In 2025, there was a systematic disruption in the supply of antiretroviral medications, particularly in the EPSs covered by the program, with the situation being especially severe at Nueva EPS, the facility with the largest and oldest population of HIV patients in Colombia. Between October and December 2024, approximately 5,900 complaints were filed by patients² who did not receive their medications on time.

Uninsured people are affected more than they used to be: Red Somos, a NGO working with non-insured HIV+ has a stock of HIV medication until June or July and they do not know what will happen afterwards. According to Red Somos, in a conversation with us in March, last year’s institutional funding cuts of 66% led to corresponding reductions in testing and treatment services.

A quick online search shows widely reported problems with the supply of ART. This affects people who are health care insured and the one who cannot afford it anyways. (The Colombian healthcare system is organised on a market basis: private companies insure the majority of the population and provide basic healthcare, which includes treatment for HIV patients.)

Newly diagnosed, often very young, HIV+ are already facing a situation that is new and unsettling. Yet many are made to wait: treatment is not prescribed immediately, or the medication they have been prescribed remains unavailable for months at EPS-operated pharmacies designated to serve their own members. Waiting times can range from several months up to six months. From both a medical and a public health perspective, this runs against the standard approach of ‘hit hard and early’: treatment should begin as soon as possible.

Other factors play a role as well: some people experience serious side effects from certain older antiretroviral therapies, which are still commonly used in COL. For example, these medications may cause depression or insomnia, but patients are often not offered alternative treatment, as this would usually be more expensive for the healthcare provider. For many, the only remaining option is to stop treatment altogether, another medically untenable consequence of the same crisis.

Another aspect of this crisis is the stigma that people living with HIV anticipate and experience within the EPS healthcare system, including from medical staff. This, too, allows EPSs to save costs, at least in the short term.

Yes. Several people have told us that it does, and there are countless posts on internet forums discussing the same issue.

Even with EPS coverage, patients are often switched to different treatment regimens because certain medicines are no longer available. There is often no medical reason for this, and it is not always clear whether the medicines are genuinely unavailable or whether they are simply no longer being ordered, for example because they are too expensive for the EPS. This leads to forced breaks in treatment until new medicines arrive, repeated trips to the pharmacy, and unclear transitions from one effective treatment to another, often without patients being told why.

Coverage varies significantly depending on the EPS. It therefore matters which EPS insurance scheme you are on and also where you live in Colombia.  

People with health insurance who are living with HIV, and with all the challenges this already brings, are therefore exposed to additional discrimination. For them, this is deeply stressful. It can reinforce trauma, discrimination and feelings of shame, all produced by a privately organised healthcare system.

Colombian people who are unable to pay their monthly contributions to their EPS lose their insurance under the contributory scheme; as a result, they have the option –and the need– to get insured in the subsidised scheme in order to continue accessing their right to healthcare. However, they may face the problem of being incorrectly classified –as a population not at economic risk– on the Sisbén scale (System for Identifying Potential Beneficiaries of Social Programmes), because this system continues to prioritise social stratification data over other factors such as income. For example, a person living in a wealthy neighbourhood but who has no stable income –or no income at all– is classified by Sisbén as non-poor or non-vulnerable, and therefore their EPS also demands them for payment even though they are insured in the subsidised scheme. For these people, the health system – which is supposed to cover everyone – becomes a trap.

As far as we know, this problem has been occurring across COL. Since the middle of last year, in the Departamento of the Valle de Cauca, including the Ciudad de Cali, HIV+ people with health insurance and ART prescriptions have faced fundamental barriers to accessing ART, with medications physically unavailable in pharmacies. This mostly affects Afro-Colombian and Indigenous communities, as well as other vulnerable groups, including trans* sex workers.

To address this situation directly, the government, which has been in office since August 2022, has purchased FN a large quantity of ART to offer it to primary healthcare facilities, EPSs, at a significantly reduced price and to improve access directly and quickly. This is a positive development, but implementation has stalled: the medications, primarily dolutegravir, are stored in large stockpiles, with rumours speaking of more than 700,000 monthly packages as of April 2026, and are readily available, but are being used only sparingly by the EPSs. As a result, the medications are not reaching those who need them.

The answer is simple: with a price of about 40,000 COP, less than 10 EUR, significantly lower than the market price of about 800,000 COP, about 190 EUR, the EPSs are not making enough profit. NO MONEY IS COMING .

