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.  

By Jessica Salzwedel

Advances over the past ten years toward an HIV cure have moved cure research from a dream to an attainable goal. The field has learned more about the power of the innate immune system through individuals who have controlled their virus, either spontaneously or post-treatment, and these insights have spurred innovation and momentum in cure research.

With such advances underway, advocacy from affected communities is essential to guide HIV cure research. When communities help shape the research agenda, it ensures alignment with real-world needs, avoids misunderstandings, and increases the chances of meaningful, lasting impact.  AVAC and the International AIDS Society have hosted an Advocacy-for-a-Cure Academy every year since 2017, which helps build the capacity of advocates in low-and-middle income countries to advance the research agenda for an HIV cure in their local context. The Academy focuses on building foundational knowledge—reviewing current approaches, major scientific barriers, and population specific concerns—and building practical skills in research translation.

The 2025 Advocacy-for-a Cure Academy was hosted in October in Lomè, Togo, the first convening in West Africa. It brought together 15 skilled advocates, representing 13 countries in East, West and Southern Africa, including former AVAC Fellows Ulanda Matamba (Malawi), Paul Sixpence (Zimbabwe), and Samuel Gorgio (Kenya). Faculty for the academy included, AVAC’s Senior Program Manager Jessica Salzwedel and IAS’s Riccardo Maddalozza, who oversee the Academy program, as well as Gabriella Chromhout of the University of Kwa-Zulu-Natal, Paul-Alain Taagnouokam of CREMER, past AVAC Fellow Charles Brown of Prevention Care International, and Katherine Bar of University of Pennsylvania.

“The experience was both inspiring and enriching,” said Kenya’s Joyce Adhiambo of Partners in Health and Development in Africa.

Academy participants developed communication and advocacy plans to disseminate the latest research news on cure strategies within their local context. Participants drew from in-depth dialogue with faculty and fellow advocates to explore what is needed for cure to be conducted within their communities.

“We emerge not only informed but equipped to bring HIV cure advocacy to the communities we serve and to shape research agendas grounded in our local realities,” said Cameroon’s Laurel Kevine of the Research Center on Emerging and Reemerging Diseases.

“This experience was eye-opening. I went in thinking a cure meant total eradication, but I left understanding that remission is also part of the story. I’m excited to turn this new knowledge into action in my communities,” said Burundi’s Ravel Gatoto, of Réseau National des Jeunes Vivant avec le VIH.

The Advocacy-for-Cure Academy will award one participant with an alumni grant to execute their plan over the course of 12 months. The 2026 Academy will be an alumni academy designed to deepen the knowledge of alumni over the past eight years of the program.

The Advocacy-For-A-Cure Academy represents sustained programming to support cure advocacy. This is essential investment in a key component of successful research—informed and supported advocates who are empowered and integrated into the process. As much as the broader HIV response recognizes how important this work is, cure research will be on track to maximize its potential. That means, on the day cure strategies show efficacy and become a reality, communities that need it most will be working hand in glove with other global health leaders to ensure not one more day is lost in speeding access to the end of AIDS.

This week, South Africa became the first African nation to register injectable lenacapavir (LEN) for PrEP. The US released a draft global health “Memorandum of Understanding” (MoU) with serious omissions related to HIV prevention and community engagement; and a leaked document indicates that the European Union may cut future funding to Gavi and the Global Fund. And just as this issue was being published, The Lancet issued a new series, Innovations in Sexual and Reproductive Health.

South Africa Registers Injectable Lenacapavir for PrEP  

South Africa has become the first African country to register the twice‑yearly injectable lenacapavir for PrEP (LEN). The approval by the South African Health Products Regulatory Authority (SAHPRA) is the fastest Africa approval of PrEP ever and opens the door for a national rollout beginning in early 2026. Additional regulatory approvals are pending in Kenya, Malawi, Zambia and Zimbabwe. In addition, earlier in October, the WHO pre-qualified both the oral and injectable forms of LEN using an expedited process. 

IMPLICATIONS: LEN’s registration in South Africa is significant progress, and reflects one of several milestones in product introduction that have happened faster for LEN than for any previous PrEP product. See AVAC’s comparative graphic on Moving PrEP Options to the Real World. At the same time, so much more needs to happen to translate this option into public impact, including securing price and volume transparency, aligning global funders, and enabling rapid country-level introduction. A robust and accelerated global rollout will create a foundation for further reduced pricing, greater choice, and real momentum in HIV prevention. See AVAC’s report, Getting PrEP Rollout Right This Time, which can support countries in the early stages of LEN planning. And visit AVAC’s LEN page for a range of resources and graphics, and PrEPWatch.org to track the rollout of all long-acting PrEP. 

