World AIDS Day in 2025 comes at a moment of unprecedented change. Over 60 years of investment in global health, forty years of innovation and progress in the fight to end the HIV epidemic, and many of the critical programs that provide access to HIV prevention in high burden countries are in disarray and at risk of collapse. As the US government withdraws and redirects resources, the just-launched UNAIDS report shows the number of people living with HIV is predicted to increase from 40 to 50 million people by 2050, unless HIV incidence reduces dramatically. Yet, in the midst of the chaos, there’s a historic opportunity to defeat HIV by scaling-up the breakthrough technology of long-acting injectable PrEP.

As governments and HIV prevention champions around the world scramble to reimagine a people-centered HIV response and build anew, what will it take to finally achieve targets to drive down incidence and reach epidemic control?

1. Fulfill the promise of science with accelerated, equitable access to injectable lenacapavir (LEN) for PrEP, delivered at scale

Science and advocacy have delivered astounding progress in developing biomedical options for HIV prevention. Injectable LEN for PrEP is moving from research to rollout faster than any product before.

Current commitments from the Global Fund and PEPFAR to provide doses for two million people by 2028 in 12 initial countries represent a good start, but fall far short of reaching targets to achieve impact, which calls for 20 million PrEP users by 2030.

Making LEN for PrEP available for all who need and want it is possible. Coordination among all stakeholders, and a shared priority to achieve epidemic control, can build a sustainable market for LEN that drives volume up and prices (and HIV incidence) down; puts communities at the center of program planning and implementation; is supported by inclusive policies; and integrates with sexual and reproductive health services that offer choices in HIV prevention to meet diverse needs. To learn more about who and what must come next to realize this potential, check out AVAC’s suite of LEN resources and track updates on rollout with our long-acting PrEP dashboard.

2. Expand, strengthen and sustain community and civil society leadership in the HIV response

Engaged advocates are fundamental to the success of HIV prevention R&D and rollout and to the larger global health movement. Involving community, civil society and global health advocates too little or too late has taught the field valuable lessons. Community leadership was on full display at last week’s Global Fund replenishment. Informed and supported community leadership has reshaped and improved both clinical trials and the broader landscape of policies, planning and programs for HIV prevention. From the strategic organizing and monitoring by the Coalition to build Momentum, Power, Activism, Strategy & Solidarity (COMPASS) Africa, to the policy wins and mentoring successes of AVAC’s Fellows & Advocacy Navigator programs, to the high-impact reach of Coalition to Accelerate & Support Prevention Research (CASPR), these initiatives represent highly effective models for community engagement. Stay tuned for detailed reports on the impact of these models in the weeks ahead.

3. Double down on the research pipeline for HIV prevention and a People’s Research Agenda

The US government’s attack on HIV research has been just as evidence-free, ideological and devastating as the drive to dismantle foreign assistance. With epidemic control in sight against one of the fastest mutating viruses ever known, HIV prevention scientists and advocates know that now is the time to press on the gas, not stall out. From vaccines and bNAbs to multipurpose technologies (such as the Dual Prevention Pill), to novel long-acting PrEP (such as a monthly PrEP pill), advancing the development of options to meet diverse needs and offer choice is key to effective HIV prevention and ending the epidemic.

We have been marshalling the evidence and the organizing to defend HIV science and research. In September, months of teach-ins, tools development, tracking and collaboration culminated in the 24 Hours to Save AIDS Research marathon. Read more about the event—and what comes next—in our new blog, 24 Hour Marathon to Save HIV Research: A Global Call to Action. (Access resources for advocacy demanding sustained support for HIV R&D and view the videos here.)

As the new year approaches, there’s no doubt what needs to happen: deliver effective options with speed, scale and equity; invest robustly in developing the options we still need; and center the leadership of communities at every level of the HIV response. The world has every capacity to end the HIV epidemic in our lifetime, now we must summon the political courage to do it.

Since January 20, 2025, the new US Presidential Administration has made massive cuts to HIV research, dismantling the infrastructure for conducting research and pushing misinformation on the benefits of research. In rapid response, AVAC worked together with a volunteer coalition of the nation’s leading HIV researchers and advocates to conceptualize, organize, and host the 24-Hour Marathon to Save AIDS Research.

The virtual marathon featured 24-hours of live, interactive presentations, discussions, and learning sessions to raise awareness about the lifesaving contributions of HIV research and highlight what is at stake if funding continues to be stripped away.

This event is a core component of AVAC’s ongoing advocacy to protect HIV research from drastic cuts to research funding, programs and partnerships. Using our convening power, research expertise, and research translation experience, this group of dedicated individuals brought advocates and researchers together in solidarity and shared critical messages about why HIV research matters with the larger global community.

In the months prior to the marathon, AVAC and partners sounded the alarm that the government’s relentless cuts to critical foreign aid would soon be followed by attacks on public health, scientific research, and science at large. As predicted, in March 2025 the administration began to cancel grants and dismantle federal institutions, with immediate and devastating impact on HIV research. AVAC worked quickly to raise awareness, educate researchers, advocates, and partners, and collaborate with these groups to protect life-saving research. The network mobilized leading voices in research, strengthened advocacy skills through teach-ins, tools, and resources, educated policy makers, and disseminated timely and accurate information to track the impact of cuts to HIV research. Researchers and advocates harnessed this momentum to bring critical messages about the urgency of reversing funding cuts and the real-world impact of breakthroughs in HIV research to a larger audience.

