The HIV prevention drug that could save millions of people – if they can afford it

The person blew a whistle. There was a crowd with placards in the conference room. Everyone in the room was aware of what it meant.

The protesters took over the stage and denounced the pharmaceutical industry. The people who had their session interrupted smiled and applauded. I would like to thank you for your work. Please allow the session to go on.

At the last international Aids conference in Montreal in 1989, the activists demanded that the doctors and scientists not discuss the disease without them. The death toll in Africa and Asia increased as the protests grew.

It was not possible to get effective treatment in low income countries. Drug company stands were covered in blood-red paint. The marchers filled the streets.

The fight was won by activism. The drugs have saved 29 million people's lives. There is a sense of conversation going on in Montreal, even though the activists are still in the city. It is still about drugs, but it is more difficult to sell to people who want to prevent HIV infections.

It is good news. People who are injected with cabotegravir every two months are less likely to get HIV. The results have been amazing. It's a big breakthrough. The guidelines produced by the World Health Organization encourage countries to use CAB-LA as soon as possible.

Ten years ago, oralPrEP arrived. There are daily pills that do the same thing. There was demand for people with HIV in wealthy countries. The pills weren't cheap for low-income countries. Generic manufacturers were allowed to copy the formula. More than 3 million people have not yet taken them.

One of the biggest problems is how to protect women and adolescents who may have sex with people who are HIV positive. The numbers are not dropping. UNAids showed 1.5 million new infections last year which is 1 million more than the target.

Girls and young women in Africa who have been forced out of school due to Covid are more likely to get new infections. They accounted for more than half of all new infections last year.

This is pandemic-altering science. Our message is: it is evil to put profits before protection from HIV

It is discreet and effective. There is an obvious comparison between long- lasting contraceptives and long- lasting injections. Young women may be able to get a jab every two months that will protect them from HIV without anyone knowing. Sex workers and gay men are at risk of being criminalized in countries with homophobia. That made women hesitant to seek it out.

The cost of a cab in LA is high. There is a not-for-profit price for a year's supply for one patient. The Clinton Health Access Initiative calculated that the cost of the ingredients could be as high as $20-40.

Asia Russell of HealthGap says thatCAB-LA is effective. It is not accessible to the communities who need it. The people's prevention shot is being treated like a luxury good instead of being an option.

Russell says it is evil to put profits before protection from HIV.

Helen McDowell, head of government affairs and global public health at ViiV, says that the treatment involves a complex technology, and that it cannot be offered for less than $60 per patient. She says that if there is demand they can bring the price down.

The company has an agreement with the Medicines Patent Pool which will allow three generics companies to be licensed to produce cheap copies. It could take up to five years for the generics to invest in technology. There is only one source at the moment.

It has the potential to turn the tide on the HIV epidemic and is excited about it. There are 6,000 adolescent girls and women getting infections on a weekly basis in sub-Saharan Africa.

The daily box of tablets that is visible is one of the reasons why women don't take oralPrEP. They want something discreet that they don't have to reveal and they are in control of it.

Mitchell Warren runs the advocacy group Avac and is close to HealthGap. The WHO, Unitaid, UNAids and the Global Fund are part of a new coalition, according to him. The coalition will find a way to give CAB-LA to people who need it. They could discuss their differences.

We don't find ways to talk more strategically. The activists are raising important issues. I would like to see more people talking. I don't believe we're that far apart.

He says that we need to think about how we market prevention. There is a bubble around us. We need to raise the temperature if we want people at risk of HIV to think about prevention.

This year's Montreal conference was partly online and had no heat of its own. There was a lot of talk of apathy in the world. A lot of the world doesn't think that Aids is a problem anymore.

Prof Sharon Lewin is the president-elect of the International Aids Society, which runs the conference. HIV has been wiped off the front pages of Covid's books. She says it's not realistic to think we can go back to the same visibility.

Risk gains can be lost. Global targets are off track. The CAB-LA could be a success story. In order to contain its HIV epidemic, Botswana achieved a number of things, one of which is that 95 percent of people with HIV know their status.

Lewin believes that the virtual elimination of HIV can be accomplished. The optimism should be seen everywhere.

You can sign up for a different view with our Global Dispatch newsletter, which contains a list of our top stories from around the world, as well as recommended reads and thoughts from our team on key development and human rights issues.