MSF supports new agreement to increase access to HIV prevention medicine

However, the licensing agreement currently leaves out various low- and middle-income countries where approximately one quarter of new HIV infections occur.

HIV remains a key global public health challenge, with 1.3 million people becoming newly infected with HIV in 2023 alone. Lenacapavir, a highly effective injection administered just twice per year, represents a transformative advance in HIV prevention—particularly for communities facing stigma, criminalization, and systemic barriers to taking daily pills. Increasing access to this game-changing form of prevention is critical at a time when supporting services and care for key populations at risk of contracting HIV is being deprioritized by governments. Yet current access strategies cover less than 10 percent of the global need as Gilead continues to prioritize profits over epidemic control.

A plan announced on September 4 between the President’s Emergency Plan for AIDS Relief (PEPFAR), Gilead Sciences, and The Global Fund to Fight AIDS, Tuberculosis and Malaria aims to reach only 2 million people in 12 countries by 2028. Modeling released last week by UNAIDS suggests that under this limited approach only 50,000 new HIV infections will be prevented out of a potential 3.8 million.

“PEPFAR’s focus on pregnant and breastfeeding people will likely result in deprioritizing key populations, such as sex workers, men who have sex with men, people who inject drugs, and transgender people,” said Mihir Mankad, director of global health advocacy and policy at MSF USA, “It is precisely among these communities where access to long-acting, injectable PrEP (LA-PrEP) would have greatest impact due to their greater vulnerability to HIV acquisition. If the US government were serious about addressing the global HIV epidemic it would work to ensure these key populations are prioritized for access to PEPFAR-supported LA-PrEP alongside pregnant and breastfeeding women.”

UNAIDS modeling highlights the importance of access for key populations, citing the Philippines, where offering lenacapavir to 58 percent of key populations (2 percent of the total population) could avert 45 percent of new HIV infections in the country. Yet at-risk populations in these excluded countries remain outside the scope of current rollout plans, including communities that participated in clinical trials for lenacapavir in Brazil, Argentina, Mexico, and Peru.

“This scenario of opaque pricing, restrictive licensing, and inadequate global targets will leave far too many people at continued risk of preventable HIV infections,” said Antonio Flores, senior HIV/TB advisor for MSF’s Southern Africa Medical Unit (SAMU). “We urge Gilead to expand its licensing to include all low- and middle-income countries, to be transparent on pricing, and to lower pricing to allow all people to access these lifesaving medicines. Global health donors need to commit resources and political will to ensure sustainable access for all who need it. The science is clear—and the demand is urgent.”