Key Takeaways
- Lenacapavir is a twice-yearly injectable HIV prevention medicine that MSF says is nearly 100 per cent effective, yet Gilead Sciences prices it at $28,000 per year in the US despite production cost estimates under $40.
- Doctors Without Borders (MSF) is calling for lenacapavir to be sold for no more than $40 per person per year in all low- and middle-income countries (LMICs).
- Brazil, along with Argentina, Mexico, and Peru, hosted the clinical trials that led to lenacapavir's approval but is excluded from Gilead's planned generic manufacturing and distribution deal.
- MSF argues governments should use World Trade Organisation TRIPS flexibilities, such as compulsory licensing, to override Gilead's monopoly if the company does not lower prices or expand access.
- MSF has launched a public campaign against Gilead and will host a satellite session on lenacapavir access on July 30 during AIDS 2026 in Rio de Janeiro.
Gilead and Governments Must Do More to Make HIV Prevention Medicine Accessible Worldwide
Brazil hosted clinical trials that paved the way for lenacapavir's approval and sale, but the medicine remains widely inaccessible for people there.
MSF is continuing to put pressure on the US pharmaceutical corporation Gilead Sciences to make the critical HIV prevention medicine lenacapavir more widely available in low- and middle-income countries (LMICs), including Brazil. If Gilead is unwilling, governments must step in to help increase access for people worldwide.
What is Lenacapavir and why it matters
Lenacapavir is an injectable version of pre-exposure prophylaxis (PrEP) that only needs to be given twice a year and is nearly 100 per cent effective in preventing HIV. It could be a game-changer for communities affected by HIV everywhere, especially those who face stigma and additional barriers accessing health care, like men who have sex with men, transgender individuals, sex workers, and people caught in conflict or humanitarian crises — if they could access it. Instead, Gilead has priced the medicine out of reach, severely restricted its supply to certain countries like Brazil, and refuses to sell it directly to MSF for use in its medical programs.
MSF's core demand is a $40 price cap
"We're here at AIDS 2026 with one main ask: lenacapavir must be available for no more than $40 per person per year in all low- and middle-income countries. We have been running HIV prevention programs and treating people with HIV/AIDS across the globe for decades. We've seen firsthand what happens when medical tools like antiretroviral treatments are priced out of reach or are simply unavailable: People die needlessly, and communities suffer. We can't let history repeat with this critical HIV prevention medicine," says Renata Reis, executive director of MSF-Brazil.
MSF's ongoing campaign and upcoming session at AIDS 2026
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The pricing and supply gap.
Gilead currently completely controls who can receive lenacapavir, where it's available, and on what terms. The pharmaceutical corporation sells it for $28,000 a year per patient in the US even though it could be produced for less than $40. Some more affordable generic versions are set to become available as early as next year, but only select manufacturers will be allowed to make them, and their sale will be restricted to certain countries. Many countries — including Brazil, Argentina, Mexico, and Peru — that hosted the lenacapavir clinical trials are excluded from that deal altogether.
Brazil's role in the clinical trials and its exclusion from access
"It is unacceptable that communities in Brazil contributed to the clinical trials that paved the way for lenacapavir's approval and sale in countries across the world, yet people here still struggle to access this game-changing medicine. Gilead alone should not decide who gets lenacapavir and who doesn't," said Antonio Flores, senior HIV and tuberculosis (TB) advisor with MSF’s Southern Africa Medical Unit.
The case for government intervention, TRIPS and compulsory licensing
If Gilead continues to charge high prices for this medicine and restrict its production, governments, including Brazil's, should take any necessary steps to make it easier to override Gilead's monopoly on this product. Governments are afforded a broad range of flexibilities under the World Trade Organisation's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). For example, countries may grant compulsory licenses on otherwise patented products, allowing their use without the authorisation of the patent holder. Actions like this can remove intellectual property barriers and may facilitate broader generic production.
"HIV isn't waiting, so why is Gilead?"
Antonio Flores, on the urgency of the situation and the responsibility of both Gilead and national governments, said, "HIV isn't waiting, so why is Gilead? Millions of people who need this medicine can't currently access it. The pharmaceutical corporation must immediately lower its prices and expand access to lenacapavir, or governments like Brazil must take action. There are international legal tools in place for a reason: to protect public health. Brazil has used them in the past, and they must use them again now."
