The promise of long-acting HIV prevention has been a beacon of hope in the global fight against the virus, yet Latin America remains in the shadows of this breakthrough. While other regions move forward with injectable pre-exposure prophylaxis (PrEP) and other extended-release options, the continent is still waiting. According to a recent report by Devex, the gap between scientific innovation and on-the-ground access in Latin America is widening, raising urgent questions about equity, infrastructure, and political will.

The Science Is Ready, but the Region Isn’t

Long-acting HIV prevention methods, such as cabotegravir injections administered every two months, have been hailed as game-changers. They offer an alternative to daily oral pills, which many people find difficult to adhere to. The clinical efficacy is well-documented, and global health organizations have endorsed these tools as critical to ending AIDS by 2030. Yet, Latin America—a region with a concentrated HIV epidemic among key populations—has been slow to integrate these innovations into public health programs.

The reasons are multifaceted. Regulatory approval processes in many Latin American countries are slower than in North America or Europe. Even when approved, the high cost of the drugs and the need for cold-chain logistics pose significant barriers. Furthermore, health systems in the region are often fragmented, with varying levels of capacity to deliver injectable treatments, especially in rural or marginalized communities.

The Burden of HIV in Latin America

HIV is not a minor issue in this part of the world. The Pan American Health Organization (PAHO) has consistently highlighted that new infections are not declining fast enough, particularly among young gay men, transgender women, and sex workers. These groups face stigma, discrimination, and legal barriers that push them away from prevention services. The lack of long-acting options only compounds these challenges, as daily pills can be difficult to store discreetly or take consistently when one’s living situation is unstable.

  • Injection vs. Oral: Injectables require fewer doses, but they also require clinical visits, which can be a deterrent for those who fear discrimination.
  • Cost Barriers: The price of long-acting PrEP is currently much higher than generic oral versions, making it unaffordable for many public health systems.
  • Supply Chain Issues: The need for refrigeration and trained personnel to administer injections is a logistical hurdle in areas with weak health infrastructure.

Global Momentum vs. Local Stagnation

While Latin America lags, other regions are moving swiftly. The United States, several European countries, and parts of Africa have already rolled out long-acting PrEP, often with support from global donors like the Global Fund or PEPFAR. In Africa, pilot programs have shown high acceptability and retention. The contrast is stark: in Latin America, only a handful of countries have begun small-scale demonstration projects, and none have achieved wide-scale implementation.

This disparity is not just about money. It’s about political prioritization. In many Latin American nations, HIV prevention has been deprioritized in favor of other health crises, or it is hampered by conservative opposition to sexual health services. Activists have long argued that the region’s governments are not doing enough to engage with civil society or to adapt global guidelines to local realities.

The Role of Regional Bodies

PAHO has issued technical guidance on long-acting HIV prevention, but guidance alone does not translate into action. Regional procurement mechanisms, such as the Strategic Fund, have been slow to negotiate lower prices for new drugs. Additionally, there is a lack of regional pooled procurement for long-acting injectables, leaving each country to negotiate individually—often with little leverage.

The private sector also plays a role. Pharmaceutical companies have focused their marketing and distribution efforts on wealthier markets, offering limited supply or high prices to Latin American countries. Some generic manufacturers have expressed interest, but the regulatory pathway for biosimilars and generics of complex injectables is still evolving.

What Needs to Change?

Accelerating access to long-acting HIV prevention in Latin America requires a multi-pronged approach. First, countries must fast-track regulatory approvals, potentially through regional harmonization. Second, innovative financing mechanisms, such as tiered pricing or voluntary licensing, could bring costs down. Third, community-led delivery models—where trusted local organizations administer injections—could overcome stigma and logistical barriers.

There is also a need for better data. Many countries lack real-time surveillance on who is most at risk and who is falling through the cracks. Without this, resources cannot be targeted effectively. Furthermore, political leadership is crucial: without champions at the highest levels of government, the issue will continue to be shelved.

Lessons from Other Regions

Africa’s experience offers valuable lessons. In countries like Kenya and South Africa, partnerships between governments, NGOs, and global donors have enabled rapid scale-up. They used existing HIV clinics to integrate injections, trained nurses to administer them, and engaged community influencers to build trust. Latin America could replicate these models, adapting them to its own social and health contexts.

Another key factor is addressing the root causes of HIV vulnerability. Long-acting prevention is not a silver bullet; it must be paired with efforts to reduce stigma, decriminalize key populations, and ensure access to education and testing. Otherwise, even the best biomedical tool will fail to reach those who need it most.

Conclusion: The Clock Is Ticking

Latin America’s wait for long-acting HIV prevention is not just a logistical delay—it’s a moral failure. Every month of inaction means more new infections, more preventable deaths, and more suffering in communities that have already been disproportionately impacted by the epidemic. The science is proven; the tools are available. What’s missing is the collective will to close the gap.

As the world moves toward the post-2030 goal of ending AIDS, Latin America must not be left behind. Governments, regional health bodies, donors, and pharmaceutical companies all have a role to play in accelerating access. The time for pilot projects and promises is over. The region needs a concrete, funded, and community-centered plan to bring long-acting HIV prevention to every person who needs it.