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Beyond Efficacy: Equitable Access Is the Next HIV Prevention Breakthrough

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Conference Coverage Clinical Thought
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Released: August 20, 2026

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AIDS 2026 made one point impossible to ignore: In HIV prevention, science is no longer the main limitation. The most practice-changing data presented at this meeting were not simply another demonstration that long-acting PrEP works. Investigators showed that long-acting PrEP can be accepted, sustained, and delivered across very different populations and settings. Read on to learn how I think our health systems can and should make that choice available.

Claudia P. Cortes
Claudia P. Cortes, MD
Equitable Access to HIV Prevention

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AIDS 2026 made one point impossible to ignore: In HIV prevention, science is no longer the main limitation. The most practice-changing data presented at this meeting were not simply another demonstration that long-acting (LA) pre-exposure prophylaxis (PrEP) works. Rather, investigators showed that LA PrEP can be accepted, sustained, and delivered across very different populations and settings. The urgent question is how our health systems can make that choice available. 

Current Evidence for LA PrEP
I found that the open-label extension of PURPOSE 1 was particularly compelling. Among more than 4000 eligible women, approximately 95% chose to start or continue twice-yearly lenacapavir. Among participants in the open-label extension, there were zero incident HIV acquisitions during almost 4500 person-years of follow-up, and injection adherence at Week 52 was 96%.

PURPOSE 2 told a similarly strong story across cisgender men and gender-diverse people: Again, 95% selected lenacapavir, with sustained high efficacy and adherence. Only 1 HIV acquisition occurred during the open-label phase despite on-time injections. This very rare event does not diminish the overall result, but it reinforces the need for careful testing and follow-up.

The way I see it, the message is straightforward: PrEP should be offered as a menu with multiple options, not as a single prescription. Daily oral PrEP remains highly effective, affordable, and appropriate for many people. Cabotegravir, lenacapavir, and future monthly oral agents do not replace it; they expand choice. This matters because convenience is not a cosmetic outcome. Fewer doses can reduce pill burden, stigma, and disclosure concerns. Some people prefer pills; others will prefer injections. We should be able to offer options for everyone. [Coder link to: https://deceraclinical.com/education/activities/infectious-disease/individualizing-prep-choices/65474-162579/content]

Upcoming LA PrEP Options
AIDS 2026 also previewed the next wave of HIV prevention options: monthly oral PrEP with alimatravir (also known as MK-8527), with modelling suggesting a generic production price near $15 USD per person-year. This agent is still in phase III trials, so there are still many steps remaining before it is approved, but accounting for licensing and delivery before efficacy results is itself an important change in the process. The production of low-cost LA oral medications is essential, given the clear limitations we already see in access to LA injectables, whether because of logistical issues or, primarily, cost.

Equity in LA PrEP Implementation
Early rollout data of LA PrEP in Africa were equally important. Nearly 66,000 people started lenacapavir across 900 sites in 9 countries, including many first-time PrEP users, adolescent girls, and members of key populations. This demonstrates feasibility, but it also exposes supply and diagnostic constraints, as in some settings demand outpaced supply. An LA drug alone does not create a sustainable program. Reliable procurement, appropriate testing, trained teams, and community-led delivery are equally essential.

From Latin America, this tension is especially sharp. Argentina, Brazil, Mexico, and Peru helped generate the pivotal PURPOSE 2 evidence, but they remain outside the voluntary license for generic lenacapavir. Several Latin American countries participating in trials of the investigational monthly oral alimatravir are also excluded from its initial licensing territory. It is difficult to call an innovation transformative when the communities that helped prove its value cannot access it.

My main takeaway from Rio is therefore both clinical and political. We now have prevention options capable of fitting people’s lives far better than before. Healthcare professionals should prepare to offer genuine choice, while governments must simplify PrEP delivery, negotiate regionally, support local manufacturing, and protect community-based services. In the Global South, the next practice-changing breakthrough will not be another efficacy percentage. It will be turning remarkable science into routine, equitable prevention.

Your Thoughts
What has the rollout of LA PrEP looked like in your country? What is being done to promote equitable access, and what do you think could be done better? Leave a comment to join the discussion!

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