Carlos Taylhardat | 3 Narratives News | September 24, 2025
From $28,000 to $40: The HIV Shot That Could Change Everything
Promise: Two Sides. One Story. You Make the Third.
A price drop with pandemic-scale stakes. For years, a twice-yearly HIV prevention shot, lenacapavir, carried a U.S. price tag north of $28,000. This week, a coalition of funders and generic makers announced that the same medicine could be available for $40 per person per year in 120 low- and middle-income countries starting in 2027 — a thousand-fold swing with life-and-death consequences. Reuters; The Guardian; Unitaid.
What’s happening and why it matters
The medicine is lenacapavir (Gilead; prevention brand approvals vary by market). In trials, the long-acting injectable PrEP showed near-complete protection when taken on schedule — with regulators and public-health agencies moving to incorporate it into prevention toolkits. CDC / MMWR; Gilead PURPOSE-1; AP (EMA green light).
Globally, about 1.3 million people acquired HIV in 2024 and roughly 630,000 died of AIDS-related illnesses. Expanding highly effective PrEP is one of the fastest ways to bend those curves down. UNAIDS fact sheet; WHO data.
Narrative 1 — The Breakthrough: $40 PrEP, finally within reach
Under voluntary generic licenses backed by Unitaid, the Gates Foundation, and others, Indian manufacturers (e.g., Dr. Reddy’s, Hetero) will ship generics at about $40 per person per year to 120 countries beginning in 2027. The branded U.S. list price has hovered near $28,000+/year. Reuters; The Guardian (cost analysis); Unitaid announcement.
Does $40 reflect real manufacturing costs? Independent analyses (University of Liverpool / James Hill et al.) estimate generic production could be viable at $35–$46 per person-year at scale — even $25 with very high volumes — aligning with the new target price. NEJM commentary; aidsmap; UNAIDS statement.
How many infections could this avert? With efficacy >95% in trials and strong adherence advantages (twice-yearly dosing), modeling suggests that reaching ~10 million people with long-acting PrEP could prevent hundreds of thousands of infections over a few years — especially outside sub-Saharan Africa, where new infections are now rising. UNAIDS prevention brief; Yale explainer.
“Securing a US$40 price for the twice-yearly injection is a historic breakthrough… This is exactly the kind of impact Unitaid was created to deliver.” — Unitaid Executive Director Dr. Philippe Duneton
Narrative 2 — The Countercurrent: RFK Jr., vaccines, and trust
As access expands abroad, U.S. vaccine politics grow more tangled. Health Secretary Robert F. Kennedy Jr. has emphasized “individual decision-making,” moved away from universal recommendations, and revamped advisory panels — shifts public-health leaders warn could erode confidence in immunization and prevention programs more broadly. The Guardian; CIDRAP; Reuters (Gates interview).
Why this matters for HIV: HIV prevention depends on trust — clinic visits, injections, and follow-up — and on steady funding. If vaccine skepticism bleeds into broader prevention, or if agencies weaken unified recommendations, uptake of long-acting PrEP could stall even as prices fall.
Bottom line of this narrative: The science is strong; policy signals and public trust are the variables.
Narrative 3 — The Silent Story: The price of waiting
The $40 roll-out doesn’t begin until 2027, and some upper-middle-income, high-incidence countries are excluded from the licensing map. Meanwhile, UNAIDS warns of budget cuts and even structural threats to the program’s future. Every year of delay means avoidable infections. Reuters (UNAIDS funding); Filter.
For a young woman in Johannesburg or a truck driver in Recife, “affordable later” may not be enough. The silent stakeholders here are the communities who need protection now — and the clinics that must stock, schedule, and staff injections twice a year.
Key Takeaways
- A twice-yearly HIV prevention shot will be $40/year in 120 countries from 2027 via generic licenses — down from a U.S. list price around $28,000+/year. Reuters.
- Independent analyses peg manufacturing costs around $25–$46 per person-year at scale, suggesting the $40 price is achievable. NEJM; UNAIDS.
- Near-complete efficacy plus twice-yearly dosing may unlock big prevention gains if uptake is strong. CDC.
- U.S. vaccine politics (RFK Jr.) could complicate uptake and public trust — even for HIV prevention tools. The Guardian.
Questions This Article Answers
- Which HIV drug fell to $40, and where will it be available?
- How can a drug that cost tens of thousands be made for ~$40?
- How effective is twice-yearly PrEP and who benefits most?
- How do U.S. vaccine politics (RFK Jr.) affect prevention uptake?
- What could delay access and how many infections are at stake?
Cover image brief: Cinematic magazine look — nurse loading a prefilled syringe, blurred clinic setting; overlaid map pins across Africa/Asia. Alt: “Nurse prepares twice-yearly HIV prevention injection for clinic patient, 2025.”
Related reading: Sudan’s Silent War | Alaska Summit
This article provides a crucial look at the promise of cheaper PrEP but also highlights the concerning delays and trust issues that could hinder its impact. The contrast between the potential breakthrough and the political roadblocks is striking.