READ:

• SA becomes the first African country to register the twice-a-year anti-HIV jab — at record speed—Bhekisisa  
• Access Strategy for Lenacapavir for PrEP in Low- and Middle-Income Countries—Gilead Sciences  

US Global Health MoU Template Raises Urgent Concerns

This week, US government country teams at embassies and missions around the world received a draft memorandum of understanding (MoU) template and guide that will shape bilateral US global health investments. These MoUs between the US and individual countries are being developed for PEPFAR but will also extend across other US global health foreign assistance programs, establishing a framework for how the US engages partner governments on health priorities. The bilateral agreements, which the Administration is aiming to finalize by mid-December, outline process and outcome metrics focused on treatment, such as ART coverage and viral suppression. However, the draft template omits HIV prevention indicators, including any reference to PrEP or new products such as injectable lenacapavir, and also also bypasses multilateral coordination, ignoring institutions like WHO or regional public health agencies, and suggests that policies favoring US commercial interests would factor into funding decisions, while providing no framework for civil society or key population engagement. 

IMPLICATIONS: The shift to direct government-to-government MoUs sidelines the community and erodes decades of progress grounded in data-driven, inclusive approaches—violating the core principle of “nothing about us without us.” The exclusion of key populations and civil society voices from these negotiations raises serious concerns about accountability and equity. Equally alarming is the fact that the US government has not released any PEPFAR data this year, leaving advocates, partners, and decisionmakers without the basic transparency needed to evaluate impact or guide decisions. These omissions must be challenged immediately by in-country advocates and Congress. 

READ: 

• Breaking: First Look at the USG Draft Memorandum of Understanding for Global Health—To End A Plague Again Substack 
• How will America’s new global health strategy change PEPFAR?—Devex  
• Devex CheckUp: ‘America First,’ but what about PEPFAR?—Devex  
• PEPFAR’s Missing Data: Why Transparency Matters More Than Ever—Center for Global Development (CGD) 
• PEPFAR Has No Plan for World AIDS Day Data Release—Emily Bass Substack

European Commission May Shift Away from Gavi and the Global Fund

The European Commission (the executive body of the European Union) plans to potentially phase out funding to Gavi, the Vaccine Alliance, and the Global Fund by 2030 according to a leaked document, which was prepared for the European Union’s Commissioner for International Partnerships. The document makes the case for concentrating EU support on initiatives where the bloc can “truly shape governance.” 

IMPLICATIONS: This signals a dramatic pivot away from institutions that have helped save 90+ million lives through vaccine access and disease prevention. While no formal decision has been made, this move mirrors similar cuts by the US under the new administration, and underscores growing skepticism in major donor governments about traditional multilateral aid. Global health financing is already under significant strain, with donors prioritizing national interests and public-private investments over long-term, predictable health aid. A shift away from core multilateral partners may leave critical gaps in vaccine delivery, HIV prevention and response to emerging disease threats. 

READ:  

• EXCLUSIVE: EU mulls copying US with end to aid for global health funds—Euractiv

Launch of The Lancet’s Innovations in Sexual & Reproductive Health Series

Fenway Health will help launch The Lancet’s five-paper series on sexual and reproductive health, edited by Profs. Kenneth Mayer and Linda-Gail Bekker. Begins October 31 at 8am ET.

Stream

What We’re Reading

• How HIV research drives health innovation in multiple diseases—Nature Medicine
• Transforming HIV Prevention in 2025, AVAC
• Gates Foundation skews global health agenda after US retreat, study says—Financial Times
• Trump Revives Foreign Aid, Helping Needy Billionaires—New York Times
• Private donors gave more than $125M to keep foreign aid programs going after US cuts—Associated Press
• Ritshidze report spotlights ‘system-wide slide’ in basics for health facility standards after Pepfar cuts—Daily Maverick
• Global security is impossible without sufficient support for global health—STAT
• African Public Health Conference Calls for ‘Health Sovereignty’ and Prioritizing Primary Care Ahead of G20—Health Policy Watch
• African Center for Economic Transformation tries to humanize debt—Devex
• John Roberts Is a Threat to the Health of Every American—The Nation
• Behind the Dismantling of the C.D.C.: Reform or ‘Humiliation’?—New York Times
• Her refusal to approve a dangerous drug changed medical history—19th News
• How Moderna, the company that helped save the world, unraveled—STAT

