Scientists and advocates gathered in Rio for the 26th International AIDS Conference (AIDS 2026) this week to discuss the future of the HIV response, just as former NIAID Director Anthony Fauci appeared before a hostile Senate Committee on Homeland Security & Governmental Affairs, reminding us that the greatest barriers to ending HIV are increasingly political, not scientific. In addition, this week’s issue covers the US Administration’s use of vaccine funding as leverage in negotiations with Gavi and a new policy restricting gain-of-function research.

Former NIAID Director, Anthony Fauci Testifies Before US Congress

Former NIAID Director Anthony Fauci appeared before the US Senate Committee on Homeland Security & Governmental Affairs after being subpoenaed to testify as part of its ongoing investigation into the US response to the COVID-19 pandemic. Questions from Republican Senators were especially hostile, and in response, Fauci answered with the same response to every one of them: “On the advice of counsel, I respectfully decline to answer based upon my rights under the Fifth Amendment to the Constitution.” Senator Rand Paul who chairs the Committee said it would vote next week on whether to hold Fauci in contempt of Congress, insinuating that he is not entitled to Fifth Amendment protection.

In advance, more than 150 scientists, physicians and public health advocates signed an open letter condemning the “ongoing vilification and harassment” of scientists noting the Administration and its allies are “waging a war on individual scientists, through public harassment, arrests, criminal indictment, and ongoing threats of prosecution” and urging lawmakers to end it. AVAC also issued its own statement of support for Fauci, calling for the Committee “to cease its erroneous investigations and harassment of renowned scientists and public servants such as Dr. Fauci, whose career, track-record, and devotion to public health research and development has changed the very course of the HIV epidemic at home and abroad.”

IMPLICATIONS: The hearing is part of the ongoing assault on evidence-based research, scientists and scientific institutions, which have been the foundation of decades of public health progress. It follows the White House Office of Management and Budget’s (OMB) proposed regulation to give political appointees greater authority over federal grant decisions, which could dramatically reshape how federal dollars are spent and who decides, replacing evidence-based decision-making with political priorities. The consequences are weakening public trust, discouraging scientific leadership and leaving the US less able to prepare for the next pandemic or public health emergency.

READ:

• Fauci Invokes Fifth Amendment Nearly 100 Times in Bitter Senate Hearing—New York Times 
• Fauci to Testify About COVID Pandemic: What His Diaries Reveal—Newsweek  
• The Unmaking of Anthony Fauci—The Atlantic 
• 5 takeaways on Fauci’s hostile Senate hearing, GOP contempt threats—The Hill 
• Stop ‘Harassment’ of Fauci, Scientists Urge Politicians—MedPage Today 
• Fauci invokes Fifth Amendment in declining to answer questions before Senate panel—STAT 

New US Policy Restricts Gain-of-Function Research

The US Administration issued a new Policy for Stopping High-Risk Life Sciences Research, which prohibits federally-supported “dangerous gain-of-function” research “strengthens oversight of other high-risk life sciences research, and restricts funding for research conducted in countries that lack appropriate safety, security, and oversight standards.” The policy goes into effect in November.

IMPLICATIONS: The policy is another example of political interference in the scientific enterprise and is seemingly being used as fuel to secure support for the Administration’s claims around Fauci and the origins of the COVID-19 pandemic. Scientists warn that broadly restricting this work could hamper efforts to predict viral evolution, develop vaccines, and prepare for future outbreaks.

READ:

• New U.S. rules on risky pathogen research draw mixed reviews—Science  
• Joint Statement on the United States Government Policy for Stopping High-Risk Life Sciences Research—US Department of State 
• Trump’s NIH Ends Funding, Support for Gain-of-Function Research—Bloomberg Law 
• Feds shut down ‘dangerous’ gain-of-function research, tighten oversight of foreign collaboration—CIDRAP  

Gavi Finally Receives its Congressionally-Appropriated Funding

The US Department of State will release the full $600 million in US funding appropriated by Congress for Gavi, the Vaccine Alliance, noting that “discussions resulted in significant commitments that strengthen vaccine safety, improve public health, and better align Gavi’s work with the principles of Gold Standard Science and transparency.” The funding, which was set to expire September 30 was being withheld by Health and Human Services Secretary, Robert F. Kennedy Jr., who criticized Gavi’s use of vaccines containing thimerosal, a preservative, which extensive reviews by the World Health Organization and other scientific bodies have found to be safe in the small amounts used in multidose vaccines. Gavi had already begun transitioning to newer vaccine formulations that do not contain thimerosal.

IMPLICATIONS: This is another example of the growing influence of politics or political ideology over global health policy and evidence-based decision-making. Although Congress appropriated the funding, the Administration delayed the release of funding as leverage to extract commitments from Gavi, including accelerating the transition away from thimerosal-containing vaccines, ending support for routine COVID-19 vaccination programs, reducing support for the World Health Organization, and creating a new mechanism to review vaccine science and safety. The delay underscored the vulnerability of global immunization programs to shifting domestic politics. Together with the evidence of disruptions to PEPFAR-supported programs following the US foreign-aid freeze presented at AIDS 2026 (see below), these developments highlight how political decisions are increasingly shaping not only the financing of global health programs, but also who can access lifesaving interventions and how scientific evidence is translated into policy and practice. 

