Former world leaders, celebrities and a Nobel prize-winning scientist who helped discover HIV have written to a leading pharmaceutical company to urge it to make a “gamechanger” HIV medicine available to people living outside wealthy countries. The US company Gilead Sciences has been urged to “shape history” by avoiding a repeat of the “horror and shame” of the early years of the Aids pandemic, when 12 million lives were lost in poorer parts of the world after effective drugs became available, because the medicines were not affordable. Gilead’s drug, Lenacapavir, can treat HIV when given as two injections a year. Ongoing trials are expected to show it is also an effective prevention drug. It is currently only available in a handful of wealthy countries and has a list price of $42,250 (£33,170) in the US for the first year of treatment, and $39,000 for subsequent years. The company’s patent will not run out for almost two decades. In a letter, campaigners said the drug “could be a real gamechanger worldwide for the people most excluded from high-quality healthcare” and “help end Aids as a public health threat by 2030 – but only if all who would benefit from it can access it”. Three hundred signatories – including the actors Gillian Anderson, Stephen Fry, Sharon Stone and Alan Cumming; former heads of state; Françoise Barré-Sinoussi, the Nobel-winning scientist who helped discover HIV; and people living with the virus – have signed the letter. It urges the company to ensure access for people in low and middle-income countries who either have, or are at risk of, HIV, at the same time as the drug becomes available in high-income countries. This could be achieved by licensing generic versions through the Unitaid-backed Medicines Patent Pool, which the company has done in the past for treatments for HIV/Aids and Hepatitis C, although only for low, rather than middle-income countries. “The global south is home to most of the people who could benefit from Lenacapavir. Currently, across Asia, Africa and Latin America, around 1 million people become infected with HIV every year; imagine if we could prevent all these people from becoming infected, and thereby change their lives, delivering them from a lifetime of treatment and medical care,” the letter, organised by the People’s Medicines Alliance, said. A twice-yearly injection could be particularly useful for marginalised groups including young women, LGBTQ+ people facing criminalisation and discrimination, sex workers and people who inject drugs, they said. “The world now recalls with horror and shame that it took 10 years and 12 million lives lost before generic versions of ARVs became available worldwide and thus HIV treatment on a large scale became possible for people in the south. “By sharing the technology with the whole of the global south, you will help save lives, prevent HIV infections, and advance the end of the world’s deadliest pandemic. You can shape history.” Festus Mogae, the president of Botswana between 1998 and 2008, and a signatory to the letter, said: “When I came to office, it would have been unthinkable to say that we could end the Aids pandemic in our lifetimes. That goal is now within reach, but it will take courageous leadership from companies like Gilead. They have a chance to turn a page on the pharmaceutical industry’s deadly neglect of Africans living with HIV.” A Gilead statement said: “As we await the results of our pivotal Phase 3 clinical trials which will start to read out later this year, we are in regular conversations with HIV advocates and partners, including governments and NGOs, as we work to reach our access goals. Those conversations have been ongoing over the course of the trials. We are extremely committed to developing an access model that ensures lenacapavir for PrEP reaches as many people as possible that can benefit. “This means delivering it swiftly, sustainably, and in sufficient volumes in low- and middle-income countries.”