AVAC Resources

• Vaccine-Preventable Disease: A Global Tracker, Think Global Health
• PEPFAR’s Missing Data: Why Transparency Matters More Than Ever, CGD
• Getting LEN Rollout Right: Resources and Tools, AVAC
• Do Not Check That Box – Impacts From the Assault on Transgender Communities and DEI + Strategies to Sustain and Rebuild, AVAC

Upcoming Webinar

Enormous changes are underway in HIV prevention and across global health. Global advocates know that we play an indispensable role as these changes take shape. It’s our work to vigilantly track new agreements, new policies and new investments in research, development and delivery. It is our voices that call out inequity, greed, misinformation, and misguided assumptions. Here are three questions we advocates are asking along with resources to support our collective work.

Q1: How do we speed access to LEN for PrEP and why is building a sustainable market a critical next step?

October 27, 2025, brought the latest news on injectable lenacapavir for PrEP (LEN). Just yesterday, South Africa’s regulatory authority approved injectable lenacapvir as PrEP, the first approval in Africa and the fastest Africa approval of PrEP ever. Additional regulatory approvals are pending in Kenya, Malawi, Zambia and Zimbabwe. In addition, earlier in October, the WHO pre-qualified both the oral and injectable forms of LEN using an expedited process. This is progress, but so much more needs to happen to translate this option into a real choice, including: securing price and volume transparency, aligning global funders, and enabling rapid country-level introduction.

To achieve impact against the epidemic and realize the potential of the full suite of HIV prevention options, policies, planning and targets can and should be bolder, with advocacy and additional investments needed.  

Building a sustainable market for LEN—and for PrEP and prevention generally—is essential for affordable and sustainable access and to achieve impact. Demand creation is fundamental to this effort, and so is setting more ambitious goals for total numbers of people on PrEP, which requires upfront investments and coordinated donor support now. Without such action, LEN’s promise could stall, delaying equity and impact. A robust and accelerated rollout will create a foundation for reduced pricing, greater choice, and real momentum in HIV prevention. Our dedicated LEN page on AVAC.org offers additional resources including:

Resources

• Getting PrEP Rollout Right This Time provides key insights from the rollout of oral PrEP and early introduction of injectable cabotegravir (CAB) and the dapivirine vaginal ring (DVR) to inform a faster, smarter and more equitable introduction of future HIV prevention tools, including lenacapavir.
• Gears of Lenacapavir for PrEP Rollout outlines a focused plan for LEN for PrEP rollout over the next few years, specifying priorities by stakeholder and evaluating volume and pricing strategies. 

Infographics

View all our LEN infographics

Q2: Global health funding is shrinking, but how is the field adapting in this period of disruption?

Global health funding is in steep decline. The Institute for Health Metrics and Evaluation estimates assistance for health dropped by 21% between 2024 and 2025 and will continue dropping over the next five years. In response, the global health field is entering a period of transition, which is marked by smaller pledges from donors, such as Germany’s 1 billion euro commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) over the next three years, which is a 25% reduction. There are also increasing calls for consolidation of the fragmented architecture of funding for global health. Leaders at last week’s World Health Summit echoed this urgency, pushing for streamlined agencies and faster reform.

Simultaneously, a new, bold framework for global health sustainability and equity known as The Accra Reset builds upon the public health leadership of African countries to counteract disruptions to the global health governance. It calls for co-creation and mutual accountability, with Global South countries determining agendas and investment in national health systems, data sovereignty, local production, and more in an effort to transform global health as a platform for prosperity rather than a cost. 

As global health undergoes a profound transformation, the central task for advocates is to ensure equitable and effective access to care among communities hardest hit by health threats.

Issue Brief

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends) published an issue brief, How the Global Fund Makes America Stronger and Safer and a call to action for the US to continue its longstanding commitment to pledge $1 for every $2 from other countries.

Q3: What’s the status of the R&D pipeline and what action steps are essential now?

From basic science to implementation studies, public support for HIV research has never been more important. An evolving, balanced and innovative pipeline of HIV prevention options is essential to epidemic control and ensuring everyone who needs HIV prevention has access to something that works for them. These resources can inform and support our collective work to defend continued investment in an inclusive and diverse pipeline of HIV prevention research and development (R&D). 

