Two injections a year. That’s all it takes to protect against HIV with lenacapavir, a revolutionary drug hailed as potentially the beginning of the end of the epidemic, but its rollout has been slow. It has efficacy close to 100% and is already being distributed in small quantities in nine priority African countries. In middle-income countries such as those in Latin America it has not yet arrived, despite the fact that their residents took part in the clinical trials. The international HIV/AIDS conference held in Rio de Janeiro a few days ago was marked by protests against the pharmaceutical company that developed the drug and which, for now, holds the global monopoly: the U.S. firm Gilead Sciences.

“Tested in Brazil, denied to Brazilians,” “They use our bodies and then deny us access,” read some of the protesters’ signs on the opening day of the event. Countries such as Brazil, Mexico, Argentina, and Peru have been left out of access to the generic version of the drug, even though experts and organizations such as Doctors Without Borders (MSF) say lenacapavir could be produced for as little as $40 a year worldwide. In the United States, Gilead Sciences sells it for $28,000 per patient, including the two annual doses.

A year ago, the Global Fund and The United States President’s Emergency Plan for AIDS Relief (PEPFAR) reached an agreement with Gilead to supply this pre-exposure prophylaxis (PrEP) to two million people in low- and middle-income countries through 2028. Jared Baeten, the company’s vice president, said at a press conference at the Rio event that agreements have been signed with six generic drug manufacturers to supply 120 countries, and that 600,000 people are expected to be on treatment before the end of the year.

In April, the Global Fund announced it would expand its agreement to benefit three million people. That would allow lenacapavir introduction to be extended to 12 additional countries, including the Dominican Republic, Haiti, and Honduras. Although deployment has not yet begun, the Global Fund expects these three Latin American and Caribbean countries to receive initial batches before the end of the year and to begin distribution soon after. “We have been encouraging all countries that will receive lenacapavir to introduce it through a phased, operationally realistic approach, aligned with each country’s level of readiness, service delivery capacity, and available financing,” the organization told this newspaper by email.

However, activists and the UN say access to lenacapavir remains insufficient. “How can Latin America continue to be excluded from licenses for life-saving medicines?” Winnie Byanyima, executive director of the Joint United Nations Program on HIV/AIDS, denounced at the conference. In her view, it is entirely feasible to eliminate HIV as a global public health threat before 2030, but it all depends “on political choices.”

How can Latin America continue to be excluded from licenses for life-saving medicines?

Winnie Byanyima, executive director of the Joint UN Program on HIV/AIDS

Pressure for lenacapavir to reach all of Latin America is not only an ethical issue — a moral obligation to compensate those who lent their bodies to science — but also a practical one. In Latin America, 2.6 million people live with HIV and, in 2025, there were 28,000 deaths related to the disease. While the global trend has been a decline in cases, the opposite has happened in Latin America: between 2010 and 2024 cases increased by 13%. In Brazil, the region’s most populous country, they rose by 25%, according to the Ministry of Health.

A quarter of new HIV infections occur in the countries excluded from current agreements to produce generics.

That is why, during the conference, activists stepped up pressure for Brazil to take the lead. “Gilead came here empty-handed, with empty words […] we want Brazil to lead and to be an example for everyone, to break the monopoly,” said Asia Russell, director of the organization Health GAP.

Brazil’s role right now could be pivotal, both because of its geopolitical weight and its size (more than 210 million inhabitants), and because it prides itself on having a universal public health system that, despite its shortcomings, is the largest in the world and excludes no Brazilian — nor foreigners. Brazil has a long record of success against the HIV/AIDS epidemic. In December last year, the World Health Organization certified the country for eliminating vertical transmission of HIV, from mother to child.

Health Minister Alexandre Padilha said this week that Brazil was willing to pay up to 19 times more for lenacapavir than the price offered to economically similar countries such as Indonesia or Thailand, but the company did not accept the proposal.

“Innovation without access is injustice. We look to these new injectable drug technologies with great hope […] but we demand that they be available, especially to national health systems, at reasonable, not astronomical, prices. We will not drain resources funded by taxpayers to benefit a single company,” the minister said at the start of the conference.

Innovation without access is injustice. We look to these new injectable drug technologies with great hope […] but we demand that they be available, especially to national health systems, at reasonable, not astronomical, prices

Alexandre Padilha, Brazilian Health Minister

In that context, calls are growing for Brazil to take decisive action and break the patent. Legally, the country could resort to compulsory licensing in situations deemed to be of public interest, as it did in 2007 with the antiretroviral efavirenz from the U.S. laboratory Merck. The price fell by 70%.

That option does not seem to be on the table, especially with Brazil in a more strained relationship than ever with the United States, cornered by tariffs and sanctions that last year affected the health minister himself. During the conference, the minister preferred not to speak about that more radical possibility and implied he still trusts in negotiations with Gilead. Pending arrival of the revolutionary lenacapavir, Brazil announced it will, for now, incorporate cabotegravir into public health care; it is also injectable but requires one injection every two months.

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“Look, those two buildings were owned by slave traders,” the historian Martín Rodrigo Alharilla, 57, says offhand while walking through Barcelona’s port area. He continues the route along La Rambla and points out a bas-relief showing chains, ropes, sugar canes and a chimney. The building that displays it on its frontispiece houses the Generalitat’s Department of Culture. “It was built at the end of the 18th century and later bought by Tomás Ribalta i Serra, an indiano (a Spaniard who emigrated to the Americas) with business in Cuba who likely ran a slave-trading factory in what is now Nigeria. An extremely wealthy man who spent his time here living off his income,” the professor explains; he curated the exhibition La infamia, la participación catalana en la esclavitud colonial (The Infamy: Catalonia’s Role in Colonial Slavery), which was shown at the city’s Maritime Museum and is now available online for consultation.

