The Ongoing HIV Drug Access Crisis: Insights from IAS President Beatriz Grinsztejn

In a world where promising new drugs hold the potential to revolutionize HIV prevention and treatment, the challenge remains: how do we ensure these life-saving medications reach those in most need? Beatriz Grinsztejn, the newly appointed president of the International AIDS Society (IAS), sheds light on this pressing issue as she advocates for a more equitable response to HIV.

Grinsztejn, the first Latin American to lead the IAS, has devoted her career to advancing science-based HIV policies that are free from stigma. Leading groundbreaking research at the Evandro Chagas National Institute of Infectious Diseases in Rio de Janeiro, she emphasizes the importance of prioritizing access to new technologies for lower-income countries.

In an exclusive interview, Grinsztejn discussed her role as IAS president, her commitment to tackling inequities, and the fight against the stigmatization and criminalization of key populations most affected by HIV. "My primary focus is to center the global South in discussions," she stated. "We must not only make our voices heard but also ensure that our specific needs are recognized and addressed."

While recent studies, such as the Purpose 1 and 2 trials, showcase the effectiveness of lenacapavir for HIV prevention—demonstrating no new infections among young African women—Grinsztejn expressed concern about access. The U.S. pharmaceutical company Gilead, responsible for developing lenacapavir, has made strides toward licensing generic versions of the drug. However, this agreement currently excludes many Latin American countries that significantly contributed to the trials, highlighting the ongoing access crisis.

Moreover, the situation is exacerbated by the intermittent availability of long-acting HIV treatments, like cabotegravir, which only saw progress in generic production two years after its introduction. "Access remains a major topic for us at IAS, and we need to use our voice to advocate for a broader conversation around this issue," she affirmed.

In Latin America, rising HIV infections among young men who have sex with men and transgender women are alarming. Although countries like Brazil have made significant progress, others continue to lag, especially in scaling up interventions like pre-exposure prophylaxis (PrEP). Meanwhile, key populations in Africa encounter additional challenges related to stigma and legal discrimination, hindering their access to necessary care.

"Criminalization and discrimination are huge barriers," Grinsztejn emphasized. "Our discussion must focus on human rights as it pertains to these marginalized populations, particularly the LGBT community facing oppression in various forms."

The headwinds against progress include under-resourced health systems in low- and middle-income countries (LMICs) and inadequate funding for legal reforms to combat discrimination. "There is a gap in treatment availability, especially between rich nations and LMICs," she added, advocating for the expansion of long-acting antiretrovirals in treatment guidelines for these regions.

Despite the slow pace of change, Grinsztejn remains optimistic. "There have been significant advancements in HIV prevention and treatment technologies," she said. However, she added with urgency, "The real work lies in ensuring these innovative treatments reach the people who need them the most."

As the international community gears up for the upcoming replenishment of the Global Fund, Grinsztejn urges collective action. "We must unite our voices to secure the necessary funding and ensure that the fight against AIDS remains a global priority."

In conclusion, while the landscape of HIV prevention and treatment is evolving, the need for equitable access and support for marginalized populations has never been more pressing. The clock is ticking, and the world must act decisively to ensure that no one is left behind in this critical battle.