These questions are guiding our work at AVAC. We know it will continue to be up to advocates, allies, and global health champions to demand answers, transparency, and programs that deliver sustainable impact. See you in the fight!  

This week major shifts in development finance make headlines as do the real-time consequences of the US cuts to foreign aid and withdrawing from the WHO. AVAC’s new issue of PxWire amplifies issues of access, equity, and accountability with an update on biomedical prevention research and rollout. 

Rethinking Health Aid  

The World Bank‑IMF Annual Meetings wrapped up last week highlighting a critical shift in development finance. African leaders and multilateral agencies signaled a move away from traditional aid models and toward investment‑led growth. They emphasized the need for stronger institutions, locally driven capacity, and private‑sector engagement rather than just grants. At a side event, Dr. Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), stated that up to 60% of the continent’s past foreign health aid may have been largely “wasted” (attributed to fragmentation in the health sector among other things), prompting calls for smarter, more accountable finance for health.  

IMPLICATIONS: With traditional aid shrinking and philanthropic models racing to adapt, the world may see healthcare investment shifting as a core aspect of economic development, which may lead to more investment in robust national health systems, supply chains, local research and development, and an expanded workforce to make countries less dependent on external aid. For HIV prevention, this means country ownership, and innovative and sustainable financing must take the lead to ensure that evidence-based programs, services and products reach everyone in need and access is not derailed by donor funding shifts.  

READ:  

• From aid to investment: Reshaping Africa’s path to growth—Devex  
• As aid shrinks, top philanthropies test new ways to spur economic growth—Devex  
• Africa CDC chief: 60% of foreign health aid was effectively wasted—Devex  
• Africa Seeks More Self-Reliance Amid Disease Outbreaks and Decline in Donor Funds—Health Policy News

Politics Reshaping Global Health 

In parallel to the discussion at the World Bank, Politico’s recent piece highlights the implications of the United States’ withdrawal from the World Health Organization and other key multilateral initiatives. This reporting underscores how deeply politics is reshaping global health. The US Administration’s “America First” strategy, combined with steep foreign aid cuts, continues to leave countries grappling with uncertainty over how to sustain essential programs once supported by US funding.  

IMPLICATIONS: Many articles this week are showing the health impacts of the upended global health system, with many questioning how the global health community will navigate not only budget cuts but recasting health aid as bilateral, strategic, and conditional rather than universal and humanitarian. 

READ:  

• Trump is cutting foreign aid. He’s not the only one.—Politico   
• The Story of the Unfolding HIV Crises As Seen in Three Countries: Uganda, Thailand and Malawi—Geneva Health Files 
• Botswana faces new HIV scare as shortage of medicines deepens—The Mail and Guardian 
• National Institutes of Health funding cuts will ‘impact us for years’—NPR 
• A Somali Hospital Closed After U.S. Aid Cuts. Fired Employees Reopened It Without Pay.—New York Times 
• Ritshidze report spotlights ‘system-wide slide’ in basics for health facility standards after Pepfar cuts—Daily Maverick 

Tracking the HIV Prevention Landscape

AVAC’s new issue of PxWire shows the promise of PrEP – across R&D and delivery. Long-acting injectable lenacapavir for PrEP is advancing toward rollout, with the first supplies expected to reach select countries before the end of the year. Simultaneously, this quarter’s issue tracks updates to pricing of existing PrEP products and the launch of Phase 3 trials for a once-monthly prevention pill. 

READ:  

• PxWire Volume 15, Issue 4—AVAC  
• The Promise of PrEP for HIV—Foreign Policy

What We’re Reading

• NEJM and public health group are launching rival to CDC’s MMWR publication—STAT
• Urgent action needed as Treatment Action Campaign highlights 50 percent cut in HIV funding—IOL South Africa
• Are Cabotegravir Injections More Tolerable Than Lenacapavir?—POZ
• Gilead agrees not to raise prices on HIV medicines for state AIDS drug programs—STAT
• CVS Caremark tells AIDS activists Gilead needs to lower the price of its new HIV drug to get on formularies—STAT
• Who should get the first doses of the twice-a-year HIV prevention jab? It could be in 360 clinics by February—Bhekisisa
• Overcoming disruption, transforming the AIDS response – World AIDS Day 2025—UNAIDS
• More Europeans are dying from HIV now than 15 years ago—Aidsmap
• Join the PrEP Revolution: How to Fight for HIV Prevention [VIDEOS]—POZ
• Anti-science bills hit statehouses, stripping away public health protections build over a century—STAT
• Can Africa’s drug regulators be both fast and trusted?—Devex

