GSK’s long-acting HIV shot offers more than relief. In Korea, it offers privacy.

In Korea, where the stigma of HIV can be more punishing than the virus itself, the act of swallowing a daily pill can carry unbearable weight.

Now reimbursed and fully launched, GSK’s long-acting injection combines Vocabria (cabotegravir) and Rekambys (rilpivirine) into a bimonthly regimen that offers patients not just medical relief but something rarer: avoid unwanted scrutiny.

The combo is marketed as Cabenuva in the U.S. and Australia but is prescribed under its component names in Korea.

For patients who’ve spent years stashing bottles in glove departments, peeling off pharmacy labels, and rationing doses, a treatment that replaces 365 daily pills with just six injections a year marks a radical shift. 

At a press conference on Tuesday marking the drug’s reimbursement, Professor Choi Jae-phil, an infectious disease specialist at Seoul Medical Center, spoke of patients still living in the shadows. One, he said, keeps his medication tucked away in the car, out of sight. Another scrapes the label from the bottle so no one might recognize it.

These aren't outliers, he added. “This is everyday life.”

The stigma is not just social, it’s institutional. Korean law punishes non-disclosure, regardless of transmission risk. Public awareness remains stalled in another era. Many still conflate HIV with AIDS. Many still believe it stems from “immoral behavior,” Choi said, a view that continues to tether the virus to homosexuality, promiscuity, and sex work.

And while medical care has improved, shame has not. Surveys presented by GSK place Korea among the highest in guilt-driven responses, with many patients believing they somehow “deserve” their illness. 

Even today, he added, “HIV is still being treated as a public threat instead of a chronic, manageable condition.”

That burden shows up in the clinic. “In Korea, people are unusually curious about what medications others are taking,” said Professor Kim Yeon-sook, an infectious disease specialist at Chungnam National University School of Medicine who has treated HIV patients since the days of multi-pill regimens with rigid food and timing rules.

“There are cases where someone snaps a photo of a pill and reverse-searches it. Patients live in constant fear of being found out.”

That fear has real costs. A community survey by advocacy group Love4One found that 52 percent of respondents said daily HIV pills caused mental distress, largely due to fear of being outed. Nearly half had missed at least one dose in the past three months, and nearly seven in ten said that, if given the option, they would choose long-acting injections over daily pills.

Now they can. After Korea’s Ministry of Food and Drug Safety approved the injectable combo in 2022, the treatment was added to the national reimbursement list in April. 

Vocabria is reimbursed at 991,802 won ($728.58) and Rekambys at 434,550 won ($319.22), but under Korea’s national health insurance system, patients are not required to pay out of pocket.

Indicated for virologically suppressed HIV-1 patients with no prior treatment failure or known resistance, Vocabria and Rekambys are administered every two months after an initial monthly lead-in -- or, in many Korean cases, no lead-in at all.

“In my experience, not a single one of the 30 patients I’ve prescribed this to choose the oral lead-in,” Kim said. “They were so eager to stop daily pills, they wanted the shot immediately.” While physician preference is still split, Kim estimated about 80 percent of patients prefer the injectable.

The psychological relief is significant, especially for patients who have spent years associating daily pills with secrecy and shame. “Every time they swallow a pill, they feel like the disease is swallowing them back,” said Kim, who has seen patients skip doses to avoid drawing attention. 

In the phase 3 SOLAR study, the injectable combo showed non-inferiority to Gilead Sciences’ Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) in maintaining viral suppression, with higher patient satisfaction scores at the 12-month mark. But Korean physicians say the local impact is bigger than efficacy.

“We’re not just talking about viral control,” Choi said. “We’re talking about shielding patients from social exposure. The cost of being found out in Korea is still incredibly high.”

The Joint United Nations Programme on HIV/AIDS’ (UNAIDS) long-standing “95-95-95” goals -- diagnosis, treatment, and suppression -- are no longer enough, Choi added. He pointed to a growing consensus around a fourth goal focused on quality of life, arguing that viral suppression is "no longer the final goal” and that the next step is to reduce treatment burden so patients can “live like anyone else.”