A biannual injection could help end AIDS. Will everyone who needs it have it?

It has been said that it is the closest the world has ever come to a vaccine against the AIDS virus, even though it is not.

It’s a twice-yearly shot that was 100% effective in preventing HIV infections in a study of women, and results from a new trial released Wednesday show it worked almost as well in men.

The pharmaceutical company Gilead announced that will allow the sale of cheap generic versions of that drug in 120 poor countries with high HIV ratesmainly in Africa, Southeast Asia and the Caribbean. But it has excluded almost all of Latin America, where the incidence of the virus is much lower but increasing, raising fears that the world is losing a golden opportunity to end AIDS.

“This is by far a superior prevention method than any other we have had; “It’s unprecedented.”said Winnie Byanyima, Executive Director of UNAIDS. Byanyima recognized Gilead’s success in developing the drug, but recalled that the world’s ability to stop this disease depends on the use of the drug in the most vulnerable countries.

In a report released Sunday to mark World AIDS Day, UNAIDS says the number of deaths from the disease last year — about 630,000 — was the lowest since 2004, when AIDS deaths peaked. historical, which suggests that the world is at “a historical crossroads” and has the opportunity to put an end to the epidemic.

The drug called lenacapavir is already sold under the brand name Sunlenca to treat HIV patients in the United States, Canada and Europe, among other places. But now the company is getting ready to soon apply for authorization to use Sunlenca in HIV prevention.

Although there are other ways to protect against this virus — condoms, daily pills, vaginal rings and bimonthly injections — experts say Gilead’s twice-yearly injections would be especially helpful for those who It is more difficult for them to ask for help due to fears or prejudices, such as sex workers, homosexual men or young women.

“It would be a miracle for these groups, because they would only have to go to a clinic twice a year and they would already be protected”Byanyima said.

That was the case for Luis Ruvalcaba, a 32-year-old man from the Mexican city of Guadalajara who participated in the most recent study. Ruvalcaba acknowledged that he was intimidated to ask for the daily prevention pills offered by the government, since he was embarrassed that people knew he was gay. Because he participated in the trial, he will continue to receive the injections for at least another year.

“Patients are very happy because it does not involve their daily lives,” explained Dr. Alma Minerva Pérez, a researcher at a private center in Guadalajara who recruited a dozen volunteers for the study. “In Latin American countries there is still a lot of discrimination and a lot of stigma… it is difficult for them to ask for (the pills), they are embarrassed” (shame).

It is still unknown how widely the injections will be available in Mexico or whether they will be accessible through public health. Health authorities declined to comment on any plans to purchase Sunlenca for their citizens. Mexicans can access daily pills to prevent HIV for free and through public health services throughout the country from 2021.

“If the possibility of using generics has been opened, I have faith that this will happen in Mexico,” Pérez confided.

Byanyima noted that, in addition to Mexico, other countries that participated in the investigation were also excluded from the generics agreement, including Brazil, Peru and Argentina. “Denying them that medication now is inconceivable,” he said.

In a statement, Gilead assured that it has a “constant commitment to contributing to access to HIV treatment and prevention where it is needed most.” Among the 120 countries that can opt for the generic version are 18, mostly African, where 70% of the people infected with this virus in the world live.

The pharmaceutical company added that it works to establish “fast and efficient routes to reach all people who need or want to use lenacapavir for HIV prevention.”

On Thursday, 15 sexual diversity advocacy groups in Peru, Argentina, Ecuador, Chile, Guatemala and Colombia wrote to Gilead to request that the Sunlenca generic be available in Latin America, and denounced the “alarming” inequality that exists. in access to new forms of HIV prevention, even though infection rates are increasing.

While countries like Norway, France, Spain and the United States pay more than $40,000 a year for Sunlenca, Experts estimate it could be produced for as little as $40 when generic production is expanded to cover 10 million people.

Dr. Chris Beyrer, director of the Global Health Institute at Duke University, said it will be enormously helpful to have Sunlenca available in the hardest-hit countries in Africa and Asia. But he recalled that the increasing rates of HIV in certain groups, such as homosexual men and transgender populations, constitute “a public health emergency” in Latin America.

Hannya Danielle Torres, a 30-year-old artist and trans woman who participated in the Sunlenca study in Mexico, hopes that her country’s government will find a way to provide the injections to those who need them most. “Mexico may have the richest people in the world, but it also has some of the most vulnerable populations, people who live in extreme poverty, in situations of violence,” he indicated.

Another drugmaker, Viiv Healthcare, also left out most of Latin America when it authorized generics of its HIV prevention shot in about 90 countries. Marketed under the name Apretude, the bimonthly injections are between 80% and 90% effective in preventing HIV. They cost about $1,500 a year in middle-income countries, more than most can afford.

Asia Russell, executive director of the advocacy group Health Gap, said that at a time when there are more than a million new HIV infections a year worldwide, current prevention methods are insufficient. That is why he urged countries like Brazil and Mexico to issue “compulsory licenses,” a mechanism by which a government can bypass patent rights in cases of health crisis.

This was a strategy that some countries adopted for HIV treatments in the late 1990s and 2000s, when the first AIDS drugs were discovered. More recently, Colombia granted its first compulsory license for the use of Tivicay – a crucial HIV treatment – ​​in April without its manufacturer Viiv granting permission.

Dr. Salim Abdool Karim, an AIDS expert at the University of KwaZulu-Natal in South Africa, said he has never seen a drug that appears to be as effective as Sunlenca.

“The missing piece of the puzzle now is how to get it to everyone who needs it,” he said.