Ultimately, the Save AIDS Research marathon on September 16-17 reached over 7,000 advocates, researchers, stakeholders, policy makers, journalists and community members from 28 countries and 30 U.S. states. The event featured 75 presenters representing major research institutions, public health organizations, civil society organizations and communities impacted by HIV all over the world, along with 42 endorsing organizations and robust engagement from viewers throughout all 24 hours of the livestream. (All 24 hours of content are available online for ongoing advocacy.) The marathon covered an incredible breadth of topics, including the legacy of innovation from HIV research; the role of advocacy in an equitable and effective HIV response; the implications of intersecting and emerging epidemics; advances in prevention, treatment, vaccine and cure research; the growing portfolio of Africa-led HIV prevention research; innovative models for delivering care; and community movements to sustain access to HIV services.

As an interactive, public event, participants also had the unique opportunity to engage directly with researchers, share their personal stories, connect with each other, and discuss ideas to strengthen future HIV research advocacy and action. As one livestream attendee reflected, “This is a valuable example of people uniting across sectors and across the globe to share evidence-based information on the importance of research.”

Dr. Joseph Eron, the Principal Investigator of the HIV/AIDS Clinical Research Unit at UNC-Chapel Hill and chair of the ACTG network, also reflected on the critical role of this kind of community engagement in research, commenting during his presentation in Hour 3, that the event was “a great example of dissemination to the community, something that’s open and accessible.”

What began as a simple idea became an incredible demonstration of the collective power and dedication of the HIV research community. Diverse members of the HIV research community came together to amplify global advocacy messages, counter misinformation, and strategically advocate to protect decades of progress to end the epidemic. Dr. Jeanne Marrazzo, the former Director of NIAID, reinforced this belief in the strength of the field during her presentation in Hour 8: “No one can stop us if we continue to fight together, stand together and continue to tell the truth and advocate for science and for our patients and our community.”

Building on this momentum, AVAC and its partner network continue the fight to save HIV research from additional funding cuts. Materials from the marathon are being translated into tools and products to support further advocacy efforts. AVAC continues to track and update the impact of funding cuts, the recent government shutdown, and ongoing budget negotiations on HIV research.

Later this month, AVAC will relaunch an updated version of its groundbreaking Peoples Research Agenda (PRA) to highlight the risks to and priorities for the HIV prevention pipeline, how federal cuts impact the prevention pipeline, and what is needed to support advocates to take action.

As the field navigates the constantly evolving funding environment, AVAC will continue to do the critical work of tracking and translating the latest scientific and funding developments, and ensuring advocates are informed and supported in the ongoing fight to end HIV. Mitchell Warren, AVAC’s Executive Director affirmed, “Saving AIDS research is not a 24-hour exercise; it is a commitment from all of us involved to tackle this collective challenge.”

2025 has been a year like no other. During these challenging times, AVAC’s Global Health Watch has been the go-to source for tracking and analyzing attacks on global health and the HIV response, pandemic preparedness, and human rights: from the US government’s foreign aid freeze and subsequent funding collapses to the politicization of science and erosion of public health infrastructure. Thanks to our partners and many supporters, we were able to introduce and push out 43 issues of Global Health Watch, providing consistent, trusted context so you can navigate the turmoil with clarity, purpose and solidarity.

Global Health Watch is about translating chaos into actionable insight, identifying risks early, informing rapid advocacy, and supporting global movements to defend evidence-informed, rights-based and community-centered health responses. In a time when misinformation and political interference threaten decades of progress, AVAC is proud of its role as a steady source of analysis, strategy, and coordination. We’ve done it for the past 43 weeks. We’ll keep going as long as these threats remain.
 
As the US moves into Thanksgiving later this week, we give thanks to our community who stops at nothing to safe-guard hard-won progress against HIV and global health equity. Next week marks our 30^th anniversary as an organization. While so much in the field has evolved in this time, what we do and why we do it remains constant—thanks to your support and collaboration.
 
Next week is Giving Tuesday. If you depend on Global Health Watch and the work that AVAC and our partners do, please support us to ensure we can continue tracking developments in real-time, strengthening advocacy networks, and equipping partners with the tools and information they need to respond effectively. Together, we can continue to protect global health and all that communities have fought so hard to build.

As seismic shifts in global health funding and strategy unfold, the 2025 International Conference on AIDS and STIs in Africa (ICASA), happening December 3–8 in Accra, Ghana, comes at a pivotal time. For more than three decades, ICASA has served as a critical platform founded by African scientists, activists, and advocates to fight stigma, drive research, and elevate African leadership in the HIV response. This year, this mission is more urgent than ever. 

AVAC and partners will be in Accra to meet this moment. On December 2, we are joining partners to co-host the 8th Biomedical HIV Prevention Forum (BHPF), an official ICASA pre-conference with the theme Advancing Biomedical HIV Prevention as a National Priority Through Choice.

This forum will bring together prevention champions; advocates, civil society representatives, researchers, youth leaders, development partners, and government officials from the Ministries of Health and Finance and ensure that the promise of biomedical prevention is fully realized.