The pragmatic proposal to prescribe state-subsidised medications is simply being boycotted. To defame this intervention, which is apparently perceived as too much market regulation, as ‘socialist’, one must first ignore the needs of one’s own HIV+ insured patients and completely disregard responsibility for a situation that has been produced by the structural problems of one’s own system.

In order to become more independent of the international pharmaceutical industry, the government is establishing in-house dolutegravir production in COL. To be able to supply HIV+ patients with antiretroviral medication itself and at low cost, the government temporarily suspended patent protection for dolutegravir, a highly effective second-generation integrase inhibitor (INSTI) used to treat HIV-1 in adults and children, marketed as Tivicay by ViiV Healthcare and approved in the U.S. and the EU in 2013/14, in order to facilitate the production of a generic version. To this end, the Colombian Ministry of Health signed a contract with the Universidad de Antioquia (UdeA) at the end of 2024 to establish and oversee production. The funding commitment is contractually guaranteed, and production is scheduled to begin in late 2025 or early 2026. At the moment, the project is on schedule, but UdeA is facing serious financial problems unrelated to this project. It is possible that the plan could be delayed or derailed if funds are paid too late. A new government would also need to honour the contract, but could attempt to block or slow down the project.

As published on 27th of April 2026³, fortunately The Andean Court of Justice ruled in Colombia’s favor, allowing the country to produce and import a generic version of the HIV drug dolutegravir through a compulsory license, after pharmaceutical companies ViiV Healthcare and Shionogi had challenged the measure as illegal.

We welcome both the suspension of the relevant patent protection and the plan to manufacture antiretrovirals domestically to meet national needs. Once production is up and running, COL should also provide neighbouring countries with affordable and easy access to these medications. Otherwise, the global pharmaceutical industry in the North is unlikely to offer any assistance if there are no profits to be made. We are currently seeing how even drug donations or global funds for treatment and prevention do not guarantee a secure supply: how right, therefore, to take the supply of antiretroviral drugs into our own hands. All critics of these efforts, whether they tout the market as the solution, denounce this national initiative as ‘socialist’, or complain about the obstacles that such a project entails, do so at the risk of potential deaths, and at the expense of people who would otherwise be denied the medications they need simply to survive.

We are not currently aware of any issues regarding the availability of PrEP medications in pharmacies. But PrEP users have told us that they are donating medication prescribed for themselves to HIV+ friends who are running out of treatment. People have also asked us whether PrEP is still effective when so many people’s viral load is apparently no longer undetectable?⁴ The clear answer is: yes, it is! The risk of infection is rising, and taking PrEP is more important than ever. But is it ethically justifiable to take pills preventively when others need them as life-saving medication?

However, the general pandemic situation can lead to a sharp rise in the number of new infections, and we advise anyone who wants to protect themselves against HIV to take PrEP if they wish to do so and if it is available to them in any way. From a public health perspective, there is an urgent need for action here to make PrEP more easily and simply accessible (i.e. not via the EPS), and this must be done urgently.

Medically necessary, in the context of HIV treatment, means first of all: never change a running system. Changes are generally possible, but they should be medically necessary. We hear of countless cases of people whose treatments are switched without medical necessity because the medications they have been taking are no longer available. This often leads to treatment interruptions, sometimes for 1-2 months, but we have also heard of cases where people are left without medication for several months, even for more than half a year. For them, this is not just an involuntary interruption of treatment. It is unsettling, creates a situation in which it is unclear whether a newly prescribed treatment will work at all and have as few side effects as the previous one, and, not least, means that people who were undetectable, previously non-infectious due to effective medication, now develop a viral load that poses a risk of transmission during sexual or other potentially infectious contacts.

In Colombia, by 2024, the prevalence (the overall number of a disease within a defined population) of HIV for trans* women was estimated at around 21% compared to 17% for men who have sex with men, which means that trans* population –specially trans* women– are 21% more likely to have HIV compared to the 17% for the male cis population⁵.

There is no statistical data on HIV prevalence among non-binary trans* people or trans* men in COL, as this issue continues to be approached through biases rooted in gender binarism. Besides, this situation is exacerbated by structural barriers to accessing and securing the right to healthcare, such as stigma and trans*phobia.

