Gilead's near-perfect HIV prevention shot stalls as Latin America battles price gap

Lenacapavir, the latest long-acting pre-exposure prophylaxis developed by Gilead Sciences, prevents HIV infection with almost perfect efficacy and requires only two injections per year. While the United States charges $14,000 per dose, Gilead has pledged a $40 generic price for 120 low- and middle-income countries, yet Brazil, Mexico, Argentina and Peru—classified as upper-middle-income—are denied that discount and face substantially higher costs.

At the International AIDS Society conference in Rio de Janeiro, activists shouted against what they called pharmaceutical greed, and Brazil's health minister Alexandre Padilha criticized the gap, calling it an injustice. UNAIDS Executive Director Winnie Byanyima highlighted Brazil's year-long, fruitless attempts to secure a deal, and experts suggest the country's constitutional obligation to provide treatment may be inflating Gilead's price expectations.

Gilead maintains it is following Brazil's regulatory and reimbursement procedures and continues negotiations, while Brazil pursues alternative options, including a partnership between Fiocruz and Merck's MSD Brasil to develop a monthly oral pill and the inclusion of ViiV Healthcare's cabotegravir into its public health system pending final approval. The dispute underscores broader challenges of scaling access to new HIV prevention tools across the region, where new infections are rising.