Other Sessions on Our Radar at ICASA

If you are in Accra, be sure to join the many satellite sessions in which AVAC and partners are involved.

Wednesday, December 3

• Future Proofing Person Centered HIV Care: Ensuring Appropriate Integration for and with Key Populations, hosted by the International AIDS Society, 17:45-18:30

Thursday, December 4

• Launch of The Lancet HIV & The Lancet Global Health Joint Series on Sustainable HIV Prevention in Africa, hosted by the Government of Malawi, Malawi’s National AIDS Commission, the African-led HIV Control Working Group (HCWG), and Georgetown University’s Center for Innovation in Global Health; learn more,10:50-11:35

Saturday, December 6

• Why CHOICE Matters in Ensuring an Integrated, Sustainable Response to HIV, hosted by the African Women Prevention Community Accountability Board (AWPCAB) and African Sex Workers Alliance (ASWA) in partnership with ViiV Healthcare, 13:10-13:55
• Innovating to Scale PrEP in a New Reality: Country-Led Strategies for Sustainability, Local Ownership, and Impact, hosted by AVAC and the Coalition to Accelerate Access to Long-Acting PrEP; download flyer, 14:05-14:50

Sunday, December 7

• Voices and Partnerships to Advance Health Innovation and Equity, hosted by Unitaid, 13:10-13:55

Community Booth

AVAC and partners will “takeover” the Unitaid Community Booth on Friday, 5 December between 9:30 and 13:30, and on Sunday, 7 December between 12:00 to 16:00 to feature programming that brings together advocates and community members with other key stakeholders to discuss LEN for PrEP rollout, emphasize prevention as sustainability, and advance youth leadership. Be sure to visit the UNITAID booth on Friday, 5 December between 9:30 and 13:30 to secure a schedule of the program and join the conversations.

As conversations unfold at ICASA, two urgent imperatives must anchor our collective advocacy: accelerating equitable access to approved HIV prevention options and sustaining a forward-looking research agenda that responds to community priorities and drives long-term impact. In the face of historic US funding cuts and a shifting global health architecture, these goals are more essential than ever. 

The People’s Research Agenda (PRA), which is being updated for ICASA, is a vital tool for shaping and demanding the HIV prevention research the world needs. Whether you’re participating in the Biomedical HIV Prevention Forum or broader ICASA conversations, we encourage you to look out for the updated PRA and use it to frame your priorities, raise your voice, and influence what comes next. 

Global public and private sector donors pledged over $11 billion at last week’s 8th Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Johannesburg, South Africa. In the current political and economic context, these pledges represent a recognition of the pivotal role of the Global Fund in saving lives and building health systems. But they fall well-short of the $18 billion goal.

At a time when HIV, TB and malaria science is delivering as never before, with long-acting injectable HIV prevention options, new malaria drugs and vaccines and improved TB treatments entering the market — and a potential TB vaccine in late-stage trials — funding must meet the moment to deliver life-saving new technology with speed, scale and equity. Ensuring highly effective innovations reach those who need them most requires resources. Universal access to effective health technologies is an achievable goal, with robust investment in expert institutions, national public health systems, and aligned private enterprise.

“This moment is a historic opportunity to save lives and meet major milestones against all three epidemics. With political will and commitment, proper investment in the Global Fund will be instrumental in maintaining progress and building on success,” said AVAC Executive Director Mitchell Warren.  

The US pledge of $4.6 billion over three years is a decrease from the $6 billion commitment in the previous replenishment cycle. But the US did reaffirm its 1:2 match, with the US continuing to contribute 1/3 of the total to the Global Fund, hopefully motivating other funders to step-up. Now, the US Congress must appropriate funding to fully meet the new US pledge, with language codifying the 1:2 match. Congress must also ensure funds appropriated for the previous replenishment, including $1.47 billion in matched funds, are distributed. 

Communities with the greatest burden of disease, which have already suffered program cuts, service disruptions and the loss of many trusted local partner organizations, and include marginalized key populations, are at even greater risk now. AVAC joins affected communities and civil society to call on all stakeholders to recommit to solidarity, transparency and global health security. Achieving this requires national governments, foundations, the private sector and civil society to develop new financial tools for sustainable, country-owned and community-led public health systems. One critical step is closing the remaining gap to reach the Global Fund goal and ensure that donors who have yet to step forward to do so with ambitious, robust pledges.

“The impact of this current shortfall will be needless death and disease. Modeling suggests up to 22 million preventable deaths by 2030 if global health funding from all sources continues to decline. Millions of lives have been saved thanks to the Global Fund, and shrinking resources threaten these achievements and risk squandering the opportunities of recent scientific advances,” said AVAC Director of Policy Advocacy Suraj Madoori.

African countries reaffirm support for a new multilateral Pandemic Accord even as pressure mounts to sign bilateral US health agreements. The UK has reduced its upcoming Global Fund pledge just weeks before the replenishment summit. Meanwhile, additional regulatory submissions of lenacapavir (LEN) for PrEP are being made, most recently in Rwanda, reflecting accelerated actions and real lessons learned from earlier PrEP rollouts, as launches in several countries are being planned for World AIDS Day.

