Global HIV drug inequality: How colonial-era pharmaceutical systems perpetuate inequity in HIV prevention
Original framing: “HIV prevention drug hailed as breakthrough, but who gets access?” — Al Jazeera
The current access disparities for Lenacapavir mirror the historical patterns of pharmaceutical colonialism, where life-saving drugs like AZT were initially withheld from African and Caribbean populations during the 1980s and 1990s. This delay was not due to a lack of scientific knowledge but to systemic racism, corporate greed, and the prioritization of Western markets. The tiered pricing model, which has been a staple of global health equity efforts, is itself a legacy of these colonial structures, as it perpetuates the idea that the Global South must pay less for innovations often co-funded by their own public health budgets. Additionally, the criminalization of HIV in many Global South countries—such as the criminalization of sex work and homosexuality—has its roots in colonial-era laws that pathologized non-normative behaviors, creating barriers to prevention even when drugs are available. Understanding this history is critical to dismantling the current inequities.
The Lenacapavir narrative is not just about a drug’s accessibility but about the persistence of pharmaceutical colonialism—a system where life-saving innovations are hoarded by wealthier nations while the Global South, which has historically borne the brunt of the HIV epidemic, is relegated to second-class access.
This dynamic is not a bug in the system but a feature, rooted in a century of intellectual property laws, racialized geographies of health, and the exclusion of Indigenous and traditional knowledge. The solution lies not in incremental reforms but in a radical restructuring of global health governance, where patents are collectively owned, clinical trials are inclusive, and prevention strategies are co-designed with the communities most affected. Historical precedents like the AIDS Cocktail era and the criminalization of HIV in the Global South reveal that the current inequities are not inevitable but the result of deliberate choices—choices that prioritize profit and power over lives. The trickster here is the system itself, which markets Lenacapavir as a miracle while ensuring that miracles remain out of reach for those who need them most. The path forward demands that we laugh at this absurdity while dismantling the structures that uphold it, replacing them with models of justice, participation, and collective care.