READ:

• US finally moves to release $600 million to Gavi—Devex  
• U.S. Department of State and U.S. Department of Health and Human Services on Strengthening Vaccine Safety, Accountability, and American Leadership in Global Health—US Department of State 
• Collins says State Department will reinstate funding for global humanitarian vaccine alliance—The Hill 
• Trump administration to dispense $600M for vaccines RFK Jr. held up—Politico  
• State Department agrees to reinstate vaccine funding for Gavi—CIDRAP  

International AIDS Conference Wraps Up

The International AIDS Conference is wrapping up as this issue goes to publication. The meeting underscored an important reality: the barriers to ending HIV are no longer primarily scientific—they are political. Across plenaries and satellite sessions, researchers, advocates and policymakers returned to the same question: will the world deliver lifesaving innovations with speed, scale and equity, or allow them to remain the privilege of a few? New data presented in Rio offered an early warning about the consequences of political choices: analyses found that disruptions linked to the US foreign aid freeze contributed to declines in PEPFAR-supported HIV treatment in 2025, including reductions in pediatric treatment coverage and the closure of HIV service sites across multiple countries. At the same time, researchers presented modeling data suggesting that the investigational monthly oral PrEP pill alimatravir (MK-8527) could potentially be manufactured for as little as $3 per person per year if produced at sufficient scale. During an AVAC satellite session, Executive Director Mitchell Warren reflected that, “16 years since we first learned that PrEP was safe and effective as a daily oral tablet, we have successfully squandered our opportunities,” arguing that the challenge is no longer discovering what works, but building the systems and political commitment needed to ensure these tools reach the people who need them most.

IMPLICATIONS: The discussion and debate makes clear that the future of the HIV response will be determined by political choices around the world. As new data on treatment, prevention, cure and delivery innovations were shared, governments are slashing foreign assistance, dismantling public health infrastructure, attacking scientist and scientific institutions and retreating from the global partnerships that made this progress possible. Without sustained investment, equitable licensing agreements, and leaders willing (and able) to defend evidence-based policymaking, the world risks repeating one of the central failures of the HIV response: allowing lifesaving innovations to arrive years—or decades—after they are needed most. 

READ:

• A rocky rollout A powerful new prevention drug could help end the HIV epidemic—but supply is falling far short—Science 
• Why is Latin America still waiting for long-acting HIV prevention?—Devex  
• Activists and leaders at global HIV meeting decry price of prevention drug—Science 
• Global AIDS conference kicks off in Rio—Bay Area Reporter 
• Special edition: Access takes center stage at International AIDS Conference—Devex  
• Promise of monthly oral pill sparks renewed interest in post-exposure prophylaxis (PEP)—AIDSMap  
• AIDS 2026: Some pieces falling into place for monthly HIV prevention pill, but key data not yet in—Spotlight (SA)  
• Will African Countries That Rejected Trump’s Health Deals Be Forced Back to the Negotiating Table?—Health Times 
• We analysed SA’s first LEN roll-out data. Here’s what we found—Bhekisisa  
• Mitchell Warren on the fallout from PEPFAR cuts—Managed Healthcare Executive 
• Nearly 200,000 lenacapavir shots given across Africa, but supply issues pose challenges–AIDSMap 
• New HIV Frontier: The Fight to Access Long-Acting Prevention Drugs—Health Policy Watch 
• 15 things the State Department said about the future of PEPFAR and global health— Lights, Camera, Equity! Substack 
• The US State Department Redraws the Map of Africa at the AIDS2026 Conference—To End A Plague…Again Substack  

What We’re Reading

• Adjusting to a Post-PEPFAR World—Health Policy Watch
• Cuts to anti-AIDS foreign aid take a toll in Africa—Washington Post 
• Donor Government Funding for HIV in Low- and Middle-Income Countries in 2025—KFF—Save HIV Funding 
• Without US aid, Africa must rethink how it funds leaders—Devex 
• African Union Pushes For Greater Domestic Spending On Health Amid Reports Of Huge Disruptions To HIV And TB Services—Health Policy Watch 
• How Trump’s “America First” Administration Could Shut U.S. Scientists Out of the Next Nobel-Worthy Discovery—ProPublica
• New Unitaid Head Gets High Marks – but Can He Save the Organization?—Health Policy Watch 
• White House offers its science blueprint: More AI, less life sciences—STAT 
• Leadership Shakeup at CDC’s Ebola Response Team—MedPage Today
• Trump’s CDC Director Nominee Moves Closer to Confirmation—MedPage Today 
• Key Senate panel backs Trump’s picks for CDC, pandemic preparedness—STAT 
• Phase 3 Trial of Weekly Oral Islatravir–Lenacapavir for HIV-1 Treatment—NEJM 
• Lenacapavir: A blueprint for innovation, regulation, and access—Global Health Technologies Coalition 
• People with HIV are living longer but have fewer years of good health. New guidelines aim to change that—Spotlight (SA) 
• Towards Elimination of Sexually Transmitted Infections: Research Developments and Vaccine Uptake—JIAS