We interviewed a Black non-binary trans* person from the Pacific Colombian Coast –they asked us for anonymity–, who told us they had to wait more than six months last year after receiving their HIV-positive diagnosis for their subsidised EPS, Salud Total, to provide them with ART so that they could start taking it. They also told us they faced a lot of stigma and struggled with trauma in the process of receiving the diagnosis and starting treatment: doctors questioned their healthcare practices related to their sex life, failed to prioritise the confidentiality of their diagnosis, and even decided to cancel one of their monthly check-up appointments and the dispensing of their medication when they asked for virtual assistance because they could not physically go to the IPS due to an asthma attack that prevented them from leaving their house.

We also interviewed Oshnur, a non-binary trans* person from Pereira, who told us they had to cancel their membership with their EPS –Nueva EPS– under the contributory scheme –the scheme for those who can economically afford health insurance– because their financial situation worsened. Oshnur were on the verge of losing access to their ART because some administrative hurdles related to their gender identity⁶ made it their change insurance from the contributory to the subsidized scheme to their EPS a very delayed process –they had to wait almost one month!– Because of that delay, they missed their monthly check-up appointment last March, and therefore were unable to collect their medication. 

Oh the other hand, trans* people who decide to affirm their gender identity through hormone replacement therapy, particularly trans* women, also face many obstacles when accessing ART and integral healthcare. In cases where HIV+ trans* women do not have health insurance or cannot obtain their ART medication from their EPS, hormone replacement therapy is often prioritised over antiretroviral treatment, although one should not have to be prioritised over the other. This is because gender identity affirmation is crucial in a world that demands cis passing in order to live free from discrimination and transphobia. In other cases, hormones and ART are combined without adequate medical supervision, which can lead to additional health risks: some ART may interfere with the pharmacokinetics of oestradiol. HIV+ trans*gender women undergoing hormone replacement therapy must therefore have access to regular follow-up checks.

These shared personal experiences, for which we are very grateful, are examples of structural disadvantage: precariousness, as well as experiences of neglect and discrimination on the grounds of gender identity, mean that trans*gender people are particularly affected by the antiretroviral treatment crisis in the country.

We do not want to live in a country where this is accepted as the norm.

Even before 2025, INVIMA, the national institute responsible for regulating drug approvals, had identified several structural causes of the chronic shortage in a report: too few suppliers on the market, a shortage of raw materials, dependence on imports, inadequate inventory management, and price regulations that deter manufacturers. The INVIMA report explicitly analyses structural factors contributing to the shortage of HIV medications. The experiences described above are therefore not isolated cases, subjective generalisations, or gossip, but part of a crisis with underlying structural causes.

Yes, there are. Recently, Red Somos⁷ conducted an online survey on barriers to access to treatment and care for HIV+ people in COL, with 238 participants nationwide between December 2025 and March 2026. It revealed the following: only 59.24% of respondents are enrolled in an HIV treatment programme, while 52.5% have been denied access to medication.

In addition, 25.6% of respondents were denied access to specialist healthcare services, and 14.7% have taken legal action at some point to assert their right to access treatment.

These findings are shocking and highlight the urgent need for action: anyone living with HIV in COL currently faces a high risk of not receiving adequate medical care.

This is how it appears, or at least how it may feel to individuals who previously had no trouble accessing medication but now face difficulties. However, many of the causes go back to the years before the current presidency and stem from a healthcare system built around profit-driven companies. Changing this creates friction and conflict, which particularly affects people living with HIV and is felt by them in an especially acute way.

To the current presidency’s credit, it is actively addressing the problem and seeking to improve the situation.

First, when we set out to investigate the HIV medication crisis, we believed that it was largely due to the political decisions taken by Donald Trump’s government in early 2025 to cut funding for the PEPFAR programme⁸, the Presidential Emergency Plan for AIDS Relief. However, we quickly realised that the problem is much greater and involves a historic crisis in Colombia’s healthcare system that has been worsening for several decades. The funding cuts mostly affect institutional funding, such as rent and social workers’ wages, prevention financing, such as condoms, and funding for HIV medication for people without health insurance, mostly refugees from VEN. These cuts are already visible. For instance, the government of COL decided not to accept any new participants into the latter programmes. This admission freeze applies to all refugees who arrived in the country after the end of January 2025. They do not have access to HIV medication.

In addition, as is the case everywhere else in the world, the far right in COL is gaining momentum thanks to Trump’s rise to power, and we are aware that we will be among the first to come under attack from their policies. But we will fight back.