African Countries Support Pandemic Accord Under Pressure to Sign Aid Agreements with US 

African governments confirmed support for a multilateral Pandemic Accord under the World Health Organization (WHO) even as they face significant pressure to sign bilateral or government-to-government global health aid agreements with the US. These controversial agreements would require countries to share pathogen data, omit HIV prevention metrics, including PrEP and products like LEN, sideline civil society and key populations by removing requirements for community engagement, and bypass multilateral coordination, ignoring WHO and regional public health institutions. Advocates warn that bypassing the WHO Pandemic Accord negotiations risks repeating the inequities of COVID-19, forcing countries to share pathogen data without securing fair access to the medical countermeasures developed from them, leaving lower-income nations without the leverage needed to protect their own populations. 

IMPLICATIONS: This shift toward government-to-government support and conditional health assistance is shifting global health engagement into more transactional, equity‑challenging territory. Without indicators, community input, guaranteed reciprocity or multilateral coordination, countries may be locked into deals that deprioritize their interests. 

READ: 

• African Countries Affirm Support for Multilateral Pandemic Agreement Amid Pressure to Make Bilateral Deals with US—Health Policy Watch 
• US template for bilateral health deals bypasses WHO pandemic negotiations—Devex  
• Bilateral deals would undermine pandemic preparedness, multilateralism is the only answer—The Independent Panel for Pandemic Preparedness & Response 
• State Department Plans New Framework to Advance America First Global Health Strategy—Bloomberg

Global Fund Replenishment at Risk: UK Reduces Pledge

The United Kingdom announced that it will reduce its upcoming pledge to the Global Fund by approximately 15% for the 2026‑2028 replenishment cycle, down from £1 billion in the previous cycle to £850 million. This news comes just two weeks ahead the Global Fund’s replenishment summit, which takes place November 21 in Johannesburg—which the UK and South Africa are co-hosting. The Global Fund proposed a target of $18 billion in its Eighth Replenishment Investment Case to save an estimated 23 million lives and prevent hundreds of millions of infections between 2027 and 2029. “It took the world 18 years to halve the combined death toll from AIDS, TB and malaria; with the right resources we can more than halve it again in only six years.” 

IMPLICATIONS: The cut from a longstanding major donor and summit co-host sets a worrying precedent, potentially signaling a retreat from multilateral leadership. Coupled with US cuts to global health funding generally, falling short of the Global Fund’s replenishment goal would increase disparities in access and likely shift resources and power away from communities and civil society.  

READ: 

• UK set to slash aid funding to fight deadly diseases – putting 250,000 lives at risk—The Independent  
• African HIV services face double blow of cuts from both Trump and UK—The Independent 
• UK cuts to HIV funding is a major blow to ending AIDS by 2030—Frontline AIDS 
• Flash quote: MSF UK reaction to UK’s Global Fund pledge—MSF  
• Eighth Replenishment background materials—Global Fund

PrEP Rollout Continues to Accelerate

Rwanda is now the 7th African country to receive a regulatory submission for lenacapavir for PrEP (LEN), which was recently approved in South Africa and Zambia, in addition to the US and European Union. For a full regulatory update, see here). The pace of progress for PrEP rollout continues to accelerate reflecting lessons learned from previous PrEP rollouts and signaling growing capacity and urgency to act. As AVAC’s new infographic below shows, the global community can learn and apply lessons, can move with speed, scale and equity, and might actually seize a PrEP opportunity instead of squandering it. 

IMPLICATIONS: Regulatory submissions and approvals are only one piece in the complex process. Turning regulatory milestones into public health impact depends on aligned global funders, transparent pricing and volume commitments, and community-engaged introduction strategies. Without this, innovation risks stagnation. 

READ: 

• Gears of Lenacapavir for PrEP Rollout—AVAC   
• Cruel Ironies: Scientific advances collide with major infrastructure upheaval—AVAC  
• Access Strategy for Lenacapavir for PrEP in Low- and Middle-Income Countries—Gilead Sciences

Download the static version of this graphic or hover over the graphic and click the three dots on the upper right to access full screen mode.

What We’re Reading

• In under a year, Trump administration has threatened decades of progress in global fight against HIV/AIDS—Prism Reports
• As Belgium Races to Save USAID Contraception, Some Supplies Are Reported Ruined—New York Times
• Implementing oral (event-driven and daily) and long-acting pre-exposure prophylaxis in mobile men in sub-Saharan Africa: a phase 3b, open-label, hybrid type 2 implementation and effectiveness trial (MOBILE MEN)—Trials
• Why ‘mobile men’ are less likely to use PrEP—Health e-News
• Pandemics are a choice—Vox
• China’s new scientist visa is a ‘serious bid’ for the world’s top talent—Nature
• Philanthropies commit $300M for climate-health solutions at COP30—Devex
• Biovac opens new vaccine lab in Cape Town to boost Africa’s manufacturing capacity—Reuters
• I’m a physician who went to the anti-vaccine movement’s biggest gathering. More of my colleagues should too—STAT
• How two top FDA officials are quietly upending vaccine regulations—STAT
• Lessons for long-acting lenacapavir: catalysing equitable PrEP access in low-income and middle-income countries—The Lancet HIV
• Lenacapavir-associated drug resistance: implications for scaling up long-acting HIV pre-exposure prophylaxis—The Lancet HIV
• Reimagining HIV prevention with artificial intelligence—The Lancet HIV
• The imperative for increased investment for an HIV cure—The Lancet HIV

Upcoming Webinar

The People’s Declaration—currently with more than 500 signatories, charts out a number of community priorities and demands. Join The Choice Agenda, The Legacy Project, and a global panel to discuss moving these priorities into actions and accountability.

