A new long-acting antiretroviral HIV medicine could have a transformative effect on the global AIDS response–significantly reducing new HIV infections, revolutionising HIV treatment, and saving many lives. Deborah Waterhouse, CEO, ViiV Healthcare Ltd (ViiV), has developed and brought one of the first of this new category of medicines—long-acting injectable Cabotegravir (CAB-LA)–to market. It is particularly important for immediate use as an HIV prevention tool.

However, there is a need to urgently ensure equitable and affordable access to the new HIV medicine that her company has developed so that it can be used globally to help close the inequalities driving the HIV pandemic. ViiV has shown willingness to collaborate with the HIV community and has recently stated intentions to negotiate a license with the Medicines Patent Pool and offer a lower price for some key countries.

Despite remarkable success in the global AIDS fight, which has cut the number of HIV infections in half, progress is now dangerously slowing. There are 1.5 million new infections annually and a person still dies every minute from AIDS. HIV infection has become rare in many communities, but others around the world face rising HIV risks. 

HIV prevention drugs have disproportionately reached people in wealthy countries while millions of those most in need around the world have limited access. If CAB-LA is not widely available and affordable, it will deepen the inequalities that both fuel the AIDS pandemic, and that are exacerbated by it.

Access to life-saving science cannot and must not be dependent on the passport one holds or the money in one’s pocket. The new long-acting medicines could reach those who need them most, first. Or they could roll out slowly, reach only a portion of those who could benefit, and have a limited impact on the AIDS pandemic. 

There is a concern that long-acting injectable PrEP may not be affordable and available for years to come, including in the very countries and communities where studies proved its efficacy unless action is taken soon. But a good collaboration with ViiV can change this.

The 24th International AIDS Conference in Montreal, Canada, in July offers a historic opportunity for Ms Waterhouse to stand with world leaders, civil society and people living with and at risk of HIV from around the world and pledge actions that will save lives and accelerate efforts to end AIDS as a public health threat by 2030.

Moreover, on the 29th of July, the World Health Organization will release new guidelines on CAB-LA at the conference. These new technologies could be a lifeline for so many, including young women who fear stigma if they are seen taking medication for HIV, gay men and transgender people facing repression and homophobia, and sex workers who need better options. As a matter of equity, they must be affordable and available to all at the same time–in particular those in the global South and the populations facing the highest risk.

As Chief Executive Officer of one of the world’s leading HIV pharmaceutical companies Ms Waterhouse can help to write a new future for millions of people living with, and at risk of, HIV. After the first antiretroviral HIV drugs received approval, prohibitive costs meant they were out of reach in the global South. Millions died. Eventually, generic competition and lower pricing reversed that course, sparing an estimated 16.5 million lives. Today, there are nearly 10 million people living with HIV globally who are not accessing life-saving treatment.

Each year, there are more than 680,000 preventable deaths from AIDS. With 2030–the United Nation’s target year for ending AIDS as a public health threat–fast approaching, there is no time to waste in mobilising new health technologies to reach those whose needs have not yet been met by the global AIDS response and to give new choices to all at risk.

Many stakeholders have a role to play. National governments need to review this new medication and urgently update their guidelines. Health systems and communities must be supported to deploy new HIV prevention options as soon as they are available. Capital investments in generic production facilities will be needed. Community treatment and prevention literacy efforts are needed to avoid misinformation. Donors must mobilize funding to purchase the medicines and fund implementation science for effective delivery. All of this will depend on affordable and sufficient supply.

Alongside these actions needed by other stakeholders and using the platform of the International AIDS Conference, a team of global healthcare practitioners, led by Quarraisha Abdool Karim is calling on Ms Waterhouse to: 

  1. Announce a lower price for the long-acting injectable ARV for prevention, CAB-LA, as close as possible to that of other HIV prevention medicines (PrEP). The current best PrEP option is approximately $60 per person per year. Make the price public and transparent, and include the cost of the accompanying syringe.
  2. Quickly finalize licenses to produce generic versions of this long-acting ARV through the Medicines Patent Pool. License across the world’s low- and middle-income countries on a nonexclusive basis, with a broad geographic scope for both treatment and prevention.
  3. Share know-how and technology. Enable producers in Africa, Asia, Latin America, Eastern and Central Europe and beyond to seek transfer and begin producing.
  4. Commit to making enough to meet demand until generic producers come online. ViiV can show the world that it can continue to accelerate progress against AIDS by ensuring the best new prevention and treatment technologies can reach the millions of people who need them most—to stop the virus and support long lives with HIV.

Quarraisha Abdool Karim is the Co-founder and Associate Scientific Director of CAPRISA – Centre for the AIDS Programme of Research in South Africa  Professor of Clinical Epidemiology at Columbia University, New York; Pro-Vice-Chancellor for African Health, University of KwaZulu-Natal, South Africa; and UNAIDS Special Ambassador for Adolescents and HIV.