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    Gilead Agrees to Allow Generic Version of Groundbreaking H.I.V. Shot in Poor Countries

    Many middle-income countries are left out of the deal, widening a gulf in access to critical medicines.The drugmaker Gilead Sciences on Wednesday announced a plan to allow six generic pharmaceutical companies in Asia and North Africa to make and sell at a lower price its groundbreaking drug lenacapavir, a twice-yearly injection that provides near-total protection from infection with H.I.V.Those companies will be permitted to sell the drug in 120 countries, including all the countries with the highest rates of H.I.V., which are in sub-Saharan Africa. Gilead will not charge the generic drugmakers for the licenses.Gilead says the deal, made just weeks after clinical trial results showed how well the drug works, will provide rapid and broad access to a medication that has the potential to end the decades-long H.I.V. pandemic.But the deal leaves out most middle- and high-income countries — including Brazil, Colombia, Mexico, China and Russia — that together account for about 20 percent of new H.I.V. infections. Gilead will sell its version of the drug in those countries at higher prices. The omission reflects a widening gulf in health care access that is increasingly isolating the people in the middle.Gilead charges $42,250 per patient per year for lenacapavir in the United States, where it is approved as a treatment for H.I.V. The company has said nothing about what lenacapavir will cost when used to prevent H.I.V. infections, a process called pre-exposure prophylaxis, or PrEP.The generics makers — four companies in India, one in Pakistan and one in Egypt — are expected to sell it for much less. Researchers at Liverpool University found the drug could profitably be produced for as little as $40 per patient per year, if it were being purchased in large volumes.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    At Least 38 Killed in Attacks in Southwestern Pakistan

    At least 38 people have been killed in several assaults across Baluchistan Province since Sunday in what appears to be part of a campaign by armed separatists in the region.The violence began with blasts that ripped through a military camp in Pakistan’s Baluchistan Province late Sunday night, killing at least one soldier. Around the same time, armed men stormed into at least four police stations in the province, spraying bullets at officers and setting police vehicles on fire, local officials said.By daybreak, militants had destroyed a bridge, bringing the major railway that runs across it to a halt. Then early Monday morning, the violence hit its apex when gunmen held up traffic on a major highway, shooting and killing nearly two dozen people.Over a 24-hour period, the new wave of violence carried out by an armed separatist group has seized Baluchistan Province in southwestern Pakistan and left at least 38 people dead, worsening the country’s already deteriorating security situation.The spate of coordinated attacks in Baluchistan began on Sunday, as the group, the Baluch Liberation Army, or B.L.A., announced that it was starting a new operation across the province. The B.L.A. is one of several insurgent groups that has demanded the province’s independence from the central government in Islamabad.The deadliest single attack in the campaign so far unfolded in Musakhel, a district in Baluchistan, officials said, when armed men stopped traffic on a highway and demanded that passengers on buses and trucks show them their identity cards, officials said.The gunmen forced some of the passengers out of the vehicles, and then shot and killed them, officials said. Nearly all of the victims were from Punjab Province, officials said, and the gunmen set at least 10 buses and trucks ablaze before fleeing the area.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Dozens Are Killed in Two Bus Crashes in Pakistan

    One of the accidents killed 12 people who were returning from a religious pilgrimage to Iraq, officials said.At least 37 people, including a dozen who were returning from a religious pilgrimage in Iraq, died Sunday in two unrelated bus crashes in Pakistan, officials said.Though the causes were under investigation, the accidents highlighted road safety in a country that experts say is known for poor road conditions, lax traffic enforcement and fatal crashes.The first accident occurred in the southwestern province of Balochistan, where a bus carrying pilgrims returning from Iraq plunged into a ravine on a coastal highway.Twelve people were killed and 23 were injured, according to rescue officials, who said the accident was probably caused by speeding or brake failure.Every year, at least 50,000 Pakistanis travel to Iraq to commemorate the Shiite holiday of Arbaeen.The second accident occurred in Kahuta, near the northern city of Rawalpindi. A bus drove into a ditch, killing all 25 people on board, including four women and a child, according to Farooq Butt, a rescue official.One injured man was pulled from wreckage but died on the way to the hospital, Mr. Butt said.Officials said the cause of the accident was not yet known. In a statement, Prime Minister Shehbaz Sharif expressed grief over the loss of life.Unsafe road conditions, insufficient traffic enforcement and neglected vehicle maintenance often lead to accidents in the country.“Poor enforcement, untrained traffic officers and unsafe vehicles make things worse,” said Syed Kaleem Imam, a former police inspector general.The crash in Balochistan came less than a week after 28 Pakistani pilgrims died in a bus accident in Iran. Twenty-three others were injured, 14 of them critically, according to Pakistani Embassy officials in Tehran. More