We’re seeing one of the most challenging moments in HIV prevention history – and the cruelest ironies. On one side, science and advocacy are delivering unprecedented progress. South Africa and Zambia have approved injectable lenacapavir (LEN) for PrEP just months after US and EU regulatory approvals, with rapid WHO guidelines and prequalification paving the way for rapid rollouts in 2026 and beyond.

On the other, the global systems meant to deliver LEN and other potential innovations, like monthly oral MK-8527 are being dismantled. The US’s new ’America First’ Global Health Strategy replaces multilateralism and broad stakeholder engagement with bilateral government-to-government deals, redirecting and conditioning funds, and sidelining communities, which threatens to unravel decades of progress in HIV prevention, science and equity made possible through meaningful community engagement and leadership. And a new framework is in development to advance this strategy.

LEN Regulatory Milestones and What’s Next

In Africa, the South African Health Products Regulatory Authority (SAHPRA) led the way with a precedent-setting fast-track approval of LEN in October, followed by Zambia last week, with regulatory reviews underway in Botswana, Kenya, Malawi, Namibia, Rwanda, Uganda, and Zimbabwe. (For a full regulatory update, see here) These early wins reflect lessons learned from previous PrEP rollouts and signal growing capacity and urgency to act – the comparative graphic below shows that our global community does learn lessons, can move with speed, scale and equity, and might actually seize a PrEP opportunity instead of squandering it.

Yet as AVAC’s Moving a Product to the Real World graphic shows, approval is only one piece in the complex process. Turning regulatory milestones into public health impact depends on aligned global funders, transparent pricing and volume commitments, and community-engaged introduction strategies. Without this, innovation risks stagnation.

Global Health Infrastructure Undermined

At the same time, the US government is pushing through a new global health framework under its “America First” strategy. This week, US embassies around the world began sharing draft Memoranda of Understanding (MoUs)with partner countries, aimed at reshaping how US health aid, including PEPFAR, is negotiated and delivered. These bilateral MoUs:

• Omit HIV prevention metrics, including PrEP and products like LEN.
• Sideline civil society and key populations by removing requirements for community engagement.
• Bypass multilateral coordination, ignoring WHO and regional public health institutions.
• Favor US commercial interests, raising concerns about procurement policies and equity.

A new Think Global Health article by KFF’s Jen Kates and colleagues explores this strategy’s assumptions including a pivot from multilateralism to bilateralism, a narrow focus on commodities and frontline workers, pooled procurement, and time-limited support with the aim to “graduate” countries from assistance. Meanwhile, Devex offers perspectives from several leaders in the field who weigh opportunities, contradictions, and raise red flags about sidelined NGOs and the communities they serve, reduced ambition in US global health programming, and weakened multilateral partnerships.

These agreements could endanger the rollout of LEN and other innovations, threaten the entire prevention pipeline and violate core principles of transparency, inclusion, and global solidarity. As Jirair Ratevosian wrote this week:

“What matters now are the decisions made in budget rooms, procurement units, regulatory authorities, and community forums…. The next phase of global health will not be defined by what Washington announces, but by what countries build.”

It will be up to countries to put forth strong plans and policies on scaling up LEN and other biomedical prevention during ongoing MOU negotiations with the US government.

Resources to Navigate the Cruel Irony

• Graphic: Where are we Now with LEN for PrEP
• Graphic: Lenacapavir Regulatory Approvals & Tracker
• Graphic: Moving a Product to the Real World
• Resource: Getting LEN Rollout Right
• Devex: US template for bilateral health deals bypasses WHO pandemic negotiations
• Think Global Health: Four Observations on America First Strategy
• Politico: How the US Exit from WHO Reshaped Global Health
• Devex: The Aid Report

This week, Zambia joined South Africa in approving injectable lenacapavir for PrEP (LEN), marking a new era of accelerated efforts to scale-up access. At the same time, there’s sharpening analyses of the major shifts in US strategy for foreign aid and global health leadership, with deep implications for the future of funding, multilateralism, and equity.

What Lies Ahead for “America First” Global Health Strategy? 

It’s been six weeks since the US Department of State issued its “America First” global health strategy, and global health leaders in the US are now sharing insights on the real-world implications of the new strategy. A new Think Global Health piece looks at questions posed by key pillars of the US strategy: a pivot from multilateralism to bilateralism, a narrow focus on funding for commodities and frontline health workers, pooled procurement and time-limited support with the aim to ‘graduate’ countries from assistance. Meanwhile, Devex offers perspectives from several leaders in the field who weigh opportunities, contradictions, and raise red flags about sidelined NGOs and the communities they serve, reduced ambition in US global health programming, and weakened multilateral partnerships. 

