Access to HIV Drugs: Overcoming Barriers Despite Promising Advances
Promising developments in HIV prevention and treatment drugs could reshape the fight against the disease. However, ensuring these innovations reach the people who need them most remains a critical challenge, says Beatriz Grinsztejn, President of the International AIDS Society (IAS).
As the first Latin American to lead the IAS—a global organization advocating for science-based HIV policies since the 1980s—Grinsztejn has prioritized equitable access, particularly for low- and middle-income countries (LMICs). Leading research efforts at Brazil’s Evandro Chagas National Institute of Infectious Diseases, she is an outspoken advocate for combating stigma and addressing the needs of marginalized communities.
Elevating the Global South
Grinsztejn’s presidency has centered on amplifying the voices and needs of the Global South. “My primary goal is to place the Global South at the forefront of discussions, ensuring our diverse challenges and perspectives are heard,” she says. This includes advocating for affordable access to new technologies, tackling stigma and discrimination, and focusing on human rights.
With the rise of right-wing ideologies in many regions, challenges around human rights and access to HIV care have intensified. Grinsztejn emphasizes the importance of supporting key populations—such as men who have sex with men, transgender individuals, and others who often face systemic discrimination—by placing their needs at the center of global HIV discussions.
Persistent Inequities in Drug Access
Recent breakthroughs, such as the drug lenacapavir, show remarkable promise. The Purpose 1 and 2 trials demonstrated lenacapavir’s efficacy in preventing HIV, with zero infections reported among women using the drug in Africa. Yet, access remains a hurdle. Although Gilead, the company behind lenacapavir, has initiated licensing agreements for generic production, these agreements exclude several Latin American nations that contributed significantly to the Purpose 2 study.
Another effective innovation, long-acting cabotegravir, has been available for years but remains inaccessible in most LMICs due to delayed generic production and limited distribution agreements. “These drugs hold transformative potential, but unless access expands significantly, their impact will remain restricted,” Grinsztejn notes.
Addressing Barriers for Key Populations
Key populations, especially in Latin America and Africa, face unique challenges, including stigma, criminalization, and systemic inequities. In Latin America, rising HIV rates among young men who have sex with men and transgender women underscore the urgent need for scaled-up interventions like pre-exposure prophylaxis (PrEP).
In Africa, criminalization and discrimination further impede care for marginalized groups, resulting in lower rates of viral suppression. Grinsztejn stresses that tackling these barriers requires not only medical advancements but also robust legal and social reforms.
Strengthening Health Systems in LMICs
Weak health systems and resource constraints in LMICs pose significant challenges to scaling up HIV prevention and treatment technologies. Stigma within healthcare settings and society at large compounds these difficulties. Legal reforms to address criminalization and better funding mechanisms are critical to bridging these gaps.
Grinsztejn also highlights disparities in treatment options. While long-acting antiretrovirals are standard in many high-income countries, they remain absent from LMIC treatment guidelines, further widening the gap in care.
Uniting for Progress
Despite slow progress, Grinsztejn remains hopeful. “We are moving, albeit slower than needed. Now more than ever, we must unite to preserve the rights we’ve gained and secure sufficient funding for the global HIV response,” she says, referencing the need for continued support for initiatives like the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Innovations like lenacapavir and cabotegravir hold the potential to revolutionize HIV care. However, the real challenge lies in ensuring these breakthroughs reach everyone in need. For Grinsztejn, the mission is clear: a universal, equitable HIV response that leaves no one behind.
