New medicines promise to transform HIV prevention. But behind the scientific breakthroughs lies an old question: who will actually be able to benefit from them?

As part of VirusOFF’s media campaign “From Rio to Geneva: HIV Prevention Choice, Access and Mobility in Practice”, supported by IAS in the context of Rethink. Rebuild. Rise., we spoke with experts from Ukraine and Latin America about what makes prevention accessible, why scientific progress alone is not enough, and the cost of inaction.

Imagine you need HIV prevention. You know there are medicines that can significantly reduce the likelihood of acquiring HIV. You may even have heard about a new injectable prevention option administered just twice a year.

But the nearest service provider is hundreds of kilometres away. Or you don’t know where to go. Or you’re afraid that, at the clinic, you’ll have to explain your sex life to someone whose first response will be judgement.

Prevention exists on paper. But not for you.

In July 2025, the World Health Organization recommended lenacapavir, an injectable HIV pre-exposure prophylaxis (PrEP) medicine administered twice a year. This breakthrough became part of the discussions at AIDS 2026 in Rio de Janeiro about making prevention more convenient and accessible.

On 2 November 2026, the US Food and Drug Administration (FDA) granted tentative approval to the first generic injectable lenacapavir for PrEP. Developed by Dr. Reddy’s Laboratories with financial, technical and regulatory support from Unitaid, Wits RHI and the Clinton Health Access Initiative, it reached this milestone just 16 months after approval of the originator product.

Under an earlier pricing agreement, the generic is expected to cost US$40 per person per year in the 120 countries and territories covered by Gilead’s voluntary licence. Initial supplies are expected before the end of 2026, with wider availability in 2027. However, tentative FDA approval does not itself mean national registration, actual supply or access for everyone who needs it.

For eastern Europe and central Asia, access to new HIV prevention options is an especially pressing issue.

UNAIDS estimates that around 130,000 people acquired HIV in the region in 2024, 7% more than in 2010. Of approximately 2.1 million people living with HIV, only 51% were receiving antiretroviral therapy.

These figures underline the scale of the challenges facing the region’s HIV response. Although treatment coverage is a distinct measure from PrEP access, both raise questions about barriers to timely HIV testing, prevention and care.

Against this backdrop, more affordable generic lenacapavir creates new possibilities. Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan are covered by Gilead’s voluntary licence, along with several other countries in the region. But inclusion in a licence does not guarantee access through prevention programmes. National regulatory decisions, financing, demand forecasting, procurement, supply, workforce readiness and community engagement are still needed.

That is the central contradiction: the path from scientific advance to a more affordable product is becoming shorter, while the path from people to prevention may remain long and difficult.

New technologies and agreements are expanding prevention choices. Yet many people still face barriers to services that already exist.

And this is where the experiences of Ukraine and Latin America reveal unexpected parallels.

Ukraine: when people cannot reach the clinic

What does a healthcare system need to do to keep functioning when people are forced to leave their homes, healthcare facilities relocate, and familiar routes to care disappear?

Olha Hvozdetska, Deputy Director General of the Public Health Center of the Ministry of Health of Ukraine, told VirusOFF that one of the most important responses was the ability to rapidly adapt services.

And, she explains, this did not require new legislation.

“We implemented all the changes within the existing regulatory framework,” Hvozdetska says.

Healthcare facilities received additional guidance, patient referral pathways were revised, and the information system was adapted. This allowed people to continue receiving antiretroviral therapy in different regions of the country and transfer between healthcare facilities without unnecessary administrative barriers.

The experience of mobile clinics is particularly revealing. Between February and November 2025, they made 1,213 outreach visits, reached 67,040 people with services and conducted 42,808 HIV tests. According to Ukraine’s Public Health Center, one in five people tested through these services had never previously been tested for the relevant infections. This is more than another way to offer a test. It is an opportunity to reach people who, for various reasons, may remain outside the conventional healthcare system. “Even when a service is officially available, a person may be unable to use it because of security concerns, internal displacement, financial difficulties, stigma or a lack of information,” Hvozdetska notes.

There is another problem, less visible in official reports.

The most recent estimate of the number of people living with HIV in Ukraine was produced before the full-scale invasion. Following large-scale migration, it no longer reflects the current situation. In other words, the system must respond to the needs of people whose exact numbers and locations are now unknown.

In these circumstances, the role of community organizations goes far beyond providing information.

“During the war, civil society organizations have not simply complemented the healthcare system. They have often ensured its flexibility and ability to respond quickly to new challenges,” Hvozdetska says.

It was civil society organizations that helped locate people who had lost contact with healthcare facilities, restore access to treatment, and organize navigation and support for those displaced within Ukraine and beyond its borders.

Ukraine’s experience shows that new technologies are indeed essential. But sometimes the most important change is not the arrival of a new medicine. It is the system’s willingness to change the way it works for the people it serves.

Argentina: rights are written into law. But who pays to make them real?