As the AIDS 2026 conference enters its second half, one message has emerged above all others: the barriers to ending HIV are no longer primarily scientific; they are political. In one of the “most spectacular plenaries”, Raphy Landovitz argued that the field now faces “a challenge of political will” and “moral decision-making,” asking whether the world will choose to deliver lifesaving innovations with “speed, scale and equity” or allow them to remain out of reach. The contrast could not have been sharper. As the global HIV community gathered in Rio, former NIAID Director Anthony Fauci sat before a US Senate committee in Washington amid politically motivated attacks on him and on the scientific institutions that helped make HIV innovations possible.

Read on for AVAC’s highlights so far at the conference.

Science, Systems, and Communities: Turning Progress into Impact

At AVAC’s satellite session, Shared Pipeline; Shared Goal: Innovations in Long-Acting Antiretrovirals for PrEP, PEP and Treatment, Executive Director Mitchell Warren reflected that “16 years since we first learned that PrEP was safe and effective as a daily oral tablet, we have successfully squandered our opportunities.” He urged panelists to focus on building not only the next generation of products, but also on the programs needed to deliver them with speed, scale and equity. The Gates Foundation’s Max Lataillade outlined an integrated vision for treatment, PrEP and PEP built around longer-acting options, emphasizing that “innovation without global access or implementation does not create the impact that we want,” and concluded that “science creates the possibility, collaboration creates the impact, but communities create the future.” Panelists repeatedly called for integrated, person-centered delivery systems. Ezintsha’s François Venter warned, “The delivery systems to get prevention to tens of millions of people are not there.” Root to Rise’s Adaobi Lisa Olisa emphasized engaging communities from the very beginning, while Stacey Hannah of AVAC closed by challenging the field to move “from the pipeline to access”—better, faster and more equitably.

The Future of the HIV Response Depends on Resilient Health Systems and Community Trust

As HIV programs transition to greater domestic ownership amid a shifting donor landscape, sustaining progress requires more than scientific advances. Sessions throughout the conference focused on protecting HIV prevention and treatment services through integrated health systems, sustainable financing, strong supply chains, and maintaining uninterrupted care. During the plenary, Rethink. Rebuild. Rise., Lloyd Mulenga of Zambia’s University Teaching Hospital, said, “Transition is not a choice—it is a mandate to countries.” He called out regional equity challenges, including the consistent exclusion of Latin American countries from voluntary licensing agreements, including conference host, Brazil, from the list of countries covered by the voluntary licenses announced in Merck’s access announcement for the investigational monthly oral pill, alimatravir.

Resilient health systems require innovations that are affordable and accessible at scale. In the session, Economics of impact: Costing studies across the cascade, Andrew Cross of Christchurch Hospital presented new modeling data which suggests that alimatravir could be mass produced for about $3 per person per year if manufactured at scale (though the scale needed to reach this price was not presented). “PrEP needs to be given to tens of millions of people to have a significant effect on the HIV epidemic.” He concluded, “alimatravir for $3 a year could be the cheapest HIV prevention drug the world has ever seen… But it needs to be $3 everywhere, not just some places. Merck needs to do the right thing and extend voluntary licensing access to include all middle-income countries, especially the countries where the EXPrESSIVE trials are taking place.”

Presenters consistently emphasized that resilient health systems represent just one aspect of a strong the HIV response. In a satellite session that shared learnings from LEN implementation in Kenya, Nigeria, Zambia, Mozambique, and Zimbabwe, ministry of health representatives highlighted country-specific experiences and common implementation challenges. Despite differences in context, speakers emphasized that successful rollout depends on more than product availability—it requires meaningful community engagement, trusted communications, informed choice, and demand generation strategies tailored to local communities. These lessons informed the development of the Demand Generation Playbook introduced by Elmari Briedenhann of Wits RHI. The playbook synthesizes experiences from early adopter countries and provides a shared framework to help others design community-centered approaches that translate scientific advances into meaningful impact.
 
Reinforcing the call for community partnership in shaping implementation, the satellite session hosted by Global Black Gay Men Connect (GBGMC), Choosing impact: Making long-acting HIV prevention a reality for key populations in sub-Saharan Africa, hosted a discussion around what it will take to make long-acting HIV prevention a reality for key populations across sub-Saharan Africa. Access Bridge Executive Director Wawira Nyagah grounded the discussion in a question: “if a young advocate named Amani walked into a clinic tomorrow seeking LEN, would he actually be able to get it?” Through Amani’s story, Nyagah illustrated how access is shaped: through scientific innovation, voluntary licensing, pricing, product allocation, national prioritization, stigma within health services, and the availability of generic products. As both Nyagah and Mitchell Warren emphasized in Rio, the future depends on building HIV programs alongside communities—not simply delivering them to communities.