On his tour he passes a plinth, now missing the sculpture of Antonio López y López, the marquis of Comillas: “The only statue in all of Spain to have been removed because the figure depicted was a slave trader.” He turns the corner by the former home of another trafficker who organized two brigantine slave voyages to the Americas. “Pedro Gil Babot lived here; he was a founder of the old Catalan Gas Lighting Company, today Naturgy. Three of the seven founders of that company were slaveholders,” he says. Step by step he maps the city with countless surnames, dates, figures and marriages that, according to his research, generated fortunes in Catalonia and Spain at the cost of the freedom, suffering, and forced labor of thousands of Africans in the 18th and 19th centuries. Two years ago he launched the project España Esclavista (Slave-owning Spain), a website on which he says he and a team have geolocated 220 tangible sites of this past — sites barely covered in textbooks but that shaped the future of the country and the African continent. That initiative was also selected for the Western Europe map on colonial memory shown in the House of European History’s exhibition Postcolonial? in Brussels.

“Today there are migrants who currently have fewer opportunities, but it must be understood that Western wealth is largely explained by slavery and colonialism. They are extractive activities. Capitalism in many territories developed through slavery,” he says at the Maritime Museum of Barcelona after explaining the exhibition. He notes that no politician from any party attended the opening, though he welcomes that the Barcelona provincial council took the initiative to promote it. “What matters is opening the debate. Work like this feeds reflection and invites people to think that social differences were built on this past. And what remains now is racism and inequality.”

This March the UN adopted a resolution declaring the trafficking of enslaved Africans and the racialized enslavement of Africans as “the most serious crime against humanity” in history, involving millions of victims over a period of 400 years. The text was backed by 123 countries, but those in the European Union abstained, and the U.S., Israel, and Argentina voted against it. “It is a carefully worked resolution and speaks of restorative justice, restitution, imprescriptibility, guarantees of non-repetition, compensation… That may explain why Spain and other slaveholding powers abstained. They may be afraid of facing these kinds of claims,” he says.

Although the text is not binding, Rodrigo sees this document as necessary and believes it could have legal implications. “It is another step toward seeking validation of this shameful past,” the professor explains. He describes the plantations where thousands upon thousands of enslaved Africans were forced to work in Cuba — amid the tropical heat, the smoke from the chimneys, and the physical strain — as “hell.” “Imagine what it must have been like. Moreover, one of the harshest realities is that most of them were men, so there was hardly any population growth. This was more like genocide. They would die, and more would be brought in from Africa,” explains Rodrigo, standing before a canvas that recreates these plantations, which enabled their owners to amass immense wealth.

In his research, he finds a legacy that is still palpable today: the acquisitions of urban expansion projects, buildings, and theaters; the founding of banks and lending institutions; annuities, inheritances… “The best-known slaveholding families in Catalonia, such as the marquis of Comillas’s, Joan Güell’s, Vidal-Quadras’s or Miquel Biada’s, are just the tip of the iceberg,” he says. He admits a personal determination to bring many more surnames to light. “But it’s not about pointing fingers at people; it’s because one must understand that slavery was an entire structure that moved huge wealth,” he says.

And indeed, the recent Maritime Museum exhibition listed long rolls of names identified as captains who commanded slave ships to the Americas, shipowners who organized human-trafficking expeditions, and many others involved. “Catalan traffickers who owned or managed factories on the African coast included José de Bérriz, Francesc Canela, Pau Freixas Ribalta, Pere Manegat, Domènech Mustich, Pere Sala, Francest Riera, Cristòfol Roig Vidal and Bonaventura Vidal Calzada,” one of the exhibition labels reads.

Although the practice was sanctioned by law, in Cuba it ceased to be considered legitimate de facto in 1886. “But the activity continued for some time with a degree of impunity,” Rodrigo says. He illustrates this conduct in the recent book La bisabuelita. Género, esclavitud y finanzas entre Cuba y Barcelona (The Great-Great-Grandmother: Gender, Slavery, and Finance Between Cuba and Barcelona), written with Lisa Surwillo, a professor of Iberian literature at Stanford. The research is based on the unpublished manuscript of Mercedes Llopart Xiqués, who recounts the life of her mother, Manuela Xiqués Romagosa, married to Roque Llopart Asúa. The book narrates that this Catalan organized slave-trading expeditions in the 19th century and amassed a fortune with which his wife later bought properties in the city. “It has been exceptional that I could obtain that first-hand family material. Normally I have no connection with slaveholding dynasties. They usually do not want to talk,” Rodrigo stresses. “I wouldn’t say they try to hide it, but it’s an uncomfortable subject. The response is to try to keep it unknown. Clearly responsibility is individual, but status and opportunities are inherited,” he says.

The Pompeu Fabra University professor regrets that Spain has not in some measure acknowledged this past the way the Netherlands did — whose government apologized in 2022 for enslaving peoples — or the French parliament, which in 2001 recognized slavery and the trafficking of Black people as a “crime against humanity” in the law known as Taubira. “Besides including it in the compulsory curriculum, one could start with symbolic reparations. And with acknowledgement of responsibility by banks or entities that had direct ties to slavery,” he suggests. He proposes funding for scholarships, measures that favor social inclusion and support for racialized people. “There should be financed study programs, exhibitions, debates… I am an activist for the truth, that this uncomfortable and painful truth be known and that it encourages reflection,” he concludes.

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