High prices and funding cuts stall HIV prevention revolution

Why it matters

• 1.2 million people acquired HIV and 570,000 died from AIDS-related illnesses in 2025
• 22 per cent of people living with HIV are still not receiving treatment
• International HIV funding fell 18 per cent, the steepest decline in nearly 20 years
• Such new medicines as lenacapavir are nearly 100 per cent effective at preventing HIV infection
• 20 million people need access to antiretroviral-based prevention to make a meaningful impact on the epidemic
• Generic versions of lenacapavir could cost as little as $40 per person per year, but they will remain unavailable in many countries

Defined by a paradox

The conference, taking place in Rio from 27 to 31 July, is defined by a paradox.

By the end of this decade, more than three million people could become infected with HIV, yet the tools to stop this crisis already exist, from groundbreaking prevention medicines to community-led interventions with a proven track record. What is missing is sustained financing.

This growing funding gap is already forcing countries to cut essential services and close community organizations, according to the new report from UNAIDS, the agency working to end the epidemic by 2030. 

Unless urgent action is taken, the agency warns, the world is on course for a resurgence of the epidemic.

That contradiction defines the 26th International AIDS Conference.

On the one side stands a revolution in HIV prevention, with a new generation of medicines now offering protection against HIV comparable to that of a vaccine.

On the other is a growing concern that these breakthroughs will remain out of reach for millions because they are priced too high and controlled by pharmaceutical patent holders.

Brazil excluded from generic production

Few countries illustrate this paradox more clearly than the conference host itself.

Although Brazil played a key role in the clinical trials that helped bring lenacapavir to market, it was excluded from the list of countries authorised to manufacture lower-cost generic versions.

Lenacapavir is a long-acting injectable medicine that requires just two injections a year and prevents HIV infection in nearly 100 per cent of cases, according to the latest studies.

Universal access is ‘distant reality’ for most

“Equitable and universal access remains a distant reality for millions of people because of high prices and the exclusion of many countries from voluntary licensing agreements,” said Variano Terto Jr., vice president of the Brazilian Interdisciplinary AIDS Association (ABIA).

He was speaking at a conference side event organized by the Community of Portuguese Language Countries (CPLP). 

He added that patents on essential drugs have been “reinforcing monopolies and privatization of public knowledge”.

One of the conference co-organizers, ABIA recently published a study showing that Brazil could manufacture lenacapavir domestically for approximately $75 per patient per year. 

By contrast, the patented version costs more than $20,000, a price considered unsustainable for Brazil’s public health system.

Risk of injustice

The true measure of success is not whether medicines exist, but whether the people who need them can actually obtain them and at an affordable price, said UNAIDS Executive Director Winnie Byanyima.

“Innovation without access is not innovation; it is injustice,” she said.

UNAIDS estimates that 20 million people need access to antiretroviral-based prevention if the world is to significantly reduce new HIV infections.

Calls for new funding model

While HIV infections and AIDS-related deaths are at their lowest levels in more than three decades, the global response remains dangerously fragile.

International HIV financing dropped by more than $1.5 billion between 2024 and 2025, an 18 per cent decline that marked its lowest level in nearly two decades, and global development assistance fell by 23 per cent last year, the largest annual decline ever recorded, with health programmes, including HIV initiatives, among the hardest hit.

Meanwhile, new HIV infections increased across three regions and in 21 countries during 2025.

The current moment should be understood as “the end of the era of dependence on international aid”, the UNAIDS chief said, calling for a new financing model, including measures such as sovereign debt restructuring, to enable governments to invest in “the future of their people”.