A new drug could revolutionise the fight against HIV: studies show it offers almost complete protection. Yet, of all things, the high price of the injection threatened to slow down its roll-out. The pharmaceutical company that developed the drug was charging $14,000 per dose. However, the health initiative ‘Unitaid’ has now announced that it will make a generic version – that is, a cheaper alternative to the drug – available from 2027. It is expected to cost just €20 per dose. Another notable feature: “Unitaid” is funded through solidarity levies on airline tickets, which some countries collect. Anyone who has bought a flight ticket has therefore, indirectly, helped make a vital HIV drug accessible.
Around 40 million people worldwide are living with HIV. About 9,000 of them in Austria. More than 600,000 people worldwide still die each year from the consequences of infection. However, a new drug named Lenacapavir has the potential to eradicate HIV infections.
Two large studies have indicated that the drug can prevent almost all HIV infections. Researchers have proven that the risk of HIV transmission reduces by more than 99.9 percent.
Unlike previous treatments, Lenacapavir only needs to be taken twice a year. This is because the drugs currently available have a major drawback: they need to be taken much more frequently. PrEP drugs approved in Europe, such as Truvada, only provide optimal protection if they are taken consistently at the same time every day, doses are never missed, and the active ingredient is not excreted through vomiting or diarrhoea before it can be fully absorbed. Since April 2024, this treatment has been available free of charge to everyone living with HIV in Austria.
$14,000 per dose: the drug’s future remains uncertain
Whether lenacapavir will end up on the shelves of local pharmacies, however, still depends on the cost: In the US, where the injections are already approved as pre-exposure prophylaxis (PrEP), the pharmaceutical company Gilead charges $28,000 per year (i.e., $14,000 per dose). That equates to €24,000 (€12,000 per dose). By way of comparison: other HIV prevention drugs cost on average 50–60 euros a month, or around 600–700 euros a year.
The pharmaceutical company Gilead justifies the high costs by citing lengthy research periods. However, experts disagree and argue that the drug can be produced at a significantly lower cost. According to calculations by pharmacologist Andrew Hill, even with a profit margin of 30 per cent, the price should be no more than around 40 dollars a year.
“Price negotiations are still ongoing for Europe, but we will see whether the drug makes it into clinical practice or whether it ultimately fails due to the price,” Mirijam Hall, chair of Aids Hilfe Wien, told ORF.
But cost is not just a barrier here in Germany. The new preventive injection would greatly benefit regions with limited healthcare funding. In countries of the Global South or in crisis and war zones, it is difficult to ensure a reliable supply of tablets that need to be taken daily. „A drug that only requires administration twice a year would be a brilliant solution for such regions. „It would be possible to ensure distribution to the population without it being a daily struggle to secure a supply of medicines,” says Hall.
Thanks to a solidarity levy on air travel, the drug could become affordable for many
But there is hope: in September 2025, Unitaid – a global health initiative – announced, in partnership with the Gates Foundation, that it would make this drug available as a generic for around $20 per dose. It is set to be available in 120 countries starting in 2027.
“Scientific advances such as lenacapavir can help us end the HIV epidemic if they are made accessible to those who can benefit most from them,” said Trevor Mundel, head of the Global Health Department at the Gates Foundation, in a statement.
The funding for the initiative comes, among other sources, from a solidarity levy on airline tickets. Since its establishment in 2006, two-thirds of Unitaid’s funding has come from these solidarity levies, which France was the first country to introduce. In 2025, a new coalition of eight countries (France, Kenya, Barbados, Spain, Somalia, Benin, Sierra Leone and Antigua and Barbuda) was launched, with the aim of levying a solidarity levy on premium flights in the future.