Reinforcing a major conference theme of translating scientific advances into real-world impact, Monica Gandi of the University of California, San Francisco, stressed the urgent need to translate breakthroughs in long-acting therapies into equitable access, calling for greater accountability from the global HIV community to ensure equitable access to innovations. This becomes all the more important as the long-acting treatment pipeline expands, as demonstrated in AVAC’s new tracker. 

Deepening our Understanding, Advancing the Science

Sessions on innovation focused on developing new approaches and maximizing the impact of existing scientific advances. In an elegant plenary, Sandy Vasan from the Henry Jackson Foundation and US Military HIV Research Program provided an update on HIV vaccine science. She described why a vaccine is still needed even with expanded PrEP options, in line with AVAC’s recent commentary in Think Global Health, describing the scientific challenges, emerging insights and innovations and highlighting what’s in the research pipeline. While focusing mainly on HIV vaccine science, Vasan also touched on long-standing partnerships with communities as foundational to vaccine research and to vaccine confidence, as well as the need for continued investment and support for upstream vaccine research. She presented while wearing her HIV Unwrapped outfit, developed in partnership with a local Brazilian fashion designer, demonstrating yet another example of how to engage in and partner with communities in advancing science.
 
At the Co-Chairs Choice session, CAPRISA announced results from the CAP012c Phase 2 trial examining a potential vaccine approach. The trial found that a six-monthly combination of two broadly neutralizing antibodies bNAbs (CAP256 and VRC07) was safe but did not provide protection against HIV acquisition in young women in South Africa and Zambia. Researchers concluded that while CAP256 demonstrated strong potency in laboratory studies, it did not achieve antibody levels needed for protection in people. As Mitchell Warren noted, “we had hoped that combining two bNAbs in this study would provide greater protection than a single antibody, but sadly it did not.” Antibody research has always been about more than product development. The CAPRISA 012c study continues to deepen our understanding of HIV and the immune system, and will, hopefully, continue to inform vaccine design, cure research and the next generation of prevention strategies.

Heading Into the Future

In the session AI & HIV: Who Owns the future of Public Health? speakers focused on potential uses of AI to strengthen the HIV response through improved efficiency and effectiveness in areas like self-care, clinical decision-making, resource allocation, and data access and protection. Presenters stressed the importance of AI governance and the need for transparent regulatory frameworks and partnership with communities in the design, use, and oversight of AI systems. ITPC Executive Director and AVAC Board member Solange Baptiste noted the urgency of approaches to AI that are human-centered: “We need a community governance layer built into the AI ecosystem – added in and not just as an afterthought…one that ensures communities help shape priorities, oversee the implementation, identify harms and hold systems accountable throughout the AI lifecycle.”

In Leadership at the tipping point: Protecting the gains and advancing progress in a new era of the HIV response, leaders from the Brazil Ministry of Health, Africa CDC and UNAIDS, along with Peter Piot, agreed that systems built to deliver HIV innovations could become a model for primary health care and global health more broadly. If countries can achieve affordable local manufacturing of lenacapavir and alimatravir, the impact could extend well beyond HIV to future technologies, including new TB vaccines. At the same time, the panel – moderated by Nomonde Ngema of HER Voice Fund in South Africa and AVAC’s Mitchell Warren – urged the HIV community to preserve the “rights-based” and inclusive approach that has made the response exceptional, while setting “reasonable, ambitious targets” supported by domestic financing and measurable goals. “The challenge [is] making sure that we actually have metrics for what resilience and sovereignty really look like.”

What We’re Taking Forward 

As we move to the final days of AIDS 2026, Access Bridge’s Nyagah summed up at GBGMC’s Choosing impact: Making long-acting HIV prevention a reality for key populations in sub-Saharan Africa satellite, “Yes, we need to rethink, rebuild, and rise. But if we don’t do it with access and with equity, then scientific innovation is not going to make the difference in people’s lives. Communities must lead the conversation on what’s next.”

And as Josephine Aseme, the first person to receive lenacapavir for PrEP in Nigeria and AVAC Advocacy Fellow alumni said during Real Talk, Real Access: KP Community Demands for the Next Wave of PrEP, “PrEP is about choice and our different lifestyles,” underscoring that scientific innovation alone is not enough. Access, equity and community involvement are what transform progress into impact. 

Look out for further reflections on the discussion and debate coming out of Rio and be sure to read AVAC’s summary of the first half of AIDS 2026. 

“Innovation without access is injustice.” That message, delivered during Monday evening’s opening ceremony of the 26th International AIDS Conference (AIDS 2026) by Brazil’s Minister of Health, Alexandre Padilha and media personality, Alberto Pereira Jr. captured the defining theme emerging from the first days of the meeting. As scientific innovation accelerates with new prevention options, cure research and long-acting antiretroviral treatment advancing, advocates, researchers, health officials and donors are warning that shrinking funding, unequal access and fragile delivery systems threaten to undermine decades of progress. The message is clear: scientific innovation alone will not end the epidemic.

Read on for AVAC’s highlights from the preconference, satellite and opening sessions.

