July 24, 2025
The IAS 2025 conference in Kigali will go down as a critical turning point in the history of the HIV response. Every session, every meeting, every presentation played out against an existential threat: will the world find the will to end the HIV epidemic, with tremendous advances in technology underway, or will the momentum seen through 2024 collapse as evidence-based interventions fall way to ideology? Leaders across the field are persevering to push forward the science, policies, programs and partnerships that are essential to achieve impact; and they are calling for solidarity. And advocates are leading the way, cutting a path and demanding equity, human rights and community leadership every step of the way. WACI Health’s Rosemary Mburu captured this call to action at the opening session, saying “Community action is not the soft side of science — it’s what gives science its soul, its reach, and its relevance.”
The Kigali Call to Action, to which AVAC is proudly a co-signor, echoes these demands, calling for new partnerships, rapid scale-up of prevention, a diverse R&D pipeline, evidence-based policy, expanded treatment access and durable protections for human rights. At the opening session, Linda-Gail Bekker of the Desmond Tutu Health Foundation (and an AVAC board member) shared findings that the US funding freeze has led to severe disruptions in oral PrEP initiations (28-65% reduction), diagnostic testing (6-39% reduction) and in monitoring viral loads (16-68% reduction), and also to initiation of treatment (2-22% reduction). Calling it a precipice, Bekker connected these numbers to modelling studies forecasting as many as 5,000-16,000 additional new HIV infections over just one year, with some countries projecting additional deaths as high as 10% by 2030, and millions of new cases of HIV by 2030 (See this, this & this from aidsmap for more). Bekker also implored everyone that “we cannot go back”.
These are warnings and calls to actions that cannot be ignored. As Yogan Pillay of the Gates Foundation said at a panel discussion on the issue, “I don’t think we should be adapting to this new normal. I think we do need to be transformative.” Solange Baptiste, of The International Treatment Preparedness Coalition (ITPC) and also on the AVAC board, urged the field to see the bigger picture, “The cuts that we’re seeing now are an opportunity to change the system. More studies, more data will not change minds. This is ideological. The HIV field has always been a leader. We have had ambition; now is the time to set the bar high.” Rising to the challenge means critical next steps for the HIV response.
Reimagined and Refinanced: With the loss of US leadership, the Global Health Community Responds
A session hosted by AVAC and the Zambian Ministry of Health, Re-imagining prevention: Planning for sustainable PrEP access in the new funding context, zeroed in on the ground-level work needed to put in place the policies and programs for new and better systems to deliver HIV prevention. Ministries of Health, implementers, and civil society pointed to key priorities: Engaging the private sector to enable delivery of HIV prevention; demedicalizing PrEP to lower costs and simplify expanded access; strengthening monitoring systems to deliver information on preferences and PrEP coverage; aligning donors behind the necessity of integrating HIV-related care with other health services; embedding implementation science into program delivery for ongoing learning; and defining a minimum package of prevention that is tailored to context and balances program costs and choice, among others.
While AVAC’s Mitchell Warren called for “making PrEP simple,” Zambia is one place taking the lead in confronting these issues. At the session, Professor Lloyd Mulenga, Director of Infectious Diseases at Zambia’s Ministry of Health, said finding political will underpins the work ahead. “We need to invest in our own systems and also need a budget line that reflects commitment from government.” Learn more about Zambia’s work in the country snapshot from AVAC’s report Getting Rollout Right This Time. See also this aidsmap coverage to learn more about the conversation at the satellite session.
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The crisis for key populations lies at the heart of the challenge. IAS 2025 brought together community and government leaders, convened by GBGMC and COMPASS, to chart a path forward, with the understanding that delivering prevention to key populations could determine success or failure of the HIV response.
The meeting showcased evidence-based strategic plans developed by community organizations, which can anchor an HIV response that is based on partnerships of trust, transparency and coordination between governments, industry, donors and community. GBGMC launched a new report — Global Roadmap for Long-Acting PrEP Among Key Populations — featuring a first-ever Global Forecast of Long-Acting PrEP Need for Key Populations (2025–2030), co-created with AVAC and Avenir Health.