Law 100 of 1993 established the Integral Social Security System (SSSI) and, in doing so, restructured healthcare provision in the country through a mixed model in which the Colombian State administers resources via the state-run ADRES fund, the Administrator of Resources for the General Social Security System for Health, while the Health Promotion Entities (EPS) and Service Provider Institutions (IPS), both of which are predominantly private in nature, are responsible for managing risk and healthcare provision using the resources guaranteed by the State. More than 30 years after this legislation came into force, the healthcare system in Colombia is mired in a profound, multi-factorial crisis, in which insufficient resources, corruption and the misappropriation of public funds, the millions in debts owed by the EPSs to the IPSs, and the resulting closures of emergency services and medicine dispensing facilities, among other issues, have meant that thousands of people are unable to effectively access their right to comprehensive healthcare, including those living with HIV.

Just to be clear: the Petro administration cannot be held responsible for these structural problems. At the same time, we would like the government, and in particular the Ministry of Health, to communicate more effectively with us about how the problem described above is to be addressed, both structurally and in the immediate term. Disputes over the EPSs must not be resolved at the expense of the weakest and most vulnerable.

Who knows better than HIV+ people that reforms of the health system are urgent and essential?

Once the elections take place in May 2026, the newly elected presidential cabinet must face the challenge of reforming the healthcare system so that people can receive more dignified care in terms of general healthcare, access to treatment and the dispensing of medicines.

Concretely, the new president has to guarantee effective and timely access to services for everyone beyond formal coverage, as well as address the financial crisis and ensure the sustainability of the healthcare system, whether this reform implies replacing the EPS/IPS model with another one, or continuing this system with new financial decisions that may help resolve the enormous debts that EPSs have with IPSs, clinics, hospitals and pharmacies. On the other hand, it is imperative to reduce disparities between urban and rural areas and update the model of socioeconomic stratification based on a modification of the targeting of social spending. The current president, Gustavo Petro, has already been working on this matter through his national development plan 2022-2026, especially after it has been shown that the place where a person lives does not necessarily determine their real income.

These administrative measures could ensure genuine and effective access to the full enjoyment of the right to health, rather than merely guaranteeing it as a service, and, ultimately, restore public confidence in the Colombian healthcare system, given that this confidence has been eroded by decades of structural failures and historic embezzlement by the EPSs from the national budget.

The EPS conflict does not just affect healthcare access, it undermines the entire HIV response. Colombia has no real national HIV programme. Everything follows a market logic that was never built to serve public health or affected communities.

Prevention and PrEP access are neglected by design, since the EPS model prioritises treatment billing over keeping people healthy. Community organisations doing actual AIDS work are structurally excluded from EPS funding, with no pathway and no resources. And yet the EPSs hold enormous power over decisions that directly affect us, while our communities have no meaningful seat at the table. That is the core problem.

If you do not have regular health insurance, you can register with Sisbén and apply for affiliation to the subsidised regime with an EPS so that you can access antiretroviral medication. In the meantime, try to contact an organisation that offers support with HIV treatment access for HIV+ people without health insurance. Addresses and contacts are listed below the article.

For those who are in a relationship or living with someone and are not yet covered under their partner’s EPS health insurance as a beneficiary, it is worth considering this option. This could potentially give them relatively straightforward access to medical treatment, including ART. It is definitely worth thinking about and finding out exactly how it works.

In general: in Colombia, everyone, regardless of insurance status or nationality, is legally entitled to emergency care. In the case of HIV, a medical emergency is deemed to exist as soon as the supply of medication is interrupted. So if there is no other option, go to A&E, urgencia, so they can help you.

It is impossible to talk about people not having access to medicines that are vital to their survival without also briefly addressing what those who no longer have access can do. FN We feel with you. What is happening to you is not right and never will be. But you are not alone.

Yes.

From a community perspective, it is simply our own decision how we protect ourselves from HIV, and individually, PrEP works very well for this.

From a public health perspective, PrEP effectively prevents many infections, but EPS-regulated access creates high barriers and unnecessary complications. Fundamental changes are urgently needed to establish a national HIV prevention programme with access outside insurance coverage. The potential is far from being realised.

In the current HIV medical crisis, PrEP also offers reliable protection in situations where users may encounter HIV+ people who are likely not undetectable. PrEP is a real safeguard right now. For the elections: PrEP users and those who want to start can check which candidates respect LGBTIQ rights. We see PrEP, alongside adoption rights for same-sex couples, trans* rights, and access to HIV medication, as a fundamental right of sexual minorities.