Innovation Without Access Is Not Innovation

Even before the conference officially opened, Merck/MSD announced voluntary licensing agreements with seven companies in four countries – including Kenya, South Africa and Uganda – for its investigational monthly oral PrEP pill, alimatravir (MK-8527). While the announcement represents an important step toward earlier access planning, advocates quickly noted that several countries involved in the clinical trials, including conference host Brazil, Argentina, Colombia and Peru, are excluded from the licensing territory. As AVAC’s Mitchell Warren noted in this Bhekisisa piece, “We don’t yet know if the medicine will work…but…adding a monthly pill to the choice of options could increase demand even more… [however] for this, we need volumes—tens of millions of doses—which we don’t yet have in the HIV prevention market.”  

Activists interrupted the conference opening ceremony calling for affordable HIV prevention and treatment, patent reform and investment in cure research, chanting, “Pills cost pennies, greed costs lives.” Brazil’s Minister Padilha reinforced the broader stakes: “Defending the response to HIV is, more than ever, defending science, human rights, democracy and life.”  

An Alarm Bell for the Global HIV Response 

The release of UNAIDS’ United to End AIDS special report and a companion KFF-UNAIDS analysis sharpened those concerns. Despite the recent UN Political Declaration on HIV/AIDS, the reports show the challenge of translating scientific progress into the impact needed to end AIDS as a public health threat by 2030. The report shows HIV financing entering one of its most precarious periods in decades, with international assistance declining 18% between 2024 and 2025. Donor government funding fell by $2.1 billion in 2025—the largest annual decline since global HIV funding began scaling up—and epidemiological progress has stalled, with new HIV infections remaining essentially unchanged for the third consecutive year. Warren described the UNAIDS report as an alarm bell: “It’s not just a warning. It’s not just a ‘cautious stabilization of where things are’,” he said. “It is an alarm bell that we have to change how we do what we do, and how we fund what we do, if we want to succeed.”  

Community Engagement is Reshaping R&D and Access

The Advancing HIV Prevention Science and Access preconference session offered a glimpse of how product development, delivery and access are evolving. Merck’s Rebeca Plank recognized that communities and advocates were advising on the development of alimatravir (MK-8527) from the outset, “even before the Phase 3 protocols were written.” Their input influenced the decision to generate data during pregnancy and lactation earlier in development, giving people the information they need to make informed decisions rather than waiting until after approval. Plank also highlighted Merck/MSD’s recently announced initial access plan, including voluntary licensing agreements with seven generic manufacturers while Phase 3 trials are still underway and noted that “these are the initial plans. They’re not comprehensive. They’re not final. We’re still working, working in close collaboration with communities and global health stakeholders as our Phase 3 studies continue.” 

HIV Cure: Expanding the Research Agenda

Cure research is also evolving beyond a single strategy. At the HIV Cure Without Borders preconference session, researchers and advocates highlighted the emerging potential of efavirenz as part of future cure approaches, not as a cure itself, but as a way to reduce inflammation and help clear the HIV reservoir before “kick-and-kill” interventions. The session featured the strength of community voices, highlighting Advocacy Academy alumni Pisci Bruja who reminded the audience cure is a “process not a product”. Tuesday’s satellite session on broadly neutralizing antibodies (bNAbs) will explore their growing role in achieving durable viral control without antiretroviral therapy. As Thumbi Ndung’u of the African Health Research Institute in KwaZulu-Natal, South Africa, observed, “This is a very exciting time to be working on HIV cure.” Together, the sessions reflected a cure agenda that is expanding beyond eradication alone toward long-term remission and reinforced the need for continued investment in basic science, community engagement and advocacy. 

The Future of PEPFAR

The science and policy discussions went hand in hand in the pre-conference. At a packed session on the US Administration’s America First Global Health Strategy new global health strategy Senior State Department officials defended the MoU agreements as voluntary partnerships designed to build country ownership, in the wake of a civil society demonstration. US delegation leader Jeff Graham said they are “commitments we did not force anybody to make” and are intended to help countries “build the capacity to solve their own challenges, rather than perpetuating dependency.” Activists interrupted the session chanting “Restore PEPFAR now,” challenging the withholding of congressionally-appropriated PEPFAR funding and highlighting increasing evidence on the impact of US policy decisions on health and lives. Jirair Ratevosian summarized the session with 15 takeaways. The following day, the George W. Bush Institute released a set of policy recommendations as next steps for Congress and the Administration in the America First Global Health Strategy, calling for stronger implementation, preserving PEPFAR’s core strengths, and supporting greater country ownership.

These early conversations have set the agenda for AIDS 2026. Stay tuned for our Thursday update after the scientific sessions Tuesday and Wednesday, where we’ll report on the latest data and what it means for the future of the HIV response.

Resources

• AVAC Infographics for AIDS 2026
• HIV Prevention Pipeline: Products to Watch
• Alimatravir (MK-8527) Licensing Timeline
• Years Ahead in HIV Prevention Research: Time to Market

New evidence ahead of next week’s International AIDS Conference continues to illustrate the challenges and opportunities facing the global HIV response. This week’s issue covers the first real-world evidence of PEPFAR disruptions, new data reinforcing the long-term potential of lenacapavir for HIV PrEP (LEN), the emerging US foreign assistance architecture and a timely analysis of the vulnerabilities facing HIV medicine supply chains.

