July 15, 2025
IAS 2025, the 13th International AIDS Society (IAS) Conference on HIV Science, started this week amidst unifying calls to confront the collapse of US support for the HIV response with commitments to reimagine funding, research, development and programming aimed at sustaining progress toward ending the epidemic. At the opening session, the voices of advocates led the way. WACI Health’s Rosemary Mburu said, “the journey to ending the pandemic is not paved with policy papers, scientific publications and procurement plans. It’s carried on the backs of communities, and it needs to be led by communities… Community action is what gives science its soul.”
Following her address, advocates stormed the stage, demanding justice and equity in the HIV response.
Also at the opening session, Linda-Gail Bekker, CEO and Co-founder of the Desmond Tutu Health Foundation, offered critical milestones for transitioning to resilience in this time of crisis:
- Find the estimated 9.2 million people living with HIV who do not have access to treatment.
- Eliminate the vertical transmission of HIV from mothers to infants.
- Double down on primary prevention, including affordable LEN for PrEP.
- Do not stop reaching out to those who have been hardly reached.
- Center communities in the response and provide resources to support their leadership.
- Be relentless.
“We as a global community need to reset the paradigm on the scale of prevention that will be needed for significant impact…. We similarly cannot stop innovating, researching and developing to stay at least one step ahead [of the virus],” said Bekker.
AVAC’s Mitchell Warren echoed these calls in an earlier session, 2025: Time to bring HIV, sexual and reproductive health together for better care, sharing guiding principles for the way forward. “We have to collaborate differently. And sustainability cannot just mean budgets; we have to sustain the impact,” he said.
Released just ahead of the conference, the 2025 Global AIDS Update from UNAIDS, AIDS, Crisis and the Power to Transform, calls for “radical shifts” by countries as imperative to counter the impact of sudden and widespread funding cuts. The report documents the toll of those cuts on communities around the world, from plummeting rates of PrEP use to an anticipated additional six million new cases of HIV between 2025-2029.
At the session Re-imagining Prevention: Planning for Sustainable PrEP Access in the New Funding Context, Warren painted a stark picture of what’s at stake if global HIV prevention continues to be underfunded.
While acknowledging past delays and missed opportunities in the rollout of oral PrEP, the panel made of government officials, donors, implementers and civil society reflected a community that does learn and can be more ambitious. Hiu Yang of the Global Fund talked about their new agreement with Gilead to hopefully reach at least 2 million people with injectable lenacapavir (LEN) for PrEP within three years. But she emphasized, “The two million target for LEN is not a ceiling, it’s a starting point for broader, faster, more inclusive PrEP rollout.”
Going one step further, Yogan Pillay of the Gates Foundation talked about being more ambitious to reach 7.5 million people over the next few years on the road to a sustainable market with multiple generic manufacturers supplying LEN at a much lower price. This ambition is aligned with AVAC’s recent brief, Now What with Injectable LEN for PrEP?, as well as a new Lancet HIV publication from Sharonann Lynch, Pillay, Raphael, Bekker and others: Lessons for long-acting lenacapavir: catalysing equitable PrEP access in low-income and middle-income countries.
The kickoff to IAS 2025 mirrored tensions between the resilience needed for sustainability with the stark realities of the impact of funding cuts on lives and livelihoods. Key announcements on Monday also put a spotlight on scientific progress that holds great potential.
WHO LEN and Testing Guidelines Released
The latest WHO recommendations on HIV prevention featured new guidelines on LEN and testing strategies for long-acting injectable pre-exposure prophylaxis. In addition to recommending the six-monthly injectable LEN as a new PrEP option, including for pregnant and breastfeeding people, WHO updates also recommended rapid diagnostic testing (RDT) for anyone initiating or continuing long-acting injectable PrEP, such as LEN and cabotegravir (CAB). HIV self-testing (HIVST) continues to be a recommended option for oral PrEP, the dapivirine vaginal ring (DVR), and for post-exposure prophylaxis (PEP). The guidelines call for further implementation research to “determine the role of HIVST in delivering long-acting injectable PrEP.”
Experts shared the fundamental role of these recommendations in informing policy and practice.
With only 3.9 million PrEP users currently, and new cases of HIV plateaued at 1.3 million globally, the HIV response “has to do better,” WHO’s Michelle Rodolph said. LEN, as an additional choice in HIV prevention is part of the solution. “Not all PrEP can be made available everywhere, but the data is clear that choice is critical…as is training providers to offer PrEP.”
The guidelines call for countries to include models of differentiated service delivery (DSD) and integration.
Injectable LEN is Effective Among Adolescents and Pregnant People
Gilead announced more data from the PURPOSE trials showing that LEN for PrEP was effective in preventing HIV in pregnant and lactating people, in adolescents, and for those taking medication for tuberculosis and other conditions. Researchers also presented preference data showing that 75% of users favored twice-yearly injectable PrEP over daily oral PrEP because they felt more protected from HIV (69%) and were more confident about not missing a dose (77%).
Merck Launches Phase 3 Trials of a Monthly Pill for PrEP
Merck announced the results of a Phase 2 safety and pharmacokinetics study of an oral monthly pill for PrEP that will now advance to Phase 3 trials known as the EXPrESSIVE trials. The monthly pill under investigation, MK-8527, is a novel, oral, nucleoside reverse transcriptase translocation inhibitor (NRTTI). Phase 2 results found the pill was well tolerated, with a similar safety profile to placebo, among 350 individuals in the randomized study. Merck Principal Scientist Rebeca Plank said, “We envision that monthly oral dosing could transform PrEP delivery and implementation models. If the Phase 3 studies are successful, this product could expand the range of delivery settings beyond medical clinics to locations that allow for flexibility and privacy.”
See AVAC’s Nandi Sikwana describing the importance of these trials, including the role of Good Participatory Practice in their protocol development. Also stay tuned for a PxPulse episode with Rebeca Plank and AVAC’s Grace Kumwenda, coming soon.
Find a roadmap of HIV prevention sessions at IAS 2025 and other resources to support your advocacy at AVAC’s dedicated IAS 2025 page. And stay tuned for more coverage ahead.