...Gilead and Global Fund face backlash over undisclosed pricing of HIV prevention injection as critics warn of dangerous precedent for transparency, access, and public health.
By Bunmi Yekini
A new deal between pharmaceutical giant Gilead Sciences and the Global Fund to Fight AIDS, Tuberculosis and Malaria has come under intense scrutiny after it was revealed that the price of long-acting injectable lenacapavir (LEN-LA) for HIV prevention will remain secret indefinitely.
The announcement, made on Tuesday, confirmed that nine African countries, including Nigeria, South Africa, Kenya, and Uganda, have been invited to participate in the rollout of the injectable PrEP. However, the undisclosed pricing arrangement has sparked global backlash from civil society, HIV activists, and public health advocates who accuse Gilead of exploiting a public health crisis for profit.
“The Global Fund is funded by public money. Its dealings, contracts, and the prices paid for life-saving tools have been made available for other medicines and should not now be kept secret because of Gilead’s bullying,” said Fatima Hassan, Director of the Health Justice Initiative. “It is inexcusable for Gilead not to allow the Global Fund to disclose the prices it will pay.”
The decision to withhold pricing information stands in contrast to previous Global Fund deals, where pricing for lifesaving tools such as antiretroviral drugs and COVID-19 vaccines was disclosed publicly. Critics say the secrecy undermines global health equity, prevents price negotiation, and restricts advocacy for lower costs in countries outside the deal’s scope.
“Gilead wants to hold all the cards in medicine pricing negotiations and will try to set prices as high as it likes in Latin American countries and other countries excluded from their plans,” warned Veriano Terto of the Interdisciplinary AIDS Association of Brazil (ABIA). “Gilead is playing a dangerous game with the health and lives of millions of people who need LEN-LA.”
Lenacapavir, administered every six months, has shown near-complete effectiveness in preventing HIV infection in clinical trials. Yet, only an estimated 2 million people over three years are slated to gain access under Gilead’s current Global South strategy—a small fraction of the estimated 10–20 million people globally who need it now.
“Access for only 2 million people over three years is just a drop in the ocean,” said Professor Brook Baker of Health GAP. “Donald Trump and Marco Rubio’s despicable cuts to HIV prevention programs mean new HIV infections are surging. Price secrecy undermines the urgent need to reach all people, everywhere, who need LEN-LA.”
Activists are demanding Gilead and the Global Fund publicly disclose the price and make the drug accessible at a cost comparable to oral PrEP—estimated at $25–$40 per person annually. They also urge governments and global health agencies to resist restrictive license clauses and use legal avenues to bypass patents where necessary.
“Coming on top of Trump and Rubio’s anti-science and anti-HIV funding cuts, Gilead’s greed has created an unprecedented, coordinated global regime of LEN-LA price secrecy that violates our basic rights and will undermine global access,” said Asia Russell, Executive Director of Health GAP.
The controversy also renews criticism of Gilead’s voluntary licensing strategy. The company has limited its licenses to just six generic manufacturers and excluded 26 countries with high HIV burdens—including Brazil, Mexico, and Argentina—from its supply plans. Many of these countries hosted Gilead’s own clinical trials.
Civil society groups warn that the lenacapavir secrecy pact could mirror mistakes made during the COVID-19 pandemic, when non-disclosure agreements hindered governments’ ability to obtain fair prices and delayed access to lifesaving treatments in the Global South.
“The world cannot wait for Gilead to do the right thing,” said Professor Baker. “This is greed in a time of crisis, and market monopoly manipulation.”
As pressure mounts, global health advocates are calling for urgent reforms to ensure transparency, expand access, and prioritize public health over profits. The future of equitable HIV prevention, they say, depends on it.