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Innovation Without Access Is Not Progress: An Advocate’s Reflections From AIDS 2026

Conference Coverage Clinical Thought
Conference Coverage Clinical Thought
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Released: August 27, 2026

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As a person living with HIV, I left Rio de Janeiro thinking less about what science can achieve and more about who will actually benefit from it. Here’s why equity needs to be built into the development, licensing, and delivery of new technologies from the outset.

Gastón Devisich
Gastón Devisich
Advocate Perspective AIDS 2026


AIDS 2026 highlighted extraordinary scientific progress in HIV prevention, treatment, cure, and implementation research. But as a person living with HIV, I left Rio de Janeiro thinking less about what science can achieve and more about who will actually benefit from it. For Latin America and the Caribbean, this distinction matters enormously.

Innovation Is Moving Fast
From twice-yearly lenacapavir for pre-exposure prophylaxis (PrEP) to once-weekly oral treatment, new vaccine research and renewed work toward an HIV cure, the tools available—or coming soon—are more powerful than ever.

But scientific progress has never automatically translated into equitable access. In Latin America and the Caribbean, we have seen this story before. Innovations arrive, but access follows slowly, unevenly, or not at all.

Lenacapavir is perhaps the clearest recent example. The data are compelling, and many people chose twice-yearly PrEP when given the option. Yet some countries that contributed to the research are still asking how and when they will be able to access it at an affordable price. At AIDS 2026, Brazil’s Minister of Health made the point clearly: Innovation without access is not innovation; it is injustice.

When Access Plans Leave a Region Behind
We are now seeing a similar concern with alimatravir, the once-monthly oral PrEP candidate. Access planning has already begun, even though phase III results are still more than a year away. That is exactly how it should be. Pricing, licensing, manufacturing, financing, and country readiness should be considered alongside product development, not after approval.

But there is a striking problem. Many countries in Latin America and the Caribbean are again excluded from the current access plan, despite the region’s persistent HIV prevention needs and the participation of countries in the clinical development of these products.

We should be willing to question a system in which patents and licensing agreements can determine who gets access to life-changing innovations and who does not. Voluntary licensing can help expand access, but it is not a substitute for an equitable access strategy. We should not accept a model in which countries and communities compete for inclusion. Equity needs to be built into the development, licensing, and delivery of new technologies from the outset.

What Should We Mean by Innovation?
For people living with HIV and the communities most affected by HIV, this is not an abstract policy discussion. We know what it means when a medicine exists but is inaccessible. We also know that participating in a clinical trial does not guarantee that the same intervention will later be available in your country.

This is why community engagement cannot stop at recruitment or consultation. Communities need a voice in defining what innovation is supposed to achieve: not simply higher efficacy, but products that fit people’s lives, are affordable, can be delivered through trusted systems, and offer genuine choice.

For me, that is the central message I took from Rio. We no longer have an innovation problem. We increasingly have an access and implementation problem.

The next measure of progress should not only be what science can achieve, but whether people—including those of us living with HIV and those in regions too often left behind—can actually benefit from it.

Your Thoughts?
As HIV healthcare professionals, how do you see the gap between scientific innovation and access affecting the people you care for? What would meaningful “access by design” look like in your setting?