First Real-World Evidence of PEPFAR’s Disruptions

Ahead of the AIDS 2026 conference starting this weekend in Brazil, amfAR released the first real-world evidence—not modeling—of the impact of the dismantling of PEPFAR-supported HIV prevention programs through a survey of 1,700 PEPFAR service delivery sites. In their report, amfAR found that three-quarters of US-funded organizations surveyed terminated services to those at highest risk from HIV — sex workers, men who have sex with men, transgender people and people who inject drugs and that “among partners providing prevention services, 43% permanently stopped at least one prevention activity, with the deepest cuts to condom programming and PrEP.” CHAI also shared new analyses of PEPFAR program data that found a 14.2% decline in children receiving PEPFAR-supported HIV treatment in 2025 compared with 2024, with five countries showing steeper-than-expected declines. The findings closely align with AVAC’s analysis showing steep declines in PEPFAR-supported PrEP initiations.

IMPLICATIONS: These findings document “not a collapse, but the narrowing of PEPFAR services concentrated among the populations and programming that, in the long term, often decide whether epidemic control is won or lost,” amfAR’s Elise Lankiewicz shared at a July 21 press conference. “Trying to carve out and cancel certain awards had ripple impacts throughout the whole program.” The system that is left “is really a treatment-heavy model, which isn’t really conducive to controlling the HIV epidemic long-term.” Lankiewicz’s remarks illustrate the urgency to reinstate and immediately scale-up the suite of lost prevention services provided by PEPFAR to all those vulnerable to HIV, as a vital component to the program’s vision for sustainability and epidemic control. The fiscal urgency was further emphasized in US Senator John Cornyn’s call for the Administration to release $1.3 billion in Congressionally-appropriated PEPFAR funding, which underscores the critical role of Congress in ensuring people remain on treatment, prevention services reach those at greatest risk and new infections continue to decline.

READ:

• Measuring the Global Impact of PEPFAR Disruptions—amfAR  
• 1,700 H.I.V. Treatment Sites Closed After Trump Aid Cuts, a Study Finds—New York Times 
• Trump’s HIV funding cuts having ‘severe and devastating’ impact around the world—The Guardian  
• Schatz Condemns State Department’s Delays In Providing Global Health Funding—Brian Schatz 
• Cornyn threatens to sink Trump nominees over PEPFAR—Semafor 

52-Week Data Strengthen the Case for Lenacapavir for HIV PrEP

New results from the open-label extension studies of the PURPOSE 1 and PURPOSE 2 trials testing lenacapavir for HIV PrEP show that the six-monthly injectable can deliver sustained HIV prevention. The studies answered three critical implementation questions: Would people choose LEN over daily oral PrEP? Would they continue returning for injections every six months? Would the remarkably high efficacy seen in the randomized trials be sustained? The answer to all three was yes. Most participants chose to remain on or switch to LEN, adherence exceeded 90%, and the high level of protection was maintained a year after the original trial results, with just one HIV acquisition reported.

IMPLICATIONS: As AVAC’s Mitchell Warren argues in a new journal commentary, “the central challenge is no longer the absence of effective tools, but the failure to deliver them equitably and at scale.” The open-label data should give policymakers, implementers and communities greater confidence that scaling-up access and investments in national rollout can translate into sustained real-world impact. To help, Unitaid announced Thursday an additional US15 million to accelerate the introduction, adoption and uptake of breakthrough HIV prevention products, including long-acting PrEP, across diverse regions. This all reinforces a growing theme across the AIDS 2026 conference next week: scientific breakthroughs alone will not end the epidemic. Success will depend on sustained financing, accelerated policy actions, robust community engagement and resilient delivery systems that can ensure people who want HIV prevention options can actually access them.

READ: 

• In ongoing trials, twice-yearly HIV prevention drug saw just one case—Devex  
• Unitaid invests an additional US$15 million to accelerate introduction, adoption and uptake of breakthrough HIV prevention products in diverse regions—Unitaid   

Foreign Assistance After USAID

Devex published a comprehensive analysis of the US Administration’s evolving foreign assistance architecture in the 18 months since the dismantling of USAID. In line with the recent reflections from global health leaders, the piece concludes that US foreign assistance is coalescing around three priorities: humanitarian response, global health and commercial diplomacy. These pillars are being delivered through a smaller, more centralized system that emphasizes bilateral partnerships, country burden-sharing and funding through a limited number of “trusted, vetted” implementing partners.

IMPLICATIONS: How this new architecture will function in practice is in question. Emily Bass reports that the US Department of State is increasingly relying on sole-source, fixed amount awards (FAAs) issued under a broad class waiver to support the transition. While the approach may help sustain HIV and other health services as the Administration finalizes bilateral health implementation plans, it raises questions about transparency, competition and oversight. FAAs tie payments to predefined milestones as opposed to actual costs, so they shift financial and operational risk to the organizations responsible for delivering programs. Whether these enlisted organizations can take on these risks while maintaining essential HIV health services is a major question to be answered.

