Adapted from reporting by Rachel Schraer, The Independent (Rethinking Global Aid Project)
The closest thing we have to an HIV vaccine has finally arrived. Lenacapavir, a long-acting injectable medication that can prevent nearly 100% of HIV infections when administered twice yearly, is being hailed as revolutionary. Yet despite its promise, only a fraction of the people who need it will gain access.
The Numbers Behind the Breakthrough
Current plans by Gilead and international funders will provide lenacapavir to 2 million people over three years, about 666,000 annually.
Research by Dr. Andrew Hill (University of Liverpool) shows this rollout could avert 165,000 infections, but scaling up to 10 million people annually could prevent half a million infections and put us on track to ending HIV transmission.
The challenge: funding cuts, particularly from the U.S. under President Donald Trump, have left prevention efforts severely under-resourced.
The Cost and Access Challenge
In the U.S., a course of lenacapavir costs $28,000.
Thanks to advocacy and licensing agreements, the drug will be sold at no profit in low-income countries, with costs reduced to around $40 per person per year.
Gilead’s plan to reach 2 million people by 2028 is described as an “initial step,” with hopes that generic manufacturers will expand access further.
Why This Matters Globally
Anne Aslett, CEO of the Elton John AIDS Foundation, called the rollout “unprecedented,” noting that doses are arriving in Eswatini at the same time as in the U.S., a sharp contrast to the early AIDS crisis, when African nations waited more than a decade for antiretroviral drugs.
Still, she warns that funding gaps threaten progress. Vulnerable populations, young women, LGBTQ communities, sex workers, and people who use drugs, are often excluded from prevention services. Without reaching these groups, the epidemic cannot be contained.
Innovation in Delivery
Foundations are experimenting with drone deliveries of drugs and testing kits.
Digital pilots in London are making PrEP accessible directly to consumers, by passing traditional clinics.
Sub-Saharan Africa is now pioneering models of care that are more advanced than those in parts of the Global North.
🇬🇧 The UK’s Role
Mike Podmore, CEO of STOPAIDS, emphasizes that UK contributions are not just charity, they fuel domestic research and innovation. Agencies like Unitaid have invested £250m into UK universities over the past decade, strengthening both global and local HIV responses.
The UK has set a goal to end new HIV transmissions by 2030, and expanding access to lenacapavir will be critical to achieving it.
The Call to Action
Ending HIV is within reach, but only if global leaders step up. Dr. Hill and advocates worldwide are urging wealthy nations to contribute to a proposed $400m fund to expand access without undermining existing HIV programs.
This is a pivotal moment: decades of research and advocacy have brought us closer than ever to a cure. But without adequate funding, only 7% of those who need lenacapavir will receive it.
What you can do:
Sign petitions demanding governments protect and expand HIV funding.
Share this story widely to raise awareness.
Pressure policymakers to prioritize vulnerable populations in prevention programs.
Together, we can ensure that this breakthrough doesn’t stall at the starting line. Let’s end HIV and make life better for all.
Original reporting by Rachel Schraer, The Independent, as part of the “Rethinking Global Aid” project.
World AIDS Day was first established in 1988 by the World Health Organization (WHO) and UNAIDS, making it the first-ever global health dayWikipediaBritannica. Its purpose is to raise awareness about HIV/AIDS, show solidarity with people living with HIV, and honor the millions who have died from AIDS-related illnesses. The red ribbon, adopted in 1991, remains the universal symbol of support and remembrance Britannica.
Each year, the day carries a theme. In 2025, the theme is “Overcoming disruption, transforming the AIDS response”, a reminder that funding cuts, stigma, and inequality threaten decades of progress Moneycontrol.
Historical Context and Data
In the 1980s and 1990s, HIV/AIDS was a rapidly escalating crisis. By 1997, new infections peaked at 3.3 million annually, and AIDS-related deaths peaked in 2004 at 2.1 million per yearBritannica.
Since then, antiretroviral therapy (ART) transformed HIV from a fatal disease into a manageable chronic condition, reducing deaths by more than 64% since 2004 Wikipedia.
As of 2024, an estimated 40.8 million people worldwide were living with HIV, with 1.3 million new infections and 630,000 AIDS-related deaths that year Business StandardMoneycontrol.
In the U.S., about 1.2 million people live with HIV, with ongoing disparities in testing and treatment Las Vegas Sun.
Strides in Treatment and Prevention
The fight against HIV/AIDS has seen remarkable progress:
ART advancements: From early AZT in 1987 to today’s single-pill regimens and long-acting injectables, treatment now allows near-normal lifespans Las Vegas Sun.
