Communities Call for Systemic Change in Access to HIV Treatment at Rio Pre-Conference

Ahead of the official opening of AIDS 2026 in Rio de Janeiro, activists, experts and community representatives came together for the Treatment Pre-Conference, a five-hour event focused on the future of access to HIV treatment.

Held under the title “HIV Treatment at a Crossroads,” the pre-conference included participants from more than ten countries, including Ukraine, South Africa, Argentina, Kenya, Thailand, Morocco, Guatemala, the Philippines, Georgia, Brazil, Eswatini and the United States.

One urgent question ran through all three sessions: Who controls innovation, and who ultimately gets access to it?

Hard-won gains are under threat

The first session examined the current state of the treatment access movement and the lessons that can be learned from earlier crises.

Participants discussed the collapse of international funding threatening treatment programmes across the Global South, shrinking civic space and the impact of 30 years of intellectual property protection under the Agreement on Trade-Related Aspects of Intellectual Property Rights, commonly known as TRIPS.

A shared and uncomfortable conclusion emerged: many of the gains communities fought for over several decades are once again under threat.

Turning evidence into political power

The second session explored how communities can transform evidence and data into tools for political change.

Activists are not waiting for governments or pharmaceutical companies to deliver equitable access. Communities are filing patent oppositions, generating evidence on medicine prices and availability, and challenging “evergreening” strategies that allow companies to extend monopolies and delay the introduction of more affordable generic medicines.

The central principle of the discussion was clear: health systems must be centred on people, not patents.

Who will govern artificial intelligence in healthcare?

The third session focused on artificial intelligence and digital platforms that are rapidly becoming part of the infrastructure used to prevent, diagnose and treat HIV.

AI is already changing how medicines are developed, how health systems are designed and how people access care. Participants warned, however, that technological progress could deepen existing inequalities if communities and countries in the Global South are excluded from decision-making.

Communities must be involved in designing these systems from the beginning, rather than being invited to comment after the technological architecture and rules have already been established.

“Perhaps it is the systems that need to change”

In his closing remarks, ITPC treatment access expert Othman Mellouk noted that for more than 40 years communities have repeatedly been asked to adapt — to new epidemics, new technologies, shrinking resources, austerity and now artificial intelligence.

Meanwhile, he said, the systems of power determining who benefits from innovation, who receives treatment, who is forced to wait and who is left behind have remained largely unchanged.

“Perhaps it is no longer communities that need to adapt. Perhaps it is the systems that need to change,” Mellouk said.