Civil society activism and competition from manufacturers of generic drugs drove down the prices of antiretroviral medicines from about US$ 14 000 per person per year for first-line regimens in high-income countries in 1990 to about US$ 1200 per year in low- and middle-income countries in 2003. By 2018, the price per person per year in sub-Saharan Africa was under US$ 100 for most fixed-dose combinations that include tenofovir. The prices of other fixed-dose combinations also have continued to decline over the past few years.
UNAIDS estimates that the market value for generic antiretroviral medicines within low- and middle-income countries was about US$ 1.8 billion in 2018. Approximately 80% of generic antiretroviral medicines procured by low- and middle-income countries are currently manufactured in one country: India.
While there remains significant scope for further price reductions in countries where generic antiretroviral medicines are not yet easily accessible, disruptions caused by the COVID-19 pandemic could have the opposite effect. Lockdowns, disruptions to production, border restrictions and transport disruption threaten to affect the supply of materials and the manufacture and distribution of HIV medicines, with tighter supply factors possibly leading to pressure on market prices.