Argentina is not experiencing a full-scale war on its territory, but the gap between official commitments and actual access to prevention is no less familiar. In 2022, the country adopted Law No. 27,675, establishing a comprehensive approach to the HIV response, the protection of rights and community participation. But what happens after a law is passed?

Gastón Devisich, Community Engagement Coordinator at Fundación Huésped, explains that a substantial share of public resources goes towards purchasing medicines. Sustainable funding for information, counselling, navigation and prevention services, meanwhile, remains a major challenge.

Much of this work is carried out by civil society organizations — with small teams, short-term grants and, sometimes, volunteer labour.

“Community-led prevention exists. But it exists despite structural limitations, not because the system fully enables it,” Devisich says.

The result is a paradox.

A healthcare system can purchase medicines. But who will explain to someone what PrEP is and how to access it? Who will help a migrant who does not speak the local language navigate healthcare services? Who will support someone after they experience discrimination at a clinic?

Medicines can be purchased centrally. Trust cannot.

According to Devisich, access to PrEP in Argentina remains uneven. It depends on where a person lives, the type of health coverage they have and their ability to navigate the healthcare system.

“Availability, access and especially equitable access are not the same thing,” he emphasizes.

He then poses a series of uncomfortable questions for countries introducing new prevention tools:

“Who has access, or who will have access? How quickly? At what cost? Under what conditions? Who is being included in the roll-out from the very beginning, and who is being left for later?”

These questions are equally relevant to Eastern Europe and Central Asia.

As international funding declines, governments are increasingly expected to take responsibility for services. But the transition to domestic financing does not automatically guarantee that programmes will be sustained — especially those working with people who face stigma, criminalization and social exclusion.

A price of US$40 per year makes these questions more immediate: who will plan procurement, fund navigation and information, and involve communities before implementation begins?

“If we do not address access from the outset, innovation will deepen inequalities instead of reducing them,” Devisich warns.

This may be one of the most troubling conclusions to emerge after Rio.

A new technology can transform HIV prevention. But if access is unequal, it may first transform the lives of those who are already best connected to healthcare.

Who Is overlooked even by well-designed programmes?

There is an even more uncomfortable question: whose lives are prevention programmes actually designed for?

Carlos García de León, a Mexican human rights advocate and expert on HIV, sexual health and LGBTIQ+ rights, points to the experience of chemsex — the use of psychoactive substances in sexual contexts.

García de León notes that some healthcare professionals view chemsex simply as a “bad choice”, without trying to understand the role of mental health, loneliness, stigma, social isolation and personal safety.

But if a prevention programme fails to reflect people’s lived realities, how effective can it really be?

“Most prevention programs aren’t designed for people who combine sex and substances intentionally, so they don’t meet their needs,” he explains.

According to García de León, consultations with communities in Latin America revealed a far more complex picture: the impact of economic vulnerability, discrimination, criminalization and violence, alongside barriers created by healthcare providers.

For example, for some trans* women, substance use in sexual contexts is closely connected to the conditions of sex work, economic dependence and personal safety.

These circumstances cannot be addressed through moral lectures or standard information campaigns.

“Lived experience shows us what truly works. Harm-reduction strategies need to be adapted to the dynamics of chemsex, and that only happens when we listen to people who practise it,” García de León emphasizes.

The question is not whether to approve or condemn someone’s behaviour.

The question is whether the system is prepared to offer that person support without judgement.

And this example reaches far beyond chemsex.

Are we designing services for real people — or for a convenient idea of what their needs and behaviours should look like?

After Rio: three questions that cannot be avoided

The world has an expanding range of HIV prevention tools. But having more choices available does not mean everyone can actually make those choices.

The first generic lenacapavir has moved closer to introduction through an accelerated regulatory pathway and an early pricing agreement. But a faster route to market is not the same as faster, equitable access for people.

The experiences of Ukraine and Latin America point to three practical questions.

First: can services follow people? Not only during war, but also when people migrate, live far from major cities, change their documentation or lose access to familiar healthcare support.

Second: who builds trust — and who pays for that work? If a government funds medicines but not navigation, counselling or community-led services, some people will remain outside the system.

Third: are communities involved in decision-making? Not as invited guests after a strategy has already been approved, but as partners who can set priorities, assess service quality and influence how resources are allocated.

Olha Hvozdetska states this principle clearly: “No decision should be made without the participation of the people directly affected by it.”

Gastón Devisich, meanwhile, reminds us that scientific advances and human rights cannot be separated:

“Trials, prevention tools, treatment advances — all of these can have an impact only if communities trust them and if people can access them without stigma or barriers.”

This is where the AIDS 2026 theme — Rethink. Rebuild. Rise. — takes on a very concrete meaning.

Rethink means no longer treating the approval of a medicine as proof that prevention is accessible.

Rebuild means changing how services are funded and delivered so that people do not fall through the cracks because of where they live, stigma or migration.

Rise means recognizing communities not as temporary implementers of someone else’s decisions, but as equal partners in the HIV response.

By IAS 2027 in Geneva, the question will no longer be how many new possibilities science has delivered. The question will be how many people have actually been able to benefit from them.