Doctors Without Borders accuses Gilead of blocking lenacapavir access

Doctors Without Borders has accused drug manufacturer Gilead of blocking access to the expansion of the HIV prevention drug lenacapavir in an open letter addressed to the company.

In the letter, leadership from Doctors Without Borders, which is also known as Médecins Sans Frontières (MSF), says Gilead is refusing to sell lenacapavir to them for humanitarian use around the world and has been doing so for months despite repeated requests.

“Lenacapavir, a twice-yearly, long-acting HIV prevention tool, represents one of the most promising advances towards ending AIDS as a public health threat to date,” Tirana Hassan, CEO of MSF USA, and Tom Ellman, director of MSF Southern Africa’s medical unit, wrote in the letter. “Gilead has an obligation to ensure that access is not restricted by where people live, who they are or what their country can pay. That this drug’s development was supported by public funding — and through the trust of communities who participated in clinical trials, many of them in countries now excluded from affordable access — makes the current restrictions even more unconscionable.”

Gilead previously provided enough lenacapavir doses for two million people over three years, which MSF currently accesses through the Global Fund. However, this amount is unable to cover all of those in need, according to the letter. This includes vulnerable populations such as people living in conflict zones, transgender individuals and sex workers.

MSF emphasized that without expanded access, the global HIV response risks falling short of prevention targets, particularly in low- and middle-income countries where incidence rates remain high.

The two organizations last met in February.

MSF argues that Gilead has the capacity to increase production and expand access to lenacapavir but is choosing not to, instead maintaining supply caps, restricting where generics can be sold through licensing agreements, and delaying broader distribution by pointing to future availability of lower-cost versions, even as many countries and humanitarian groups are ready and willing to purchase additional doses immediately.

MSF also says the dispute highlights broader concerns about how new HIV prevention tools are brought to market and distributed globally. The organization argues that public investment in drug development should be matched by equitable access commitments, especially for populations in high-burden regions. It warns that without stronger safeguards for affordability and availability, breakthrough treatments like lenacapavir risk benefiting far fewer people than their scientific potential would allow.

Gilead provided the following statement in their defense:

“Gilead is committed to ensuring broad, sustainable access to lenacapavir for HIV prevention in high‑incidence, resource‑limited countries,” a Gilead spokesperson told Managed Healthcare Executive in an email. “We are working closely with partners — including the Global Fund, PEPFAR and others — to accelerate delivery at unprecedented speed and at no profit to Gilead until generic manufacturers are able to meet demand.”

MSF is requesting a follow-up meeting with Gilead. Specifically, they ask Gilead if they will sell lenacapavir directly to them and, if not, why, and if yes, at what price and when to expect it. They request answers by April 13, 2026.