IMPLICATIONS: The way forward requires a major recalibration by implementers, partner countries and communities. The next chapter under this new system could exacerbate ongoing service disruptions and existing challenges in HIV prevention and treatment delivery, in particular to key populations. As funding becomes more conditional and bilateral agreements take precedence, mechanisms for community-driven priority setting, program monitoring, comprehensive data collection and sharing, and universal access to prevention tools must be preserved.  

READ: 

• Questions for the America First Global Health Strategy—Think Global Health 
• ‘America First’ in global health: Oxymoron or opportunity?—Devex  

New Resources on the Foreign Aid Crisis 

Two powerful new resources shed light on the far-reaching impacts of the United States’ foreign aid cuts. The New Yorker released Rovina’s Choice, a new documentary that follows a mother in Kenya navigating the collapse of care for her daughter living with HIV. The film captures the cascading effects of the loss of USAID support, including the dismantling of HIV wards, malaria clinics, refugee camps and health centers. Atul Gawande, the last Assistant Administrator of USAID, penned an accompanying commentary, The Shutdown of USAID Has Already Killed Hundreds of Thousands. Devex also launched The Aid Report, a central hub for tracking funding reductions, program disruptions, and structural shifts across the ecosystem of global aid. 

Meanwhile, The New York Times and Washington Post highlighted AVAC and the Global Health Council’s court cases against the foreign aid freeze as part of a broader test of executive power, with direct implications for foreign assistance policy. See AVAC’s trackers to stay abreast of the impact of US cuts to foreign aid and HIV prevention research.  

IMPLICATIONS: These resources demonstrate the scale and impact of US disengagement from global health leadership. They document how political decisions in Washington are directly destabilizing care systems, reversing progress, and threatening lives—especially in communities already facing high burdens of disease. The loss of predictable US funding has ended vital health programs around the world and is shifting the architecture for global health to a transactional model that may deprioritize equity, local voices, and long-term sustainability. 

READ: 

• The Shutdown of USAID Has Already Killed Hundreds of Thousands—The New Yorker 
• The Monthslong Legal Battle to Save Foreign Aid—The New York Times 
• Supreme Court has expanded presidential powers under Trump. How far will it go?—Washington Post 
• WHO issues guidance to address drastic global health financing cuts—World Health Organization  
• Withdrawal of US aid has hurt South Africa’s HIV programme—Spotlight South Africa 
• Impact Trackers—AVAC  

Zambia Approves LEN for PrEP

Zambia is the latest country to approve injectable lenacapavir for PrEP (LEN), following the South African Health Products Regulatory Authority (SAHPRA) approval two weeks ago. These are the first low- and middle-income countries to approve an HIV prevention method within just months of regulatory approvals in the US and EU. Regulatory reviews are also underway in a number of additional countries, with decisions expected over the next few months.

IMPLICATIONS: These swift approvals mark a major milestone in the global HIV response and set a new precedent for accelerating the process of scaling-up biomedical interventions in high-burden regions. But approvals alone are not enough. Turning access into impact will require aligned funding, community engagement, strong demand creation, and clear strategies for equitable rollout. These early regulatory wins are a strong start, but continued advocacy is essential.  

READ:  

• Moving a Product to the Real World—AVAC (infographic) 
• Lenacapavir Regulatory Approval—AVAC (infographic)  
• Access Strategy for Long-Acting PrEP—Gilead Sciences 
• Gears of Lenacapavir for PrEP Rollout—AVAC

What We’re Reading

• Exclusive: The Trump administration dismantled the CDC’s peer review system. Staffers scrambled to salvage it.—Inside Medicine Substack
• ‘You cannot fight an invisible problem’: Atul Gawande on US aid cuts—Devex
• Top researchers consider leaving U.S. amid funding cuts: ‘The science world is ending’—PBS Newshour
• Public Health Was a Place for Warriors Once. It Needs to Be Again.—The Nation
• On Eve of Record Shutdown, Trump Administration Threatens Pain Could Worsen—The New York Times
• UN staffers depart Manhattan’s urban canyons for Kenya’s leafy capital—Devex
• New Covid virus found in wild Brazilian bats—The Telegraph
• Nancy Pelosi announces her retirement from Congress—Washington Post
• Vaccine-Preventable Disease: A Global Tracker—Think Global Health

Upcoming Webinar

This round up offers on-the-ground tools for stakeholders involved in rolling out injectable lenacapavir for PrEP; updated articles on AVAC’s court case on foreign assistance; resources on the state of defending rights to health and inclusion for key populations; an up-close look at AVAC’s Advocacy Navigator program and the accomplishments of this year’s cohort; updates on the Dual Prevention Pill featured at The International Conference on Family Planning; and several new advocacy resources for cure research and the prevention of sexually transmitted infections (STIs).

Getting Rollout Right for LEN

This collection of tools is for stakeholders working to accelerate access to injectable LEN for PrEP. Continually updated, these tools support critical steps in rolling out LEN, including interactive tools for planning, monitoring and evaluation; toolkits for provider training; templates for technical working groups to establish terms of reference; and adaptable standard operating procedures for country planning to align with WHO guidelines among others. Additional tools will be added as they are available. For more on LEN, visit avac.org/lenacapavir.

