Dear Advocate,
In response to today’s announcement of the increased volume commitments for lenacapavir (LEN) for HIV prevention, AVAC and Access Bridge call for global leaders to do even more to ensure meaningful, expanded access. Unveiled at an event hosted by the Center for Strategic and International Studies, the U.S. Department of State, the Global Fund and Gilead announced a catalytic increase in their commitment to reach people with LEN for PrEP: from 2 million to 3 million people over the next three years, signaling some progress in efforts to scale access to LEN for PrEP.
“This is an overdue step forward, but it is just that — a step in the right direction,” said Mitchell Warren, Executive Director of AVAC. “It is good to go from 2 million to 3 million over three years, but this is not yet in line with what the market can bear and what is needed for impact. A meaningful volume commitment of at least four million LEN users in two years is both possible and has the potential to unlock faster access, strengthen market confidence, and accelerate access to prevention for communities that need it most. Volume guarantees must be seen as a floor, not a ceiling. Ultimately, LEN must reach more than five million people per year to have real impact, build a sustainable market, and drive prices down even further. Today’s announcement is progress, but it does not go far enough or fast enough, and the entire field must act faster and think bigger to achieve meaningful progress.”
In July 2025, AVAC published a market assessment that the world could go much faster than the original Global Fund/PEPFAR/Gilead partnership announced in December 2024 and reach at least 1.5 million people with LEN in just one year in low- and middle-income countries if resources were made available. Today’s announcement still falls short of that target.
LEN has been widely recognized as a transformative HIV prevention option, with the every-six-month injection providing highly effective protection. However, translating the scientific breakthrough of LEN into population-level access and impact requires coordinated action across many sectors, including financing, manufacturing, pricing, regulatory, and delivery.
“This could be a pivotal moment, but we cannot bend the epidemic curve with only 3 million doses”, said Wawira Nyagah, Executive Director of Access Bridge. “LEN for PrEP has achieved critical milestones in record time compared to oral PrEP, DVR, and CAB, but speed, scale and equity are still needed to deliver impact. It’s great to see global support lining up behind the science, but much stronger commitments from global actors and national governments are needed. To see LEN truly succeed, we must ensure that programs are designed with communities at the center and that commitments translate into real access for the people who need it. Access Bridge is working across countries in Eastern and Southern Africa to ensure countries are equipped to meet this moment.”
AVAC and Access Bridge call on stakeholders to meet the current moment of scientific opportunity and public health need with bolder ambition. The past decade of PrEP programs have highlighted numerous lessons on how to get LEN rollout right as part of comprehensive HIV prevention programs so that today’s announcement translates into real-world impact. Key considerations include:
Today’s announcement builds on prior commitments from the Global Fund and PEPFAR to reach two million people with LEN over three years, as well as investments from the Gates Foundation and Unitaid to accelerate development and access to generic LEN at lower prices. With generic LEN likely entering the market in the first half of 2027, now is the time to strengthen and grow the market with Gilead’s supply: the faster the market grows, the more infections that can be averted at lower cost.
“Commitments are important, but orders are essential. In Gilead’s own words, they can produce far more if orders are made,” said Warren. “Especially for 2027, clear timelines and ambitious orders for both originator and generic supply will be critical to avoid gaps in care of current LEN users and to expand the reach of this innovation.”
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