Long-acting HIV prevention medicines could dramatically reduce new HIV infections worldwide, but ensuring affordable and equitable access remains the biggest challenge, global health leaders, researchers, pharmaceutical executives and community advocates said on Tuesday at the 26th International AIDS Conference (AIDS 2026).
For countries such as Bangladesh, where the overall HIV burden remains relatively low but prevention among key populations remains crucial, the key question is whether these new medicines can be made affordable and integrated into existing health systems.
The issue took center stage during a high-level roundtable that brought together International AIDS Society (IAS) President Dr Beatriz Grinsztejn, representatives from ViiV Healthcare, Gilead Sciences, MSD, Unitaid, community organizations and implementation scientists to discuss how scientific breakthroughs can be translated into real-world public health impact.
Opening the discussion, Dr Grinsztejn described the current moment as "a remarkable era" for HIV prevention, citing encouraging results from the PURPOSE 1 and PURPOSE 2 trials of long-acting pre-exposure prophylaxis (PrEP).
But she stressed that scientific progress alone is not enough.
"Scientific innovation only matters if people can access it," she said, echoing the Brazilian Ministry of Health's message that "innovation without access is not innovation, it is injustice."
Jean van Wyk, chief medical officer of ViiV Healthcare, said injectable cabotegravir is becoming an increasingly important HIV prevention option and reaffirmed the company's commitment to expanding access.
He noted that ViiV signed a licensing agreement with the Medicines Patent Pool within three months of regulatory approval, allowing three generic manufacturers to begin developing affordable versions expected to reach markets by 2028.
Until then, the company has committed to supplying at least two million doses of long-acting PrEP at a non-profit price for lower-middle-income countries beginning in 2025.
Brazil has also recommended incorporating injectable cabotegravir into its public health system.
Presenting findings from pilot implementation projects in South Africa, Elzette Rousseau of the Desmond Tutu Health Foundation said demand for injectable HIV prevention has exceeded expectations.
Across the projects, nearly three-quarters of participants chose injectable PrEP over daily oral pills, while long-acting lenacapavir showed particularly high acceptability.
Jared Baeten, senior vice president at Gilead Sciences, described the approval of twice-yearly injectable lenacapavir as one of the most significant advances in HIV prevention in decades.
He said the PURPOSE 1 trial reported no HIV infections among women receiving lenacapavir, while PURPOSE 2 also demonstrated very high efficacy among men and gender-diverse populations.
Baeten added that Gilead pursued simultaneous regulatory submissions around the world, enabling countries such as Zambia and Eswatini to receive the medicine almost at the same time as wealthier nations — a first for an antiretroviral drug.
To bridge the gap before generic production begins, Gilead has committed enough lenacapavir to protect three million people and expects around 600,000 individuals to be receiving it for HIV prevention by the end of this year.
Despite the scientific breakthroughs, community leaders warned that implementation—not efficacy—will determine success.
Adaobi Lisa Olisa of the Nigerian advocacy organization Root to Rise said communities must be placed at the center of HIV prevention programs.
Olisa said the challenge was implementation rather than science.
"The science is not failing," she said, adding that trust, awareness and community leadership are essential for people to embrace new prevention technologies.
She argued that governments and donors must invest not only in medicines but also in delivery systems, education and demand generation to ensure equitable uptake.
MSD researcher Eliav Barr presented new data on islatravir, an investigational once-monthly oral PrEP pill currently under development.
Phase II trials suggest the medicine begins providing protection within an hour after administration and could be distributed through community health workers without requiring specialized clinical infrastructure.
The session concluded with a debate over access in middle-income countries, particularly those that hosted clinical trials but remain excluded from voluntary licensing agreements.
Representatives from Health GAP questioned the ethics of recruiting participants for research in countries such as Brazil while limiting access through tiered pricing instead of allowing generic production.
Industry representatives defended bridge supply programs, differential pricing and local manufacturing partnerships while regulatory approvals continue.
The discussion underscored a growing consensus that long-acting HIV prevention medicines could transform the global response to HIV, but only if countries can make them affordable and accessible to those who need them most.