New & Updated AVAC Resources

• PxWire Volume 15, Issue 4
• Source of Programmatic Cabotegravir for PrEP Supply
• Source of Lenacapavir for PrEP Supply to Early Adopter Countries
• EXPrESSIVE Phase 3 Trials Countries of MK-8527
• Years Ahead in HIV Prevention Research: Time to Market
• Lenacapavir Implementation Studies 

Upcoming Webinar

This issue provides a range of maps to help orient the field on critical HIV prevention activities: the status of delivering injectable cabotegravir (CAB for PrEP); funders and countries on track for early introduction of injectable lenacapavir (LEN for PrEP); and where new Phase 3 efficacy trials testing MK-8527 as a monthly pill for PrEP are taking place.

Key Takeaways

• Supply of LEN is due to begin arriving in countries in late 2025 with service delivery planned to start in early 2026.
• The Global Fund, with support from CIFF, and PEPFAR have jointly committed to reaching up to two million people with LEN for PrEP over three years.
• Seventeen countries are hosting sites for the Phase 3 efficacy trials of a monthly PrEP pill, MK-8527, being developed by Merck. Merck announced the launch of the Phase 3 trials at IAS 2025 in Kigali. MK-8527 was found to be safe and well-tolerated in Phase 2 clinical trials.
• Merck’s commitment to stakeholder engagement to date contributes an important model of Good Participatory Practice (GPP) to the field, by putting global advocates at the forefront of planning for the program and trial design. Merck has expressed a commitment to sustain this vital engagement throughout the program and next steps.

The US government shutdown escalated this week as the Administration acted on its Reduction in Force (RIF) threats across federal health agencies, laying off thousands and then retracting many of these notices, yet again increasing the chaos and confusion. The UK-based Children’s Investment Fund Foundation (CIFF) abruptly cut all funding to US-based NGOs, and world leaders urged a streamlined global health system amid funding cuts, as Germany pledged €1B to the Global Fund at the World Health Summit.

US CDC Layoffs

Late Friday, the US Centers for Disease Control and Prevention (CDC) issued more than 1,300 layoff notices in response to the US government shutdown. These RIFs eliminated entire units across global health, epidemiology, disease surveillance and the writers of the Morbidity and Mortality Weekly Report (MMWR), one of the most valued public health publications. However, within days, chaos and confusion intensified as many notices were retracted due to “coding errors”. Despite the backtracking, critical offices such as IRB, ethics, human resources, and policy liaison remain shuttered.  

IMPLICATIONS: These disruptions are not just a domestic crisis; they are derailing global health efforts. The CDC is central to surveillance, epidemic response, vaccine research, and technical guidance for implementing programs in the US and around the world. When it loses capacity, these critical initiatives falter.  
READ:  

• Haphazard US CDC staff cuts leave questions around impact—Devex  
• Trump’s shutdown firings at CDC cause whiplash, despair: What to know—The Hill  
• ‘Instability and whiplash’ as CDC slashes 1,300 jobs before reinstating half—The Guardian  
• With new cuts at CDC, some fear there’s ‘nobody to answer the phone’—NPR  
• Trump Administration Admits It Laid Off Twice as Many HHS Employees as Intended—NOTUS  
• Trump Administration Lays Off Dozens of C.D.C. Officials—New York Times  
• ‘A Kick in the Mouth’: Trump Administration Makes Staffing Cuts to CDC’s Safety Office Months After Shooting—NOTUS

CIFF Cuts US Funding

The UK-based Children’s Investment Fund Foundation (CIFF), a major global funder in child health and HIV prevention (including to AVAC), announced that it will immediately stop all grants to organizations based in the US amid increasing ambiguity in US laws governing foreign philanthropy. This decision terminates all active US contracts effective at the end of October, including grants to many organizations, including AVAC, that are still reeling from USAID stop-work orders earlier this year. According to Devex, in 2024, CIFF gave $12.7 million to the Rockefeller Philanthropy Advisors, $7.3 million to PATH; $7.1 million to Piramal Foundation USA; $6 million to The Carter Center, and $2.6 million to AVAC. The decision to cease funding in the US follows weeks of pressure, including a critical National Review article targeting CIFF’s founder Sir Chris Hohn.  