Iván Cepeda (Pacto Histórico) wants to continue the Petro reform, moving away from the EPS model towards a more state-directed system. The current government has taken concrete steps on HIV, including centralised procurement of ART such as dolutegravir, but implementation has stalled. Cepeda is progressive on LGBTQ+ issues.

Paloma Valencia (Centro Democrático) does not want to abolish the EPS system, but rather stabilise it through a public-private hybrid model. Her openly gay running mate, Oviedo, explicitly positions himself as an LGBTQ+ advocate. Valencia herself, however, has sent very conservative signals by distancing herself on the issues of adoption and trans rights, while the rest of her party remains hostile to the LGBTQ+ community.

Sergio Fajardo (Dignidad y Compromiso) takes a technical middle ground: strengthening primary care, securing funding streams, and preserving a role for the market. However, there are hardly any explicit statements from him on HIV or chronic diseases.

Abelardo de la Espriella, on the far right, does not even mention HIV in his emergency plan and has publicly mocked a rival’s homosexuality. He is clearly not a recommended choice for HIV+ and LGBTQ+ people.

We would like to emphasise at this point that we are politically independent and intend to remain so. Our stance is autonomous and must not be subsumed into any political movement or party. This will enable us to continue voicing our criticism in the future. At the same time, we remain open to dialogue and cooperation.

The EPS crisis is structural and financial. Cepeda would seek to implement far-reaching systemic reforms, which also carries a risk: greater uncertainty during the transition, because the intention is to take money, meaning possible profits, out of the EPS system. Valencia and Fajardo would take a more pragmatic approach to the current debt crisis, but would not change a system that is clearly not working, as we have seen above. There is absolutely no indication here that the situation of HIV+ insured people would change quickly.

The political landscape outlined by the speeches and proposals of the candidates for the Colombian presidency is marked by a striking ideological contradiction that can be understood in terms of their affiliation with progressive left-wing, centrist and conservative right-wing movements.

Firstly, candidate Iván Cepeda’s left-progressive government programme addresses the rights of LGBTIQA+ people within the framework of their full recognition as human rights. He also proposes the continuation and strengthening of public policies on inclusion, equity and the fight against all forms of discrimination, all framed within a differential and intersectional perspective on ethnic, sexual and gender diversity.

On the other hand, although the right-wing candidate Paloma Valencia chose Juan Daniel Oviedo as her running mate, a man who is openly gay and has sought to position himself as a representative of the country’s LGBTIQ+ community, in various public appearances, such as campaign speeches and media interviews, she has made questionable statements expressing her opposition to guaranteeing the right of same-sex couples to adopt children, and has strongly criticised the rights of trans* people to affirm their gender identity and to access the full exercise and guarantee of their rights, bringing back into public debate the ghost of gender ideology, a fallacy that the conservative right has been using worldwide to delegitimise the just demands of trans* people for self-determination outside the cis-heteronormative regime. We have nothing to say about the other right-wing candidate, Abelardo De La Espriella, as he too has shown a blatant disregard for LGBTIQA+ people by mocking Juan Daniel Oviedo with homophobic comments. What can we expect for trans* people in this scenario?

As for the centrist candidates, Claudia López and Sergio Fajardo, there is nothing new or revolutionary about their proposals: they advocate for the protection of rights already secured, such as equal marriage, adoption by same-sex couples and non-discrimination, but they say nothing about extending other rights, such as respect for the gender identity of trans* people. To add a point on this matter, Claudia López positioned herself rhetorically as an advocate of LGBTIQA+ causes whilst serving as a senator in the previous legislative term, but she was conspicuously absent when it came to supporting the Integral Trans* Bill, which still requires two further debates in Congress before it can be passed into law.

First: we as HIV+ people are citizens, we have needs and rights, and we are many. We are a relevant group of possible voters.

From a wider perspective, one could say: a society can be judged by how it cares for its HIV+ citizens, who are often also queer and trans* people, people who use drugs, sex workers, women, and members of minorities who are still morally stigmatised.

When discrimination intersects with other forms of exclusion, for example because someone is Black or Indigenous, or does not even have Colombian citizenship, it reveals how a society stands up for the interests of oppressed people. These issues are interconnected. Let us stand together and support one another.

We, HIV+ voters, jointly call on the next COL government to resolve the above-mentioned issues quickly and in the public interest.