READ: 

• ‘The ashes of USAID’—Devex  
• No Bids, Big Risks: State’s New Slew of Sole-Source Global Health Awards—Emily Bass Substack  

What We’re Reading

• An HIV vaccine is within reach—Vox  
• How the culture war came for condoms, PrEP, and HIV testing—Vox  
• CDC Not Renewing HIV Prevention Funding for Nearly 100 Community-Based Organizations—Save HIV Funding 
• ‘Complete shock and dismay’: scientists unite against Trump’s $1tn grant attack—The Guardian 
• Gilead, Merck’s phase 3 data back first weekly HIV pill—Fierce Pharma 
• Rapid spread of Ebola spurs ‘remarkably’ quick drug and vaccine trials—Science  
• The Lessons About Ebola the U.S. Wants to Forget—The Atlantic  
• US-Congo Ebola Travel Restrictions May Hamper Humanitarian Aid Response—Bloomberg  
• Thembi Xulu, the hip-hop mum trying to bring the anti-HIV jab home—Bhekisisa  
• What The Polygamist gets wrong about HIV — and what would save lives in real life—Bhekisisa  
• Unitaid’s Opaque Leadership Search Advances Amid Plunging Budgets, Calls For Reform—Health Policy Watch 
• A New Strategy May Finally Put An HIV Vaccine Within Reach—Forbes  
• I’ve been on PrEP for 11 years. Access to the HIV prevention drug is in danger.—USA Today 
• A Sunrise for UNAIDS?—Ben Plumley Substack  

AVAC and Access Bridge applaud Merck’s announcement today that it has granted seven direct licenses to generic manufacturers to produce their investigational monthly pill for HIV prevention, known as MK-8527, or alimatravir, while Phase 3 clinical trials are still enrolling.

The announcement from Merck/MSD reflects responsiveness to advocates’ longstanding calls to accelerate access to PrEP options. Since 2012, each successive PrEP introduction has gone faster than the previous one, yet the time to market and to public health impact remains too slow.  

In advance of the AIDS 2026 conference, Merck, known as MSD outside the US and Canada, today announced voluntary licensing agreements with seven manufacturers, including three in East and Southern Africa, to produce and market alimatravir for PrEP in 129 countries.  

“Today’s news reflects truly positive momentum in future access to alimatravir for PrEP, if proven safe and effective,” said Mitchell Warren, AVAC’s executive director. “Granting licensing agreements to generic manufacturers while clinical trials are still enrolling, before it is known if the product is effective, should significantly reduce the time to market for the product. The timeline announced today gives us ample opportunity to work with ministries of health, donors, communities, and Merck to plan for broad access to the monthly PrEP pill. This option lends itself to innovative delivery models – from pharmacies to community-based distribution approaches. While trials are still enrolling, we have the time to collectively ensure models are well-conceived and planned, adequately funded, and set up for success. With this timeline in hand, there’s no excuse for getting it wrong.”

“Merck’s early access announcement represents significant potential time-savings, compared to the experience with cabotegravir (CAB) and lenacapavir (LEN) in both timeline for licensing, and inclusion of those with greatest need. With three generic manufacturers in Kenya, Uganda, and South Africa included, these agreements go beyond those put in place for CAB and LEN and help to ensure that countries with some of the highest HIV burdens and largest PrEP markets will be able to make the product locally, should alimatravir prove safe and effective in phase 3 trials,” Warren added. “But while these voluntary licenses are essential, they are not sufficient on their own to translate exciting science into public health impact. Ultimately, access is about far more than licensure alone.”

Merck has worked with communities and advocates throughout the development of alimatravir, as exemplified by community representatives helping conceptualize the design of the phase 3 trials, even before Merck spoke to regulators. “We’ve appreciated the partnership between Merck and advocates in the research process. We’re seeing that commitment to community priorities translate into product introduction and access steps. As advocates, we will continue to watchdog this space, ensure communities remain at the center of access planning as it moves forward, and ensure accountability among all stakeholders,” said Stacey Hannah, AVAC’s Director of Research Engagement. 

Every step in the process of moving a product to market can and should go faster with alimatravir than it went with CAB and LEN. To ensure the monthly PrEP pill is introduced and broadly accessible with speed, scale, and equity, AVAC and Access Bridge call on the broad range of stakeholders ensure these critical actions take place:  

• Merck/MSD, governments, and donors to commit to reach at least two million people with alimatravir within the first year of product launch and five million people within the first two years.  

• Merck/MSD to agree to sell the product to any public health procurer or donor at a price no more than the price of generic daily oral PrEP and injectable lenacapavir. 

• Merck/MSD to guarantee that alimatravir will be available in low and middle-income countries within three months of first approval; halving the timeline it took for LEN to become available.  

• Merck/MSD to articulate a transparent and robust plan for ensuring affordable, equitable access to alimatravir in Latin America, with a specific priority on countries hosting the EXPrESSIVE 11 trial, and direct work with advocates to navigate country specifics where voluntary licenses are not in place.  

