Pharmaceutical Sovereignty as HIV Justice: Colombia's Dolutegravir License and the Future of ART Access in Latin America

Access to antiretroviral therapy (ART) remains one of the most pressing challenges in Latin America's HIV response.Despite major biomedical advances, persistent inequalities in affordability, availability and regional production of ART continue to impede progress towards the UNAIDS 95-95-95 targets [ 1 ].Latin America has an estimated 2.3 million people living with HIV, of whom approximately 73% are receiving ART and only 67% have achieved viral suppression [ 1 ].Access remains closely tied to health systems financing, as ART costs constitute a substantial share of national HIV budgets.In Colombia, for instance, HIV-related expenditures reached USD 194.6 million in 2022 [ 2 ].Recent international HIV funding cuts are projected to exacerbate structural vulnerabilities, increasing the risk of ART access interruptions and inequities across the region [ 3 ].Colombia invoked the "government use" clause of Andean Decision 486, a regional intellectual property framework governing patents across the Andean Community (Bolivia, Colombia, Ecuador and Peru).This mechanism is supported under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and reaffirmed in the Doha Declaration, which states that public health takes precedence over patent protections.By activating it, Colombia demonstrated what other countries in the region have lacked: legal readiness with political