In a major step toward global HIV prevention, Gilead Sciences and the Global Fund have finalized a plan to supply a breakthrough HIV prevention drug to some of the world’s poorest countries. The move comes despite a lack of funding from a major U.S. program traditionally at the forefront of the global AIDS fight.
The drug in focus is lenacapavir, a long-acting injection approved by the U.S. FDA just last month. It’s administered twice a year and has shown promise in preventing HIV infections in adults and adolescents.
Under the agreement, Gilead will provide the drug at cost to reach up to 2 million people over the next three years across Global Fund-supported countries. While pricing details remain confidential, the focus is on prioritizing nations with high HIV rates — especially in sub-Saharan Africa. South Africa is expected to be among the first 10 countries to receive the drug, with the first deliveries planned before the end of this year.
Peter Sands, Executive Director of the Global Fund, noted the historical significance: “For the first time, a tool to prevent HIV infection is coming available in low and middle-income countries at the same time as in high-income countries.” Typically, such access has been delayed by years.
Gilead is also working with six generic manufacturers to make low-cost versions of lenacapavir available in 120 low- and middle-income countries, but those supplies will take time to roll out.
The initiative is moving forward even as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) faces funding cutbacks under the Trump administration, which has restricted HIV prevention efforts primarily to pregnant and breastfeeding women. While core services like treatment and mother-to-child prevention continue, broader outreach is currently under review, according to a U.S. State Department spokesperson.
Despite this setback, Gilead CEO Daniel O’Day remains optimistic. “We want to be spending less over time on HIV because the incidence is lower,” he said. “We should put resources toward things that actually reduce the burden of disease.”
The drug, branded Yeztugo, has a U.S. list price of over $28,000 per year, highlighting the importance of partnerships and donor support to ensure affordability abroad. The Children’s Investment Fund Foundation has already pledged $150 million, but more global donors are needed to keep the initiative going strong.
