HIV prevention drug hailed as breakthrough, but who gets access?

What the report says

Al Jazeera reports that lenacapavir, a long-acting HIV prevention injection given twice a year, is being described by health advocates as a major advance in pre-exposure prophylaxis, or PrEP. The drug, developed by US-based Gilead Sciences, showed strong results in a 2024 trial of more than 2,000 young women in South Africa and Uganda, where no participants who received the injection contracted HIV. The World Health Organization has recommended it as an additional prevention option.

The article says the medical promise is being overshadowed by access and pricing questions. In the United States, lenacapavir is priced at about $28,000 per person a year, while generic versions are expected to cost far less, though large-scale rollout is not expected until 2027. Gilead is also supplying its own version at no profit for some programmes backed by the Global Fund and PEPFAR, with early use under way in countries including South Africa, Kenya, Zambia, Nigeria and Eswatini.

Al Jazeera highlights criticism from Médecins Sans Frontières, which says at least 26 middle-income countries are excluded from Gilead’s generic licensing deal, including Brazil, Mexico, Argentina and Peru. MSF argues that this could leave countries with significant HIV burdens dependent on the company or waiting for legal workarounds. The piece also notes that governments can use WTO-related tools such as compulsory licensing to bypass patent barriers in some cases, a path Brazil has used before for HIV medicines.

The report places the debate in a broader context of shrinking global HIV funding, warning that a breakthrough treatment may not have its full impact unless access expands beyond wealthier health systems.