Fighting in the US courts for Fairness and Sustainability in Global Health 

AVAC is a lead plaintiff in one of many cases attempting to hold the US Presidential Administration accountable to the US Constitution, Congress, global commitments and the American people. The Washington Post and the New York Times published stories this week on the implications of pending US Supreme Court decisions. As AVAC Executive Director Mitchell Warren told the Washington Post, the high court’s ruling “potentially implies that the Administration can disregard Congressional power of the purse.”

Defending and Demanding the Right to Health and Inclusion for Key Populations

This webinar included an unflinching assessment of the impacts of the ongoing assault on transgender health and rights and strategies to sustain programming.

At the same time, the 4th Conference on Public Health in Africa (CPHIA 2025) reaffirmed Africa’s shift from aid dependency toward health sovereignty, self-reliance, and regional solidarity. The conference culminated in The Durban Promise, a commitment to mobilize Africa’s wealth and innovation for health sovereignty. When it comes to HIV services, COMPASS advocates at the conference, including AVAC’s Richard Muko, made clear that strengthening healthcare systems requires a commitment to person-sensitive care and the leadership of key population (KPs) communities to achieve impact. Learn more about KP priorities for HIV prevention here.

Preparing the Next Generation of HIV Prevention Advocates: Advocacy Navigators 

AVAC’s The Advocacy Navigator program mobilizes ambitious, emerging advocates and provides them with resources to build knowledge, skills and confidence to advance HIV prevention in their communities and countries. Navigators are paired with mentors, alumni of AVAC’s Advocacy Fellows Program, to provide support and guidance to ensure the next generation of HIV advocates are fierce and effective in demanding speed, scale, and equity in the HIV response.

Check out Navigating Change: Young Advocates Lead the Future of HIV Prevention, by AVAC’s Bridget Jjuuko & Jeanne Baron, for an up-close look at how and why the model works and critical accomplishments by this year’s cohort, representing 10 countries across Africa. Their achievements include changing national and regional policies; expanding access to PrEP; connecting youth to HIV services; and establishing youth leadership in the HIV response. 

The DPP at ICFP 

The International Conference on Family Planning (ICFP) 2025, happening in Bogota this week, shines a spotlight on the Dual Prevention Pill (DPP). Still in development, the DPP would prevent both pregnancy and HIV. If approved, the DPP will require integration of contraception and PrEP in guidelines, health systems, delivery approaches, and demand creation. AVAC’s ICFP panel discussion, The Dual Prevention Pill Introduction Plan: Both a Question and an Answer to Integration, covers how programs should think about rolling out novel prevention products like the DPP in the current landscape, learning from projects across sub-Saharan Africa.

Also at ICFP, The Self-Care Trailblazers group is launching a report, 2025 State of Self-Care Report: Self-Care in a Changing World, featuring a DPP case study, authored by AVAC’s Natasha Mwila, Community-Centered Perspectives on the Dual Prevention Pill as a Self-Care Product, covering how community engagement with women and adolescent girls informed design, decision-making in support of the DPP as a self-care product with the potential to advance rights, equity, and choice.

Time for Advocacy for Cure Research

Advocacy and HIV Cure Research Agenda: Highlights from the Advocacy-for-an-HIV-Cure Academy by AVAC’s Jessica Salzwedel showcases the recent AVAC/IAS Academy, the eighth Academy in eight years—and why advocacy for cure research matters and how advocates are preparing their communities for this fast-moving and important area in HIV prevention and treatment.  

For a deep dive on these issues, check out the HIV Cure podcast episode, Community Involvement in HIV Cure and Vaccine Research, featuring Jessica and hosted by Sekgabo Seselamarumo, a member of AVAC’s Clinical Trial Design Academy and alumna of the AVAC and IAS Advocacy-for-Cure Academy.

Advancing Integration and Investment for HIV & STI, from Research to Rollout 

• ‘Self-Testing’ Versus ‘Self-Collection’—The critical role of consistent language in the field of STI diagnostics: This editorial from AVAC’s Alison Footman and colleagues makes the case for precise and consistent language around self-testing and self-collection, because clarity impacts policy, expectations, and access.
• Innovations in Sexual & Reproductive Health: This Lancet series contains a suite of five papers that describe the global implications of sociocultural and epidemiological changes in sexual and reproductive health (SRH), the innovations being developed, and analyses of the cost of scaling up these innovations versus the cost of the maintaining the status quo.
• Beyond Borders: In this October webinar, AVAC and partners featured speakers who were not able to attend the STI & HIV 2025 World Congress in July because of financial and political barriers. Presenters shared research findings, debated results, and discussed priorities for the STI field.

Coming Up!

From Courtrooms to Communities: Funding Advocacy to Protect HIV Responses is a webinar hosted by Funders Concerned About AIDS for representatives of funding and philanthropy serving organizations. Advocacy is one of the most underfunded areas of HIV philanthropy—yet essential to defending rights and sustaining progress.
November 12, 2025 from 10:00-11:30 AM EST

The breadth and depth of the HIV response and the crosscurrent of forces bringing comprehensive change are not easy to track or translate. But it’s vital work. Informed advocates are the world’s best hope for bringing speed, scale and equity to global health and to people who need HIV prevention. We hope these resources help to keep you connected and ready for the fight.

