At the International AIDS Conference in Rio de Janeiro this July, one number stood out from the rest of the program: three dollars. That is roughly what Merck says it could cost to manufacture a year’s supply of its investigational once-monthly PrEP pill, which would make it potentially the cheapest HIV prevention drug ever brought to market.

The conference also brought long-term follow-up data on the injectable option already in use, plus a reminder that a low manufacturing cost and actual access are two very different things.

Where PrEP stands today

Right now, people have a few real choices for PrEP. Daily oral pills have been the standard for years and remain highly effective when taken consistently. Twice-yearly injectable lenacapavir became available more recently and offers strong protection without a daily routine. At AIDS 2026, Gilead presented longer follow-up data from the trials behind that injectable, called PURPOSE 1 and PURPOSE 2. More than 95 percent of eligible participants across both trials chose to continue on lenacapavir or switch to it from daily oral PrEP, and infection rates during that extended follow-up stayed extremely low.

The new development is alimatravir, also known as MK-8527, an investigational pill from Merck taken just once a month instead of daily. It is still in phase 3 trials, so it is not available yet, but the interest at the conference was less about the drug itself and more about what it could cost to produce.

The cost story and the access gap

An independent analysis presented at the conference estimated that generic manufacturers could produce alimatravir for around three dollars per person per year. For comparison, some existing long-acting PrEP options are estimated to cost tens of dollars to produce but are priced tens of thousands of dollars a year in the US. If that three dollar estimate holds up, a monthly pill could be one of the least expensive prevention tools ever available.

But the licensing agreement Merck announced ahead of the conference tells a more complicated story. The deal covers 129 low and middle income countries, but it excludes most of Latin America, including Brazil, Argentina, Chile, Colombia, Mexico, and several others, some of which hosted the drug’s own phase 3 trials. Countries that took part in the research to prove the drug works are not currently included in the plan to make it affordable there. Advocacy groups have already flagged this as a gap worth watching as the drug moves toward approval.

Why this matters even if you are not changing your PrEP

Cheaper manufacturing costs do not automatically become cheaper prices for the people who need the drug, and licensing decisions made in boardrooms can leave out the exact places that made the research possible. Whichever PrEP option ends up working for you, the value of testing and disclosure does not change. More options on the market are good news, but only if the plan for who gets them keeps pace with the science.

Sources

• Monthly PrEP pill could be made for US$3 a year, but Latin America is shut out of generic licensing, aidsmap via EATG
• Alimatravir Should Cost $3 a Year: A Voluntary License Won’t Get Us There, Make Medicines Affordable
• Gilead to Present New HIV Research at AIDS 2026 Across Prevention, Treatment and Cure
• Merck Announces Initial Access Plans for Alimatravir

Two stories about HIV came out of the medical press within a day of each other in early August, and they only make sense read together. One says providers need to talk about HIV more. The other says that even where providers are talking about it, the newest prevention tool is not reaching everyone equally.

The push to normalize the conversation

On August 6, 2026, the American College of Obstetricians and Gynecologists issued updated guidance advising providers to normalize conversations about HIV screening and PrEP during routine visits, not just when a patient raises the topic first. The statement recommends offering at least one lifetime HIV test to every patient through an opt-out approach, and it points out that ob-gyns provide close to half of all women’s preventive health visits each year, often the only contact some patients have with the health system at all.

The reasoning behind the push is straightforward. Research consistently shows that one of the biggest factors in whether someone gets tested is whether their doctor brings it up. Waiting for a patient to ask puts the burden on the person least likely to know it is worth asking. Shifting that burden onto routine care, folded into the same shared decision-making providers already use for contraceptive counseling, is meant to make the conversation feel as ordinary as any other preventive topic.

Access is not catching up as fast

The day before the ACOG statement, Medscape reported on new data presented at the AIDS 2026 conference showing that uptake of lenacapavir, the newer long-acting injectable PrEP option, is substantially lower among Black, Hispanic, and younger patients compared with white and older patients. One researcher put it bluntly to the audience: within just six months of release, the same inequities researchers have tracked for 14 years of oral PrEP were already showing up again.

Put the two stories side by side and the picture is clear. Providers are being told, correctly, to bring up prevention more often and treat it as routine. But a system-level push to talk about HIV more does not by itself close the gap in who actually gets access to the newest tools once the conversation happens. Both things can be true and both need attention.

This is also part of why we treat HIV status differently at Protecht. Sharing your HIV status through the app is permanently free, not a promotional feature. It reflects a belief that the ability to disclose accurately, and to have that disclosure trusted, should not depend on what someone can afford or how comfortable their provider is bringing up the subject first.

What this means for you

If your provider has not brought up HIV testing or PrEP recently, ACOG’s own guidance says that is worth raising yourself, at your next routine visit. And if you are curious about newer PrEP options, ask directly rather than assuming your provider will default to whichever one is most convenient to prescribe. The data suggests that default is not landing evenly across patients yet.

Sources

• Normalize Patient Conversations About HIV and PrEP, ACOG Advises, Medscape, August 6, 2026
• Human Immunodeficiency Virus Screening and Preexposure Prophylaxis, ACOG Committee Statement No. 32
• Lenacapavir PrEP Uptake in US Remains Low, Especially Among Black, Hispanic, and Young, Medscape, August 5, 2026