide public funding for an injectable pre-exposure prophylaxis (PrEP) medication to prevent HIV infection. The decision was approved by the government’s Interministerial Commission on Medicine Prices (CIPM), which agreed to incorporate the drug Apretude into the Spanish public healthcare system.

The medication uses long-acting cabotegravir, an antiretroviral designed to prevent HIV infection before exposure. This development is specifically aimed at HIV-negative individuals who are considered at high risk of contracting the virus through sexual transmission.

Shift from Daily Pills to Long-Acting Injections

Apretude represents a significant departure from traditional PrEP methods. While standard oral PrEP requires the patient to take a pill every day, the long-acting cabotegravir treatment is administered via intramuscular injection once every two months.

Health experts indicate that this injectable format may significantly improve prevention efforts, particularly for population profiles that struggle with the adherence required for a daily pill regimen. Clinical trials have demonstrated that the long-acting drug is extremely effective at preventing HIV infection and has often performed better than daily oral treatments in scenarios where adherence is difficult.

Public Health Strategy and Access

Although the European Medicines Agency (EMA) had previously approved the medication for use across European Union countries, Spain is the first to fully fund it through its national healthcare system. The Spanish government stated that this move ensures equal access for patients across the country via the public health network.

This policy is part of a broader national strategy to combat HIV, which focuses on a combination of the following elements:

• Combined prevention methods
• Early diagnosis
• Antiretroviral treatment
• Reduction of the stigma associated with the disease

The integration of Apretude into the National Health System (SNS) aligns with recommendations from international bodies, including the World Health Organization (WHO) and UNAIDS, which advocate for expanding access to effective prevention tools to reduce the number of new infections.

Broader European Context of Injectable PrEP

The authorization of long-acting injectables in Europe is an evolving field. In addition to cabotegravir, the European Medicines Agency approved the use of lenacapavir as PrEP on October 10, 2025. Unlike Apretude, lenacapavir is a twice-yearly injectable option available for adults and adolescents who are HIV-negative, weigh at least 35 kg, and are at high risk of sexual exposure.

Clinical trials for lenacapavir have shown an efficacy rate very close to 100%. However, similar to other new therapies, its availability in Spain and other European nations depends on specific price and reimbursement agreements with national healthcare systems.

Medical professionals emphasize that these long-acting antiretrovirals are not vaccines. They are intended to be used as part of a comprehensive prevention strategy that includes regular testing and the use of condoms.