Based on editorial work with Claudia P. Cortes (Director, Center for HIV/AIDS Research CHAIR, University of Chile) and Pedro Cahn (Director, Fundación Huesped) for the Journal of the International AIDS Society (JIAS).
A new generation of HIV tools is poised to transform the fight against AIDS.
Long-acting medicines that can prevent HIV infection or replace daily treatment pills are already changing lives. For someone facing stigma, violence, unstable housing, migration, or simply the challenge of taking medication every day, these innovations are, potentially, revolutionary.
Yet there is a troubling paradox.
Many of the countries that helped generate the evidence behind these breakthroughs may be among the last to benefit from them.
Across Latin America and the Caribbean, home to more than 650 million people, HIV remains a significant public health challenge. The region accounts for around one in ten new HIV infections globally, while treatment coverage is limited to 71% of people living with HIV, leaving many without the care they need. New infections and AIDS-related mortality continue to disproportionately affect key populations, including men who have sex with men, transgender people, sex workers, migrants and others facing social and economic marginalization.
These are not simply failures of medicine. They are the consequence of deeper forces: inequality, stigma, discrimination, violence, migration and uneven access to healthcare and innovation. They reflect a reality that can often be overlooked in global health discussions.
Latin America and the Caribbean occupy an uncomfortable middle ground. Most countries in the region are classified as middle-income economies. On paper, this suggests they can finance their own health responses. In practice, many face severe fiscal constraints, fragmented procurement systems, regulatory hurdles and limited negotiating power when new health technologies come to market.
The result is a dangerous access gap.
Countries are often considered too wealthy to qualify for donor-supported pricing and procurement mechanisms, yet lack the resources needed to rapidly introduce cutting-edge innovations at scale. This “missing middle” has become one of the defining challenges of the HIV response in the region. And the consequences are becoming increasingly visible.
Long-acting HIV prevention and treatment tools are generating excitement worldwide because they can overcome some of the barriers that have limited the effectiveness of daily oral medicines. For many people, taking a pill every day is not simply a matter of remembering. It can expose them to stigma, threaten confidentiality or prove impossible amid unstable living conditions and interrupted access to care.
The science has advanced. The question now is whether access will follow.
Bridging that gap between innovation and access is one of the defining challenges in global health today. It is also where organizations such as Unitaid have played an important role: helping generate evidence for new health technologies, working with partners to make them more affordable and supporting countries to introduce innovations more quickly and equitably. As long-acting HIV prevention and treatment tools move from promise to implementation, those lessons will become increasingly important for Latin America and the Caribbean.
This challenge arrives at a particularly difficult moment. Global health financing is under pressure as development assistance shrinks. Governments are making difficult decisions about competing priorities. While most HIV treatment programs in Latin America and the Caribbean are financed domestically, critical areas such as prevention, community-led services and support for vulnerable populations remain especially exposed to funding shocks.
Yet focusing only on the challenges would miss an equally important part of the story.
Latin America and the Caribbean have long been innovators in the HIV response. Countries across the region were early leaders in expanding access to antiretroviral treatment and advancing rights-based approaches to care. Researchers, clinicians, civil society organizations and communities have helped shape global understanding of what effective HIV programs look like.
The region has also demonstrated what is possible when political commitment aligns with public health ambition. Several Caribbean countries have achieved the elimination of mother-to-child transmission of HIV and syphilis, while Brazil recently received validation for eliminating mother-to-child transmission of HIV. These achievements were not accidents. They were built on strong health systems, community engagement, rights-based policies and sustained investment.
A new supplement of the Journal of the International AIDS Society focused on this region highlights both sides of this story.
The collection of articles explores the realities of HIV in Latin America and the Caribbean through multiple lenses: financing, pharmaceutical sovereignty, stigma, prevention, adherence, community-centred care, research collaboration and emerging epidemiological trends. Together, they reveal a region characterized not only by persistent inequities but also by resilience, scientific leadership and innovation.
Importantly, they also point towards a future in which the region is not simply a recipient of innovation, but an active partner in shaping how it is developed, produced and delivered. Discussions taking place across the HIV community increasingly recognize that expanding access will require more than scientific advances alone. It will also require coordinated efforts on licensing, procurement, regulation, technology transfer and market shaping to ensure that new treatment options reach people in all settings.
There is also an opportunity to rethink how innovation reaches the region. Several countries in Latin America and the Caribbean are strengthening local and regional pharmaceutical manufacturing capacity, creating the potential not only for greater health security but also for more sustainable access to essential medicines and future HIV technologies. Combined with stronger regional procurement mechanisms and regulatory cooperation, these efforts could help reduce dependence on fragmented markets and shorten the time between scientific breakthrough and patient access.
The message emerging from this body of work is clear that the future of the HIV response cannot be built around a two-tier world in which the poorest countries receive support, wealthier countries can afford innovation, and everyone in between is left waiting.
If the world is serious about ending AIDS as a public health threat, innovation cannot stop at invention. It must extend to access. The next chapter of the HIV response will be defined not only by scientific breakthroughs, but by whether countries can obtain them quickly, affordably and equitably. This is precisely the challenge that Unitaid has sought to address – helping accelerate access to health innovations and ensuring that the benefits of scientific progress reach the people who need them most.
Latin America and the Caribbean have contributed enormously to the global HIV response. The region has generated evidence, pioneered approaches and demonstrated what progress can look like.
Now, as a new generation of HIV tools emerges, the world faces a choice. Will the region help shape the future once again – or be forced to watch it arrive elsewhere first?
*Unitaid is the sponsor of the Latin America and the Caribbean supplement of the Journal of the International AIDS Society (JIAS), launched today.
Unitaid will be participating in sessions on HIV elimination at AIDS 2026. Including: Expanding HIV treatment options in Latin America and the Caribbean: From global recommendations to implementation (co-organized with MPP and PAHO). Find Unitaid’s event page here.