Prevention tools: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have proven highly effective in preventing infection Business Standard.
U=U (Undetectable = Untransmittable): People on effective ART who maintain undetectable viral loads cannot sexually transmit HIV Business Standard.
Mother-to-child transmission: Once a major concern, it has been drastically reduced through targeted interventions Las Vegas Sun.
The Future Outlook
While progress is undeniable, challenges remain:
Funding cuts and inequality threaten to reverse gains, especially in vulnerable communities Moneycontrol.
Late diagnoses continue to hinder progress, with over half of new cases in Europe detected too late for optimal treatment News-Medical.Net.
Research breakthroughs offer hope: trials with engineered antibodies, CRISPR gene editing, and long-acting injectables like lenacapavir suggest that a functional cure may be within reach Smithsonian MagazineAIDS.ORG.
The global goal remains clear: end AIDS as a public health threat by 2030, a target set by UNAIDS and the UN Sustainable Development Goals BritannicaUNAIDS.
Closing Reflection
World AIDS Day is not just about remembrance, it is about renewed commitment. We have turned HIV from a death sentence into a chronic condition, but stigma, inequity, and funding gaps still stand in the way of ending the epidemic. The future depends on global solidarity, scientific innovation, and community-led action.
Ending AIDS is possible but only if we choose compassion, equity, and sustained investment.
In a major stride for HIV prevention, the Biden administration announced recently that long-acting injectable PrEP, sold as Apretude by ViiV Healthcare, will now be covered without cost-sharing under the Affordable Care Act (ACA). This policy shift is significant in making HIV prevention tools more accessible. However, for many Black Americans and those living in rural areas, barriers to healthcare persist, limiting the full potential of this policy change.
The Disparity in Access to PrEP
While this new policy represents progress, the reality is that Black people—who are disproportionately affected by HIV—are still underrepresented among those using PrEP. Despite making up over 40% of new HIV diagnoses in the U.S., only about 11% of PrEP users are Black, according to the Centers for Disease Control and Prevention (CDC). These numbers reveal the systemic barriers that exist: financial challenges, healthcare access gaps, and lingering stigma that keep many from obtaining life-saving medication.
In States Like Georgia, Where Medicaid Has Yet to Expand, HIV Rates Remain Alarmingly High
In states like Georgia, where Medicaid has yet to expand under the Affordable Care Act (ACA), HIV infection rates remain among the highest in the nation. The consequences of this policy decision are staggering. According to the most recent CDC surveillance data from 2023, Georgia reported over 2,674 new HIV diagnoses, placing it at the forefront of the ongoing HIV epidemic in the United States.
Despite widespread advances in treatment, Georgia’s healthcare system continues to face significant challenges, particularly in achieving viral suppression among its population living with HIV. Roughly 72% of people living with HIV in the state have not reached viral suppression, a rate well above the national average of 58%. This failure not only heightens the risk of HIV transmission but also places Georgia’s most vulnerable populations in an untenable situation.
The city of Atlanta, in particular, bears the brunt of this crisis. Recent data from the CDC, the Georgia Department of Public Health, and AIDSVu place Atlanta as third in the nation for the highest number of people living with HIV, trailing only Miami and New York City. In specific communities, particularly those with large Black and Brown populations, infection rates are comparable to those seen in regions of sub-Saharan Africa. In some areas of Atlanta, the prevalence of HIV mirrors the situation in countries like South Africa or Eswatini, where access to healthcare resources remains limited and the virus continues to pose significant public health challenges.
In contrast, states like Louisiana, which expanded Medicaid in 2016, have seen significant improvements in their public health outcomes related to HIV. Louisiana’s experience demonstrates the impact that Medicaid expansion can have on populations affected by HIV. According to the Louisiana Department of Health, viral suppression rates in the state rose from 63% in 2016 to 82% by 2022, and new diagnoses dropped by 20%. Louisiana’s expansion allowed thousands more residents to access crucial services, including PrEP—pre-exposure prophylaxis, a life-saving medication that helps prevent HIV transmission.
However, in Georgia, thousands of residents remain uninsured and unable to afford these same preventative measures. The failure to adopt Medicaid expansion in the state has created a vacuum in the healthcare system, leaving vulnerable populations without the necessary tools to protect themselves or manage their conditions. This gap in coverage disproportionately affects Georgia’s Black and Brown communities, where socioeconomic factors exacerbate existing health disparities.
