The big news from the International AIDS Conference in Munich last month was a promising new HIV prevention injection – Lenacapavir – whose effectiveness for women in a recent clinical trial showed 100% efficacy.

The palpable enthusiasm for this new preexposure prophylaxis (PrEP) was muted, though, when presenters announced the price: US$42,250 per patient per year. Needless to say, this is a sobering reminder of the economic challenges facing many health systems and households—one that underlines the prevailing imperative to address the policy and financing barriers to make new medications and other promising approaches available and affordable to all who need them.

But what are the barriers?

Around the world, the HIV epidemic continues to increase out-of-pocket health spending for households and put a greater strain on health systems, with 1.3 billion new infections recorded in 2023. Yet, the amount of foreign assistance funding has decreased by 30% since 2009, and approximately 40 countries reported financing shortfalls. Integrating HIV prevention and treatment services into primary care facilities has been too slow.

The COVID-19 pandemic also exposed weaknesses across health systems. Those weaknesses are driving a shift towards integrating more health services under the umbrella of primary health care where providers are more closely attuned to the needs of their own communities and more plugged in to emerging trends and threats.

Against this backdrop, talk at the conference turned to promising approaches for HIV and primary health care integration and global health security.

At a satellite session co-hosted by South Africa’s HE2RO and Palladium -- HIV and Global Health Security: Policy, Financing and Data -- panelists showcased efforts in Kenya and Central America, where Palladium-supported projects are establishing multisectoral coordination mechanisms integrating disease surveillance systems and adapting financing mechanisms to be more resilient.

The session showcased Kenya’s efforts to use legislation to anchor health reforms within a legal framework. The goal is universal healthcare, and this approach brings more sustainable funding to primary health care networks.

While system and policy-level interventions are crucial, we believe that some pragmatic immediate actions should include:

• Using private pharmacies to deliver HIV prevention, and
• Leveraging PEPFAR’s (U.S. President's Emergency Plan for AIDS Relief) workforce of approximately 346,000 health workers globally (including 160,000 community health workers) to develop a multidisciplinary team of highly skilled workers.

Ultimately, the future of affordable prevention, care, and treatment programs will depend on domestic entities and community systems to deliver them. Partners, including PEPFAR and other development partners like Palladium, have a central role in strengthening our local partners’ systems and services to achieve this goal.

Our takeaway from AIDS2024 is that that long-term action from both the public and private sectors is essential to address barriers, consolidate gains, and accelerate progress towards integrated HIV and primary health care targets.

This can be achieved by engaging the private sector to reduce drug prices, advocating for PrEP (such as Lenacapavir when it becomes fully available) to be fully subsidised and part of the basic health benefit packages, increasing domestic financing through a primary health care lens, revising laws to be rights-based and non-discriminatory, restructuring donor incentives, and reducing fragmentation.

The future of HIV prevention hinges on the global community's ability to make medications like Lenacapavir accessible and affordable for all. But to get there, we’ll need stronger partnerships between the public and private sectors, pushing for price reductions, domestic financing, and comprehensive health policies. By restructuring donor incentives and integrating services into primary care, the global response can shift towards sustainable, equitable solutions that meet the needs of vulnerable populations while ensuring long-term health security.

This shift is already occurring, and we’ve seen it discussed firsthand at AIDS2024, but now is the time for global action.

Mark Achaw is Senior Technical Advisor for Health Financing on USAID-funded global PROPEL Health project. Suneeta Sharma is Vice President of Global Health and Director of the PROPEL Health Project.