PAHO-Gilead HIV Prevention Deal in Latin America Welcomed by AHF as Civil Society Victory
AIDS Healthcare Foundation (AHF), one of the world’s largest HIV/AIDS healthcare organizations, has welcomed a new agreement between Gilead Sciences and the Pan American Health Organization (PAHO) that could expand access to lenacapavir for HIV prevention across 14 countries in Latin America. The organization described the development as an important step toward improving availability of HIV prevention options in the region while emphasizing that affordability, timely implementation, transparency, and acceptability will be critical to determining the agreement’s public health impact.
The agreement follows concerns from civil society organizations about the geographic scope of an earlier voluntary licensing arrangement involving Gilead and the World Health Organization (WHO). According to AHF, Latin American countries were not included in that initial arrangement, prompting the organization and other civil society groups to advocate for broader regional access to lenacapavir.
Lenacapavir is a long-acting HIV medicine that has generated significant interest as a potential HIV prevention tool because of its dosing schedule and demonstrated efficacy in clinical research. The new arrangement with PAHO is intended to create an additional pathway for access in countries that were not covered by the earlier Gilead-WHO agreement.
AHF said the development demonstrates the role that civil society organizations, communities, and other non-state actors can play in shaping access to HIV medicines and prevention technologies. The organization noted that community groups and advocacy organizations have been involved in efforts to improve access to HIV treatment and prevention since the early years of the HIV epidemic.
AHF Calls for Affordable Pricing
While welcoming the Gilead-PAHO arrangement, AHF emphasized that the agreement will need to translate into practical and affordable access for people who could benefit from lenacapavir. The organization argued that establishing a procurement mechanism is only one part of the process and that pricing will ultimately be a major determinant of public health impact.
Dr. Jorge Saavedra, Executive Director of the AHF Global Public Health Institute and former Director General of Mexico’s National AIDS Program, said the new agreement provides a pathway for countries that were previously excluded but stressed that affordability should remain central to implementation.
“It is encouraging to see PAHO and Gilead creating a pathway for access in countries that were excluded from the previous Gilead-WHO agreement,” Saavedra said. He added that the separate arrangement should target not only a fair price but one that is genuinely affordable for public health systems.
Saavedra also highlighted the economic considerations surrounding HIV prevention. He pointed to the principle that preventing disease can be more cost-effective than treating it after infection, while questioning how governments could justify paying a higher price for a preventive intervention when antiretroviral treatment may be available at a lower cost.
The issue is particularly relevant for countries managing HIV programs with limited healthcare resources. For governments, the price of a new prevention technology must be considered alongside existing prevention strategies, treatment programs, healthcare infrastructure, and other competing public health priorities.
Latin American Countries Contributed to Lenacapavir Research
AHF also highlighted the involvement of several Latin American countries in the clinical development of lenacapavir. Dr. Patricia Campos, AHF Bureau Chief for Latin America and the Caribbean, pointed specifically to Argentina, Brazil, Mexico, and Peru, which contributed to the clinical evidence generated through Gilead’s pivotal PURPOSE 2 trial.
Campos said the participation of these countries in the research process makes subsequent access considerations particularly important.
“People who help make medical innovation possible should not then find themselves on the wrong side of an access barrier,” Campos said.
The PURPOSE clinical development program has been central to evaluating lenacapavir as a potential HIV prevention option. Research from the program has contributed to the growing evidence base surrounding long-acting HIV prevention and has increased attention on how such technologies could be incorporated into public health programs.
For AHF, the issue is therefore not limited to the availability of a new medicine. It also concerns how the benefits of medical innovation are distributed among the populations and countries that participate in clinical research and face significant HIV prevention needs.
AHF Study Examined Potential Regional Impact
AHF has previously examined the potential role of lenacapavir in Latin America through research conducted by the AHF Global Public Health Institute in partnership with Mexico’s National Institute of Public Health.
The study assessed the potential impact that lenacapavir could have across Latin American countries and highlighted two important considerations: price and acceptability.
According to AHF, lowering the cost of lenacapavir will be essential if countries are expected to achieve substantial population-level impact. At the same time, even a highly effective prevention product will have limited impact if people who could benefit from it do not find the intervention acceptable or suitable for their circumstances.
