MOYO POSITION STATEMENT: Universal Access to Antiretroviral Drugs
Universal access to antiretroviral drugs (ARVs) means ensuring that all individuals who need HIV treatment have access to it, regardless of their location, socioeconomic status, or other factors. This global commitment aims to provide comprehensive HIV prevention, treatment, care, and support services to everyone in need. While significant progress has been made, achieving true universal access remains a challenge.
It is estimated that the introduction and scaleup of ARVs has averted about 9.5 million deaths from AIDS and 7.9 million HIV infections between 1995 to 2015.i Nevertheless, ART coverage has not been equitable across all populations and settings world wide.ii In Canada, coverage for medications including antiretrovirals is not uniformly managed—each province or territory manages and delivers ARVs separately .iii “As a result, individuals with the same prescription pay a different amount for their medications depending on the jurisdiction in which they reside, and may need to use a combination of private insurance, public funders, and out-of-pocket payments “.iv,v,vi For example, as of 03/04/2025 , the formulary estimates that a single tablet of abacavir/lamivudine/dolutegravir is $CAD 52.14, which is estimated to cost approximately $CAD 18,770.40 annually.vii
• Equitable access:
Services should be available to all, including marginalized groups, without discrimination.
• Accessible services:
Information and services need to be available where and when people need them, in a way they can understand and use without fear.
• Affordable access:
The cost of ARVs and related services should not be a barrier to treatment.
• Comprehensive approach:
Universal access encompasses not just treatment, but also prevention, care, and support services.
• Resource limitations:
Many countries struggle to provide the necessary resources for testing, treatment, and care.
• Geographic barriers:
Accessing healthcare facilities can be difficult for people in remote or underserved areas.
• Social and cultural barriers:
Stigma, discrimination, and lack of awareness can prevent people from seeking or receiving treatment.
• Financial barriers:
The cost of ARVs and related services can be prohibitive for some individuals.
While the concept of universal access to ARVs is widely accepted, achieving it requires ongoing efforts to address resource limitations, geographic barriers, and social and cultural factors that hinder access to essential HIV prevention and treatment services.
In Ontario, Canada, universal access to antiretroviral (ARV) drugs for individuals living with HIV is primarily achieved through a combination of government-sponsored programs and private insurance. While Ontario does not have a single, unified program offering universal access like some other provinces, individuals can access necessary medications through programs like the Ontario Drug Benefit (ODB) Program, the Trillium Drug Program, and Ontario Works/Ontario Disability Support Program (OW/ODSP), depending on their eligibility.
A more detailed description of these programs includes:
Ontario Drug Benefit (ODB) Program:
This program provides coverage for certain prescription drugs, including ART, for eligible individuals, including seniors (65+) and those under 25 without private insurance.
Trillium Drug Program:
Individuals not covered by ODB or private insurance can apply for the Trillium Drug Program, which provides coverage after a deductible is met (usually around 4% of income after taxes).
OW/ODSP:
Individuals receiving benefits from these programs are automatically enrolled in the ODB program and pay a minimal co-payment for prescriptions.
Exceptional Drug Status (EDS) Program:
HIV medications are also covered under the EDS program, ensuring full coverage at no cost regardless of age or income, with no deductible or co-payment, according to the Canadian government.
Private Insurance:
Many individuals with HIV also have private insurance plans that cover their medication costs.
Cost-sharing:
Even with these programs, some individuals may still face out-of-pocket costs for their medications, particularly if they have a deductible or co-payment requirements, according to a study on the impact of universal coverage for antiretroviral therapy.
Complexity of Programs:
Navigating the different programs and eligibility criteria can be complex, potentially creating barriers to access.
Confidentiality Concerns:
Accessing medications through private insurance plans may raise confidentiality concerns, as some individuals may not want their HIV status known to their insurance providers or others who have access to their plan information.
Overall, while Ontario has made significant strides in ensuring access to HIV medications, ongoing efforts are needed to address cost barriers and ensure all individuals living with HIV can access treatment without financial or administrative hurdles, according to the Ontario HIV Treatment Network.
Moyo finds it equally important to support universal access to Art for all Age Groups, including children and youth. We reaffirm the findings listed within the American Academy of Pediatrics: “Although significant progress has been made in prevention and treatment of HIV ….globally, infants and children younger than 13 years have less access to optimal antiretroviral therapy compared with youth (13–24 years) and adults, which can negatively affect health outcomes for those with HIV. Despite youth having nearly as many antiretroviral options for HIV management as adults, optimal HIV management in youth is challenged by psychosocial and structural barriers that result in poor access to HIV prevention and care. Significant barriers remain in providing equitable access to optimal HIV treatment and prevention services in the pediatric population.viii
If you are unable to access to medications for HIV please contact Moyo to meet with a member of our support team who will work with you to get access to the medications you need.
i Forsythe SS, McGreevey W, Whiteside A, Shah M, Cohen J, Hecht R, et al. Twenty years of antiretroviral therapy for people living with HIV: Global costs, health achievements, economic benefits. Health Affairs. 2019;38(7):1163–7.
ii Assefa Y, Hill PS, Van Damme W, Dean J, Gilks CF. Leaving no one behind: Lessons from implementation of policies for universal HIV treatment to universal health coverage. Global Health. 2020;16(1):17.
iii Yoong D, Bayoumi AM, Robinson L, Rachlis B, Antoniou T. Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: A descriptive study. CMAJ Open. 2018;6(4):E551– E60.
iv Ontario HIV Treatment Network. Impact of universal coverage for antiretroviral therapy (ART) on health outcomes. Rapid Response Service; #159, APRIL 2021. 1-13
v Yoong D, Bayoumi AM, Robinson L, Rachlis B, Antoniou T. Public prescription drug plan coverage for antiretrovirals and the potential cost to people living with HIV in Canada: A descriptive study. CMAJ Open. 2018;6(4):E551– E60.
vi Campbell DJ, Manns BJ, Soril LJ, Clement F. Comparison of Canadian public medication insurance plans and the impact on out-ofpocket costs. CMAJ Open. 2017;5(4):E808.
vii Ontario Ministry of Health. Formulary search results. 03/04/2025 . Available from: http:// www.formulary.health.gov. on.ca/formulary/results. xhtml?q=abacavir&type=1 Accessed July 8, 2025.
viii Olivero R, Gillespie S; American Academy of Pediatrics, Committee on Pediatric and Adolescent HIV. Increasing Access to Antiretroviral Therapy for the Prevention and Treatment of HIV in Infants, Children, and Youth in the United States: Policy Statement. Pediatrics. 2025;156(2): e2025072718 (last accessed Aug 5, 2025).