Ministry of Health announces purchase of long-acting injectable PrEP against HIV

The agreement will be submitted to Conitec (National Commission for the Incorporation of Technologies in the SUS) next week, according to minister Alexandre Padilha (Health) during the international AIDS conference, taking place in Rio de Janeiro.

Padilha did not publicly confirm the value of US$400 (R$2,032, at this Monday's exchange rate) per dose that was circulating behind the scenes of the event, but, when asked directly about the figure, he indicated that the ceiling that the Brazilian government is willing to pay is equivalent to a maximum of 10 to 12 times the amount offered to countries like Indonesia and Thailand - US$40 per dose -, which brings the bill closer to the speculated value.

According to the minister, the number of doses to be purchased initially has not yet been defined, as negotiations with the laboratory remain open. The government's expectation is that, once the incorporation by Conitec is approved, the medicine will be available "in the arms" of Brazilian patients this year.

Anvisa approved cabotegravir in 2023, which began to be sold on the private market in August last year. The injection is given every two months, while in usual prevention the tablets must be taken daily. Today the medicine arrives in Brazil with a list price of R$4,000.

The announcement was accompanied by an assessment of the Brazilian response to AIDS in recent years. According to Padilha, the country recorded the biggest reduction in the AIDS mortality rate in its history in 2024, with the number of deaths falling below 10,000 for the first time.

He attributed the result to the 150% increase in the supply of PrEP medications by the SUS and the 100% increase in rapid testing exams in the last three years - which, according to him, made it possible to identify new infections and start treatment more quickly. Today, 22% of people diagnosed with HIV in Brazil begin treatment on the same day of confirmation, and more than half begin treatment within 30 days.

Padilha listed three fronts that, according to him, remain obstacles to the Brazilian response to the epidemic: discrimination and stigma against people living with HIV, also fueled by international movements that attack the human rights of this population; scientific denialism and health misinformation; and access to new technologies.

"Innovation without access should not be called innovation. Innovation without access is injustice," he said. He also announced a new financing program to accelerate access to imaging exams and other more complex procedures - such as orthoses and prosthetics - associated with comorbidities of people living with HIV, an area in which, according to him, the system is still slower than in testing and starting antiretroviral treatment.

The minister also addressed the impasse surrounding lenacapavir, Gilead's semi-annual injectable PrEP, approved by Anvisa in January this year.

According to Padilha, Brazil was willing to pay up to ten times the amount offered to countries like Indonesia and Thailand - but even so, the pharmaceutical company said it was not possible to offer the product to the Brazilian public system at that price.

"We are not going to drain the resource that is the result of taxes from Brazilian citizens [in] the interest of profit from just one company," he said, reiterating that the country remains willing to negotiate, but not to pay amounts considered outside the budgetary reality of the SUS.

Padilha also announced that Fiocruz had signed this Tuesday (28) an agreement with the pharmaceutical company MSD (Merck outside the United States and Canada) to monitor the development of a new oral PrEP for long-term use - MK-8527, still in clinical studies, in which Brazil is participating.

According to the minister, the expectation is that the collaboration will evolve, in the future, into a partnership for the production and inclusion of the medicine in the SUS.

The partnership took on a more tense tone during the press conference, when the minister was asked about the fact that Brazil had been excluded from the voluntary licensing agreement for the production of generics for MK-8527 announced by MSD days before the conference - despite the country being part of the 16 countries participating in the Expressive clinical studies.

Padilha acknowledged that "it is not the first time that Brazil has not been chosen to receive these conditions of access to medication", but stated that this does not prevent the country from negotiating directly with the pharmaceutical company.

He did not directly answer whether the Brazilian government is considering adopting compulsory licensing of the medicine - an instrument provided for in international agreements that allows the production of a generic without patent authorization -, limiting himself to reinforcing the refusal of "stratospheric prices" and the difference between negotiating with a universal public system, such as the SUS, and with countries that depend on private health systems.

He also cited Brazil's role in regional coordination through PAHO (Pan American Health Organization), stating that the country's negotiations also take into account the access of Latin American neighbors to the same technologies.

Padilha's announcement took place alongside Tedros Adhanom Ghebreyesus, director general of the WHO (World Health Organization), and Jarbas Barbosa, director of PAHO (Pan American Health Organization), in a press conference that preceded the opening ceremony of AIDS 2026 - the first time that the international conference has taken place in South America.

Tedros said that new HIV infections have fallen by 42% worldwide since 2010, and AIDS-related deaths by 57% in the same period, but warned that cuts in international funding put these advances at risk.

He called lenacapavir a "game changer" in prevention, but argued that the moment requires more resources, not less, in addition to protection for organizations led by