Accelerating Access to New PrEP Options: The devil’s in the details
As the field regroups, making good on the promise of injectable lenacapavir (LEN) for PrEP hangs in the balance. With the release of new WHO recommendations for offering LEN on the first day of the conference, the success of LEN rollout depends on addressing an array of complex factors. Funding, transparent price and volume agreements, supply chain coordination, empowered and trained health care workers, and comprehensive community engagement are required.
“I can feel the excitement about these [WHO] guidelines. It now calls for collective action. The next step is the difficult one, access! Access is it, or we go back to the disappointment and mistrust,” said Florence Anam, Co-Executive Director of GNP+.
Check out AVAC’s Now What with Injectable LEN for PrEP? that outlines what is actually known — and not — and what needs to happen next.
WHO guidelines for LEN also extended the recommendation to pregnant and lactating populations (PLP), an important advance in access to PrEP. This aligns with data Gilead presented showing efficacy of LEN for PrEP for PLP (see this aidsmap story to learn more). Other announcements at IAS similarly signal progress in this area.
And while much of the buzz centered around rollout of next-gen PrEP injectables, AVAC notes the importance of ongoing research to develop additional products to fill the prevention toolbox. Merck announced the EXPrESSIVE trials, which will be testing efficacy of a monthly pill for PrEP in diverse settings and populations, including PLP. They also presented Phase 2 data, which apart from a positive safety profile at every dosage tested, indicated a predicted time to protection of one hour after intake. See this aidsmap story to learn more along with this new AVAC infographic showing where the trials will take place.
The Dual Prevention Pill, a daily pill for HIV and pregnancy prevention, was also in the spotlight in Kigali, with the launch of #DPPDecoded, a campaign by APHA to raise awareness by and for young women in Africa for this new option. The DPP could be available as early as next year. For more info on the DPP, see this video and resources, and be sure follow @apha_sa for real-time updates.
New Science, New Technology & Emerging Leadership
Striking examples of the use of artificial intelligence (AI) in the delivery of treatment, care and prevention were presented, demonstrating its potential to expand the reach of HIV and other health services. Several countries are using AI technology for interventions from mobile diagnosis to supply chain improvements and in programs supporting adherence to medication. See this aidsmap story for more.
African leadership is on the rise in advancing research for cure and vaccine strategies. The Africa Cure Consortium (comprised of the African Alliance, AVAC, CIDRZ, GGTI, HCAAP, IAS & SANTHE) is incorporating community advocacy and research literacy into its efforts to influence policy and investment in cure research on the continent. Scientific insights from recent cure research include the impact of broadly neutralizing antibodies (bNAbs) on viral rebound and other aspects of immune dynamics (see this & this at aidsmap for more). Another IAS session, Success stories and future directions in African HIV vaccine research, showcased African-based research and initiatives that have transformed the field, from clinical trials to community-driven innovation.
These far-sighted initiatives are in advocacy, too; be sure to check out the outstanding vision and energy of youth advocates in this episode of A Shot in the Arm podcast, where African youth leaders, members of APHA’s Ground Forces program, call on the field to be prepared to succeed. “You are going to need sunglasses! Because the future will be bright for HIV prevention,” said Sinehlanhla Gogela.
These examples of leadership are just the beginning and must be matched with solidarity from across the field and a commitment to fight like hell. As Kenya’s former Minister of Health James Nyikal said, “When you mobilize civil society and the people, and it becomes a crying need amongst the people, politicians listen. That is how the world works.”
Global and country leaders, from communities to advocates, from researchers to implementers, from policy makers to donors, must recommit to the HIV response — or gains against HIV will unravel and the epidemic, with its end in sight, will instead intensify, taking with it countless lives. The discussion in Kigali did not finalize the answers at this pressing hour, but the first steps have begun.
For AVAC resources supporting your advocacy, including slide decks addressing key issues discussed above, go to AVAC’s dedicated page on IAS2025. Onwards!