HIV Prevention Drug: 'Everyone Should Access It for $40 a Year' – Doctors Without Borders Launches Campaign Against U.S. Pharmaceutical Company

A 29-year-old woman working in the sex industry in Malawi. Doctors Without Borders provides support to people at risk of HIV and other health threats. © Diego Menjibar

On June 17, Doctors Without Borders (MSF) launched a campaign urging Gilead Sciences, a U.S.-based pharmaceutical company, to make the highly effective HIV prevention drug 'lenacapavir' rapidly and widely available worldwide.

Launched ahead of next week’s United Nations High-Level Meeting on HIV/AIDS in New York, MSF is calling for the two annual injections required for HIV prevention to be available in all regions for $40 (approximately 6,400 yen) or less.

MSF is also urging governments worldwide to take all necessary legal measures to counter Gilead’s monopoly, enabling other pharmaceutical companies to expand supply and further reduce prices.

HIV prevention with two annual injections

Gilead, which holds a monopoly on the manufacturing and sale of lenacapavir, currently sells the drug at extremely high prices in only a limited number of countries. It severely restricts supply to low- and middle-income countries and refuses to sell directly to MSF.

Lenacapavir is a long-acting injectable formulation for pre-exposure prophylaxis (PrEP), providing nearly 100% protection against HIV infection with just two doses per year. It is particularly beneficial for people at higher risk of infection, including men who have sex with men, gay men, transgender people, people who inject drugs, and sex workers.

It is also a crucial preventive tool for people forced to move, those living in remote areas with limited healthcare access, and those in humanitarian crises. In 2025, approximately 1.2 million people worldwide will be newly infected with HIV, indicating extremely high demand.

"Right now, millions of people need lenacapavir," said Dr. Tom Ellman, Director of MSF’s Southern Africa Medical Unit (SAMU).

"When HIV/AIDS first emerged, pharmaceutical companies sold antiretroviral drugs only to buyers who could pay the highest prices, leaving us powerless in regions like South Africa. The consequences were clear: HIV patients died, and entire communities suffered. We must not repeat the same mistake with this innovative prevention drug, lenacapavir. Gilead and governments worldwide must intensify efforts to ensure global access to this medicine."

MSF staff providing counseling to a woman working in the sex industry in Malawi. © Diego Menjibar

Countries excluded from supply, widening gaps

Over the past year, MSF has repeatedly requested to purchase lenacapavir for use in its programs worldwide, but Gilead has refused to supply MSF at any price.

Instead, the company directs MSF to procure the drug through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which supplies limited quantities to low- and middle-income countries. However, this supply is already insufficient in countries like Eswatini and Kenya, and some countries and regions MSF aims to support are excluded from eligibility.

Meanwhile, lenacapavir is available and actively marketed in the U.S., priced at over $28,000 (approximately 4.48 million yen) per patient annually. "Gilead claims it wants to end the HIV epidemic 'for everyone, everywhere,' but its strategy raises serious questions," said Melissa Barber, MSF USA’s Global Health Advocacy and Policy Lead.

"It’s a major problem that countries like Brazil, where HIV infections are rising, are excluded from generic lenacapavir licensing. Moreover, Gilead is now refusing to sell to MSF for use in regions like southern Africa and Central America, effectively shutting us out. Gilead must take stronger action to ensure the two annual preventive injections are available for $40 or less in all regions."

A man in Mozambique receiving an HIV consultation at an MSF clinic. © Martim Gray Pereira/MSF

Structural barriers to access—now is the time for legal action

A deeper structural issue is that Gilead controls who receives lenacapavir, where it is supplied, and under what conditions.

The company has agreements with select generic manufacturers to supply the drug at lower prices than in wealthy countries, but generic versions are not expected to be available until at least 2027.

Even countries where clinical trials were conducted—Argentina, Brazil, Mexico, and Peru—are excluded from these licensing agreements. In fact, about one-quarter of new HIV infections occur in countries excluded from these licenses.

Beyond Gilead, governments have a crucial role in expanding access to lenacapavir. If the company continues high pricing and manufacturing restrictions, governments must take all necessary measures to overcome monopolistic control. Governments have broad flexibility under the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). For example, they can issue 'compulsory licenses' to allow production and sale without the patent holder’s permission. Such measures could remove intellectual property barriers and promote expanded generic drug production.

"If Gilead continues to prioritize profits over people’s health, governments must intervene," said Dr. Ellman.

"TRIPS provides legal tools to bypass patents that block access to essential medicines like lenacapavir. Governments must now use these tools to ensure this vital HIV prevention drug reaches as many people as possible."

An MSF midwife caring for a pregnant woman diagnosed with HIV. © Augustin Mudiayi/MSF

Join and sign the campaign at the MSF USA website

Tell Gilead: Drop the price of long-acting PrEP!