Over the past decade, the cost of antiretroviral therapy (ART) has become an increasingly complex challengefor health systems in low- and middle-income countries (LMICs). This article offers a comprehensive reviewof the literature and key documents to explore both the direct and indirect costs associated with ART. It placesparticular emphasis on comparing generic versus brand-name medications, the impact of international aidprograms—such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund—and the role of public policies in shaping access and equity in healthcare. To conduct this analysis, weconducted a narrative review of studies published between 2010 and 2023, drawing from indexed databaseslike PubMed, Scielo, and LILACS, as well as reports from leading global health organizations including theWHO, PAHO, and UNAIDS. The findings reveal a gradual reduction in drug costs, largely driven by theintroduction of generics. However, significant barriers remain, particularly in terms of out-of-pocket expensesand unequal access to coverage. In Costa Rica, pilot initiatives involving pre-exposure prophylaxis (PrEP)have provided valuable insights into the financial sustainability of HIV prevention efforts within theframework of the Costa Rican Social Security Fund (CCSS), the country’s sole public healthcare provider.This review contributes meaningful evidence to inform public health decision-making, highlighting theimportance of sustainable financing for comprehensive HIV prevention strategies and long-term ART accessin resource-constrained settings