This distinction is particularly important for HIV prevention programs, where effectiveness at the individual level does not automatically translate into effectiveness at the population level. Public health programs must also consider awareness, willingness to use prevention products, access to healthcare services, regulatory requirements, supply availability, and continuity of prevention.
Transparency Will Be Important During Implementation
AHF is calling on Gilead and PAHO to provide greater transparency regarding how the new agreement will be implemented. The organization said important details should include pricing, implementation timelines, regulatory requirements, procurement arrangements, and other terms that could affect access.
The organization also stressed that countries should be able to move from an agreement on paper to actual availability of the medicine without unnecessary delays.
A new procurement pathway can potentially make it easier for governments and public health programs to obtain lenacapavir. However, AHF argues that procurement arrangements must ultimately result in products being accessible to people who need them.
Regulatory approval represents another important part of the process. Individual countries may have their own regulatory procedures and public health requirements before a new medicine can be incorporated into national programs. Consequently, the timing of regulatory submissions, approvals, procurement, distribution, and program implementation could influence how quickly people gain access.
Lenacapavir Is One Component of HIV Prevention
AHF also cautioned against viewing lenacapavir as a single solution to the global HIV epidemic. Although the organization recognizes the medicine’s high efficacy, it emphasized the continuing importance of a comprehensive HIV prevention strategy.
HIV prevention programs typically involve multiple tools and approaches tailored to different populations and circumstances. These can include condoms, testing, treatment as prevention, pre-exposure prophylaxis, post-exposure prophylaxis, harm-reduction interventions, education, and other public health measures.
AHF said it will continue advocating for equitable and sustainable access to lenacapavir while supporting the broader range of established HIV prevention tools, including condoms.
The organization also emphasized the importance of acceptability among populations at increased risk of HIV. Uptake of any prevention intervention can depend on factors extending beyond clinical efficacy, including convenience, dosing preferences, perceptions of the intervention, healthcare access, social circumstances, and trust in health systems.
Civil Society Continues to Play a Role
The agreement between Gilead and PAHO also reflects the broader history of civil society involvement in HIV policy and access. Since the emergence of the HIV epidemic in the 1980s, advocacy organizations and affected communities have pushed governments, pharmaceutical companies, international organizations, and other stakeholders to address treatment availability, affordability, prevention, and health equity.
AHF said its advocacy surrounding lenacapavir access is part of this longer history of civil society engagement. The organization was among the groups that raised concerns about the exclusion of Latin American countries from the earlier Gilead-WHO arrangement and called for expanded access.
The new Gilead-PAHO agreement could therefore represent an important development for countries seeking to incorporate long-acting HIV prevention into their public health strategies. However, the ultimate effect will depend on how the agreement is translated into procurement, regulatory approval, pricing, distribution, and community uptake.
For AHF, the focus now shifts toward implementation. The organization is urging stakeholders to ensure that the new pathway delivers affordable and timely access rather than simply establishing a formal mechanism without sufficient practical reach.
About AIDS Healthcare Foundation
AIDS Healthcare Foundation (AHF) is an HIV/AIDS healthcare organization providing medical care, advocacy, and related services to more than 3 million people across 50 countries. Its operations extend across the United States, Africa, Latin America and the Caribbean, the Asia-Pacific region, and Eastern Europe.
AHF combines healthcare delivery with public health advocacy and campaigns focused on HIV treatment and prevention. The organization has also worked on issues involving access to medicines, public health policy, and healthcare equity.
In January 2025, AHF received the Martin Luther King Jr. Social Justice Award from The King Center, recognizing its work in the social justice arena.
The organization continues to advocate for expanded access to HIV prevention and treatment services worldwide. In Latin America and the Caribbean, its current focus on the Gilead-PAHO agreement reflects broader efforts to ensure that advances in HIV prevention reach communities in need through sustainable, affordable, and accessible public health programs.
As governments across the region consider the potential role of lenacapavir, the coming stages of implementation will determine how effectively the agreement translates into real-world prevention access. Pricing, regulatory processes, procurement, availability, and community acceptability are expected to remain central considerations as countries evaluate how the long-acting HIV prevention option can complement existing strategies.