Equity is a prerequisite for a globally relevant HIV cure

HIV cure-related research encompasses an expanding range of investigational strategies, but its global impact will depend on whether cure-related interventions are scientifically valid, acceptable and implementable in the populations most affected by the epidemic. Low- and middle-income countries carry a disproportionate HIV burden, yet cure-related research remains concentrated in high-income settings. This imbalance is not only an issue of access or social justice. Differences in viral subtypes, reservoir characteristics, timing of antiretroviral therapy initiation, co-infections and anatomical persistence may affect the safety, efficacy and generalizability of cure-related interventions. Psychological and structural factors, including stigma, trust in research, treatment-interruption anxiety, partner-protection needs, financial insecurity, research infrastructure and health-system capacity also influence participation, retention and the interpretation of trial outcomes. We argue that equity should therefore be embedded throughout HIV cure-related research, from study design and population selection to analytical treatment interruption, community engagement and planning for implementation. Priorities include conducting studies in biologically diverse populations, strengthening locally led research capacity, treating partner protection and repeated informed consent as core trial requirements, protecting existing HIV services and anticipating affordability and delivery before efficacy is established. Without these measures, advances in HIV cure may reinforce rather than reduce existing global disparities.