Profits over patients
New breakthrough medicines could end HIV, but a manufacturer’s restrictions on access could cost millions of lives.
About 1.3 million people every year contract HIV. That means access to highly effective new prevention tools such as long-acting pre-exposure prophylaxis (PrEP) medications urgently needs to be scaled up.
These new tools – like injectable lenacapavir – function almost like vaccinations. When used before exposure to the HIV virus, they are highly effective at helping people remain free from infection.
Lenacapavir is administered twice a year and could be life-changing, especially for people in communities where stigma and systemic barriers can hinder a regular daily pill regime. It could be just as transformative for public health, with the potential to end the HIV epidemic. Lenacapavir manufacturer Gilead Sciences’ CEO Daniel O’Day said in Health Policy Watch that it had taken Gilead 17 years to develop the drug and that it was “a unicorn of a molecule”. But while Gilead has said it can expand production of lenacapavir to meet the need, the company will not sell the medication to humanitarian organisations like MSF for use in our programs.
Instead, the company has referred MSF to the Global Fund, which, along with PEPFAR, has negotiated access to a limited supply of lenacapavir for low- and middle-income countries. But this supply is already overstretched and only enough doses to reach up to 3 million patients over three years.
UNAIDS previously set a target for 21.2 million people to be on PrEP by 2025 to reduce new infections, so this contribution represents just 15 per cent of the need. Only nine countries have received doses of lenacapavir so far, while millions of people worldwide remain at high risk of HIV infection.
Many countries where MSF works face very limited supply, restrictions or complete exclusion from the Global Fund agreement, meaning that vulnerable people in need will be denied access to HIV prevention unless Gilead sells it to MSF directly.
“Blocking humanitarian organisations from accessing a medical breakthrough puts vulnerable people in danger,” says Dr Tom Ellman, director of MSF’s Southern Africa Medical Unit.
Gilead sells lenacapavir at a price of US$28,000 a year per patient in the USA, even though it could be sold at a profit for less than US$40.
At their annual stockholder meeting in May, the company declared profits of almost US$7 billion in quarter one of 2026, of which more than $5 billion was derived from the sale of its HIV products. Gilead made more money from HIV drugs last year than the Global Fund was able to spend on tackling HIV over the last decade.
“Gilead must decide whether it prioritises protecting people or protecting control and profit. This is a chilling echo of the policies we saw in the 1990s when antiretrovirals were provided to those in the global North, while the rest of the world was denied access and many lives were lost to HIV/AIDS,” says Dr Ellman.
Gilead made more money from HIV drugs last year than the Global Fund was able to spend on tackling HIV over the last decade.
While Gilead has agreed for six generic manufacturers to make and sell the medicine at a lower price, countries like Argentina, Brazil, Mexico and Peru – where the clinical trials leading to the drug’s approval were held – are excluded from that deal. In fact, up to a quarter of new HIV infections are happening in countries excluded from the agreement.
“That this drug’s development was supported by public funding – and through the trust of communities who participated in clinical trials, many of them in countries now excluded from affordable access – makes the current restrictions even more unconscionable,” says Dr Ellman. Giving other manufacturers permission to make lenacapavir, without restricting where they can sell it, to help boost the global supply, is necessary to reach everyone who needs this medicine.
“It is not enough for this groundbreaking medicine to only be available to people living in wealthy countries. To truly curb HIV transmission, lenacapavir must be affordable and accessible for vulnerable people across the world who are at the highest risk of contracting the virus,” adds Tirana Hassan, CEO of MSF USA.
“If Gilead has the capacity to produce more,” Dr Ellman says, “it’s indefensible and inhumane that they’re choosing not to.”
HIV and PrEP in Eswatini
With the world’s highest rates of HIV among adults 15-49 years old (23.4 per cent in 2024), Eswatini was the first to receive lenacapavir in November 2025.
MSF negotiated a limited number of doses for its program in Eswatini though the Ministry of Health, which procured them through the Global Fund. Within four weeks of implementation, MSF had already exhausted its allocated supply. One of the early recipients was Philiswa Mbingo.
“I am a very young woman, and in our times there are a lot of things that can happen to you unexpectedly,” she says, reflecting on the complex realities many young women face in Eswatini, where sexual violence against women and girls is high.
“I heard about the six-month PrEP injection, which made me very happy,” she says. The extended protection appealed to her, reducing the need for frequent clinic visits, daily pills or other methods of protection. Beyond convenience, Philiswa believes the injectable option is more effective for her.
“We normally say it is better to prevent than to treat,” she says. However, lenacapavir is still not an option for many in Eswatini, and around the world, who are still waiting to access it.