The lack of access to PrEP in Georgia is especially concerning. PrEP has been widely recognized as one of the most effective tools in preventing HIV transmission, but without access to affordable healthcare, many Georgians are unable to benefit from it. In states that have embraced Medicaid expansion, PrEP has been made more readily available to populations at risk, resulting in significant reductions in new HIV infections.
The contrast between Georgia and states like Louisiana underscores a broader public health failure. While Medicaid expansion has been proven to improve health outcomes and reduce the spread of HIV, Georgia remains one of the 10 states that have resisted expanding coverage. This resistance leaves the state’s residents at a higher risk of HIV transmission and prevents thousands of people from achieving viral suppression, perpetuating a cycle of preventable infections.
The urgency of this crisis cannot be overstated. Georgia’s decision not to expand Medicaid is contributing to an ongoing public health catastrophe. Without bold action from state leaders and policymakers, the state will continue to fall behind in addressing one of the most pressing healthcare issues of our time.
As the evidence from Louisiana shows, Medicaid expansion is not just a policy choice—it is a life-saving measure. By expanding access to healthcare, Georgia could prevent new infections, improve viral suppression rates, and offer a path forward for thousands of people living with HIV. The stakes are high, and the time for action is now.
The current situation in Georgia should serve as a wake-up call to policymakers and healthcare leaders across the country. As the state grapples with the consequences of inaction, the need for comprehensive healthcare reform becomes clearer with each passing day. Until Georgia expands Medicaid and prioritizes HIV prevention and care, it will continue to suffer the consequences of a public health system that leaves too many behind.
Breaking Barriers: The Role of PrEP in HIV Prevention
PrEP, or pre-exposure prophylaxis, is a critical tool in preventing the spread of HIV. For those at higher risk, particularly in marginalized communities, PrEP offers a way to stay HIV-negative. Yet, too few people who could benefit from this treatment are using it. Barriers such as cost, geographic location, and a lack of healthcare providers familiar with HIV prevention often make it difficult to access.
Take Darrell, a sex worker who faced significant barriers to accessing PrEP in his rural community. Before the Affordable Care Act mandated expanded access, Darrell, who knew he was at higher risk for HIV, couldn’t afford PrEP or find local clinics that offered it.
“I remember feeling like I had no options,” Darrell shares. “I was in an industry where the risk was high, but I didn’t have the resources to protect myself. Once I was able to get on PrEP, everything changed. I’m HIV-negative today, and I’m living my life without fear.”
Darrell’s story is not unique. Thousands of Black Americans, particularly in rural areas, face similar struggles. Even with the Biden administration’s new policy, ensuring access for everyone remains a significant challenge.
Rural America and the Gaps in Healthcare Access
The barriers to healthcare are particularly stark in rural communities.
In these areas, healthcare providers familiar with HIV prevention are few, and geographic isolation makes it harder for people to reach the services they need. For many, even if PrEP is available at no cost, they may still need to travel long distances to find a clinic or pharmacy that offers it.
This problem is compounded by many pharmacies in rural areas lacking the infrastructure to bill for Medicare Part B, which now covers injectable PrEP. The gap in services is a serious barrier to ensuring that rural residents, many of whom are Black or LGBTQ+, can benefit from the new policy.
States like Mississippi and Alabama—which have some of the highest rates of new HIV infections in the U.S.—are prime examples of the challenges rural populations face. In Mississippi, for example, less than 5% of those who could benefit from PrEP are currently using it, reflecting a critical need to address these access gaps.
Dr. Michael Saag from the University of Alabama at Birmingham’s 1917 Clinic highlights how stigma and long distances are key challenges: “People want to avoid being seen at clinics known for HIV care, so many end up traveling to other cities for privacy.” In Mississippi, Dr. Robert Brock of UMMC explains that patients may travel over 50 miles to find the nearest pharmacy or clinic capable of providing HIV treatment.
To address these gaps, programs like mobile testing units and expanded telemedicine have been instrumental in reducing the burden of travel and increasing access to care. Policy changes to better support rural pharmacies and clinics can also help ensure that residents in these underserved regions receive the care they need without the barriers of distance and stigma.
To be continued in Part Two…
“Miles Apart Confronting Stigma and Barriers in HIV Care for Rural America”
Dash Daggs
Community Activist | Business Consultant | Writer Director of Development & CommunicationPower Atlanta Inc.
“Empowering communities, one step at a time, for a future where every voice matters.” Email: poweredbydash@gmail.com
Please read this article because I know you know someone living with HIV. I want to thank Dash for writing this article and giving this update alluding to Public Health. This is so important.
Changing Trends and Times 