By Bridget Jjuuko and Jeanne Baron

Last year, Gloria Nawanyaga decided to do something about the devastating numbers of adolescent girls and young women (AGYW) who acquire HIV in her country, Uganda. At approximately 10,000 new cases of HIV among AGYW each year, it’s an HIV rate that demands urgent attention and better access to prevention. Gloria found the support she needed to take action when she became an AVAC Advocacy Navigator, a program that combined virtual coursework, personalized mentorship, and opportunities to directly apply learning through a community advocacy project over the course of six months.

She developed a plan to reach communities of young women with information about injectable cabotegravir for PrEP. Gloria explains her campaign in this short video. By the end of her project, she’d reached one million people through social media and other outreach, and kicked-off policy discussions with the Uganda AIDS Commission to improve access to new PrEP methods.

The Advocacy Navigator Model

Gloria was one of twelve navigators who developed concrete, on-the-ground, advocacy projects that advanced HIV prevention in ways that are relevant to their communities. A look at the work of the 2024-2025 AVAC’s Advocacy Navigators is testimony to the value of this model of supported mentoring. These stories also demonstrate the essential power of advocacy to make policy, inform communities, improve the HIV response and change lives.

Mentorship has been a cornerstone of the Advocacy Navigator Program, and this approach offers a sustainable model for supporting emerging advocates in the HIV field. This unique, low resource approach to building a new generation of HIV prevention advocates leverages digital learning, volunteer mentors, and community driven initiatives, making it highly cost effective and adaptable across contexts. With minimal resources, this model of structured mentorship strengthened individual advocacy know-how, built confidence, fostered strong networks, and if adopted by others across the field, it will support a future generation of leaders who can innovate, adapt and sustain progress in the HIV response.

“The advocacy navigator program is something I wish I had access to when I started my advocacy journey because it provides guidance, mentorship as well as the practical experience through seed funding. You get the experience of doing a project but with guidance and mentorship,” said Anna Miti a former AVAC Fellow and journalist who now is the co-moderator of of The Choice Agenda listserv.

More Highlights of Advocacy in Action in the Navigator Model

Takunda Clement Chanetsa worked at the grassroots and policy-level in Zimbabwe to address stigma and mental health needs among young people living with HIV. He ran focus groups, developed advocacy toolkits, engaged traditional leaders and government agencies, and ultimately secured concrete commitments to improve youth access to healthcare. “I knew I was making a difference when young people started telling me they felt safe to talk about their challenges for the first time. I saw them transform and become advocates. Now I am going to fight for policies that include mental health services in HIV care. Never underestimate the power of youth advocates.”

Madalitso Juwayeyi’s university student community faced barriers to access to PrEP, and Malawi’s existing strategic planning for HIV prevention made no unique provisions for university students. Her project created platforms for student advocates, clinic personnel and National AIDS Commission policymakers to meet and learn from each other, resulting in agreements to develop strategies for PrEP distribution to Malawi’s university students. “This is a proof that when young people are given a chance to demand what they want then change comes.”

Joseph Linda saw that vast areas of Kampala, Uganda, were home to youth who needed HIV services but with few pathways to find them. He created an accessible database of HIV providers that for the first time connected vulnerable communities to landscape of care. He trained a cadre peer educators to raise awareness of life-saving options in HIV treatment and prevention and where to find them. “The problem I saw was the young people in the slum areas had no direct access or information about where to get HIV prevention. My long-time goal is that young people know about HIV services and can find them.”

Other highlights from Navigator projects include:

• Jessica Booysen created comprehensive workshops on reproductive health and rights in her South African community.
• Gcebile Yvette Dlamini worked in Eswatini to educate community leaders and youth, particularly young women, about HIV prevention.
• Renny Mulala deployed a multi-media campaign in Zambia, including print and radio, to reach youth and dispel myths about long-acting injectable cabotegravir as PrEP, promoting access and informed choice.
• Rumbidzai Munhanzi of Zimbabwe and Sharon Ramantele of Botswana championed the equity and health challenges faced by people who use or inject drugs (PWID).
• Nicole Ondisa Oduya’s advocacy reshaped access to PrEP among sex workers in her Kenya community.
• Elizabeth Zahabu’s project in Tanzania introduced sexually transmitted infection (STI) self-testing kits, trained a cadre of peer educators, and engaged government leaders who became allies in supporting reproductive rights, and ultimately achieving increased funding for local clinics.

Mentoring Future Leaders: Next Generation Advocacy for Equity and Impact in HIV prevention

Civil society and advocacy organizations can adapt and implement the Advocacy Navigator model to fit their context. This model is designed to be flexible and respond to opportunities in a given community rather than a rigid curriculum. Virtual training, mentorship, and local advocacy projects are core components which can be easily tailored to different contexts, populations, and priorities to address specific health or social issues beyond HIV prevention.

Mentorship can also be aligned with local expertise and deliver sessions in local languages or through accessible digital platforms such as WhatsApp or Zoom. The model allows for variation in project scope depending on available resources, ranging from small grassroots initiatives to national advocacy campaigns. Because it relies on partnerships, peer learning, and virtual engagement, it can be implemented in both urban and rural settings with minimal cost while maintaining high impact.

The range and depth of the work of these young leaders is an inspiration and an opportunity. In the current environment, where investment in HIV prevention has constricted, the Advocacy Navigator model provides a dynamic, effective way forward for advocacy that is needed now more than ever.