IMPLICATIONS: US foreign policy is becoming more hostile toward philanthropy—both inside and outside the US—and is reshaping the future of HIV prevention and global health funding. As donors like CIFF bypass US-based institutions, NGOs are confronting a new reality where political pressure—not program performance—can sever funding overnight. While these changes in the funding landscape can align with broader calls to recenter global health and accelerate investment in local organizations, it also creates challenges for organizations in the Global South to rapidly scale their governance, compliance, and financial systems to receive direct investment.  

READ:   

• Update for Our Partners—CIFF  
• Major foundation pauses grants to US, citing unclear policy changes—Devex  
• EU Foundation Suspends Partnering With U.S. Charities—Nonprofit Times

World Health Summit Updates

Global health leaders, civil society, and policy makers were in Berlin, Germany, this week for this year’s World Health Summit. With the theme of Taking Responsibility for Health in a Fragmenting World, this year’s Summit reflects the converging challenges of funding cuts, broken systems and geopolitics. Leaders from WHO, Gavi and Global Fund urged the sector to reduce duplication across agencies and consolidate the global health architecture, calling the aid system “too fragmented” and “too confusing” and urging fast action. Meanwhile, Germany committed €1 billion over three years to support the Global Fund. Despite being 25 percent lower than Germany’s previous pledge, it is an important sign of the importance of global health in German foreign policy and, hopefully, a catalyst for other European funders to step up in support of the Global Fund. Also, African leaders recommitted to local manufacturing of vaccines, diagnostics, therapeutics, and health technologies as part of a push toward sovereignty in health systems. 

IMPLICATIONS: The financial crisis facing global health, with the abrupt withdrawal of US aid as well as reductions from other donors, exposes structural problems that many acknowledge have existed for years—and now need urgent attention. The latest data from the Institute for Health Metrics and Evaluation showed global development assistance for health fell 21% between 2024 and 2025, driven almost entirely by a 67% drop in US financing, more than $9 billion. As Global Fund Executive Director, Peter Sands said, “I do think we’re actually going to have to reduce the number of entities. The system is too fragmented. There are too many underfunded institutions. There’s too much duplication. It’s too complex. That diagnosis, I think, is pretty straightforward.” 

READ:  

• Global Health Leaders Urge Fewer Agencies Amid Funding Crisis—Health Policy Watch 
• Africa inches toward local production of vaccines and more—Devex  
• Germany commits €1B to Global Fund as aid cuts shape World Health Summit—Devex  

What We’re Reading

• The only thing standing between humanity and the end of HIV—Vox
• New HIV preventive drug under discussion—Newzroom Afrika
• They Fought Outbreaks Worldwide. Now They’re Fighting for New Lives.—New York Times
• PEPFAR’s Contributions to Health Systems and Global Health Security—Journal of Infectious Diseases
• Inside FDA, career staffers describe how political pressure is influencing their work—STAT
• Judge says she plans to order Trump administration to pause shutdown layoffs—Washington Post
• As US shutdown drags on, ‘it’s just one blow after another’—Science
• Maldives becomes the first country to achieve ‘triple elimination’ of mother-to-child transmission of HIV, syphilis and hepatitis B—WHO
• No eradication without innovation: the EU at a crossroads to eliminate HIV/AIDS, TB, and malaria—Global Health Advocates
• Foreign Aid Is Mostly Gone. It Could Be Replaced With Something Better.—New York Times (opinion)
• Pharma’s shift away from infectious disease research could spell disaster for the world’s poorest people—STAT

AVAC Resources

• Lenacapavir Regulatory Approval
• Potential Demand for LEN for PrEP
• HIV Prevention Product Overview
• Where We Are Now With LEN
• PrEP Price Comparison

Upcoming Webinars

Join our panelists for an unflinchingly honest—and interactive—conversation as we assess the impacts of the ongoing assault on transgender communities, gender affirming health care, data collection, and Diversity, Equity and Inclusion writ large. Strategies to restore trust, sustain programming, and rebuild from the ashes will be explored.

Join Funders Concerned About AIDS (FCAA) to explore how shifting legal and policy environments are shaping HIV responses, why bold and intersectional advocacy strategies matter, and where philanthropy can make catalytic investments to protect and advance progress.