• WHO to accelerate the guidelines development process.Merck/MSD to clarify its regulatory strategy and prioritize broad regulatory submissions in parallel with its FDA submission, working with the WHO’s Collaborative Registration Procedure, the EMA’s Medicine4All program, and the African Medicines Agency. 

• Donors working with WHO and ministries of health to design and embed a robust implementation science agenda within programmatic rollout to answer critical questions, particularly about adherence, for this new, monthly method of prevention, as part of introduction.  

• All stakeholders to create and plan now for innovative service delivery that continues to simplify PrEP, working with private pharmacies, community-based organizations, and other innovative service delivery efforts.

• National governments start to prepare ambitious and costed implementation plans, guidelines, and comprehensive programs to integrate alimatravir into existing HIV prevention programs.

“Today’s announcement shows that the HIV prevention field can learn and apply lessons in real time. LEN for PrEP is now in limited distribution in ten African countries within two years of proven efficacy; this was a huge step forward, but we as a field can still do better,” said Wawira Nyagah, executive director of Access Bridge. “Now is the time to plan for even speedier and wider access if alimatravir works. This must include pricing transparency from Merck and their generic licensees, accelerated investments by donors to design and implement integrated programs that offer the monthly pill as part of choice of product and service delivery models that actually reach people who need and can benefit from it, everywhere, based on public health imperatives, and not on World Bank country classifications or geographical location. Anywhere the HIV epidemic is increasing must be included, full stop.”

For more than a decade, AVAC has mapped the roadmap and timelines for moving PrEP products from earliest research stages to market. With each successive option, AVAC has flagged what is failing, where the global community is watching, where things are improving, and where there’s room to do better still. As a result of this work, the global community is executing better, faster, more inclusively, and more equitably with every new option. Learn more about AVAC’s work on alimatravir. AVAC and Access Bridge will continue to monitor the research, approval processes and product implementation of PrEP options at https://avac.org/prevention-option/prep/ and www.prepwatch.org.

The future of HIV prevention won’t build itself—it will be built by communities. 
 
AVAC is proud to release the CASPR Impact Report: Celebrating Growth, Inspiring the Future, celebrating what is possible when long-term investment in African leadership, partnerships and coalition-based advocacy is matched with shared purpose. CASPR, the Coalition to Accelerate and Support Prevention Research, proved that community-led coalitions are central to turning innovation into action, and ensuring that advances in HIV prevention are shaped by the people they are meant to serve.  

From 2016 through 2025, CASPR built an Africa-led movement that connected communities, researchers, policymakers, journalists and funders to transform HIV prevention advocacy. At our recent webinar, The Future Won’t Build Itself: Lessons from CASPR and the Future of Africa-Led HIV Prevention Advocacy, CASPR partners Chilufya Kasanda, Ida Jooste and Yvette Raphael delivered powerful remarks on the impact of CASPR and how they’re carrying its legacy forward.

In addition, our latest blog post, by AVAC’s Breanne Lievense and Navita Jain and CASPR partner Barbra Ncube from Pangaea Zimbabwe, reflects on CASPR’s legacy and how community leadership shaped research agendas, improved accountability and helped accelerate the translation of scientific discovery into public health impact.

“As we honor CASPR’s legacy, let us carry forward African-led, evidence-based, community-grounded coalition advocacy from research to rollout.”

Yvette Raphael

Advocacy for Prevention of HIV and AIDS South Africa

“CASPR has shaped the prevention landscape in Africa and globally. By fighting for community-centric research agendas, and for research to move to rollout as efficiently and equitably as possible, this global network of advocates has helped improve prevention options and realities for their communities, countries, and the world.”

Stacey Hannah

AVAC, CASPR Director

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Coming Up

Several CASPR partners will be leading key discussions next week at the AIDS 2026 conference in Rio de Janeiro, Brazil. AVAC’s roadmap lists the key HIV prevention sessions at the conference you won’t want to miss, and we’ll be covering conversations and events at the conference in real-time. Be sure to join us at the HIV Cure and Prevention Research Networking Zone in the Global Village where delegates, researchers, advocates and community members can come together for interactive discussions, expert-led sessions and networking. Follow along on social media and find updates on our AIDS 2026 page. 

More than half a million comments were submitted in response to the White House’s proposal to politicize federal research grants – with a significant majority opposing it. At the same time, questions mounted over the future of the CDC, PEPFAR, and the Administration’s vision for transitioning US global health programs. This week also features reflections from former USAID global health leader Atul Gawande on the human cost of dismantling USAID and the likely discussions ahead at AIDS 2026 on the consequences of US policy changes for HIV programs and global health.

Scientists Respond to Escalating Political Attacks

As the assault on scientific independence continues on multiple fronts, an extraordinary response came from scientists, advocates, universities, professional societies and civil society organizations. It culminated in a wave of submissions as the public comment period ended on Monday for the White House Office of Management and Budget’s (OMB) proposed regulation to give political appointees greater authority over federal grant decisions. Nearly 500,000 comments were submitted and analyses published in STAT show nearly 95% opposed the proposal, with many warning it would replace independent peer review with political and ideological oversight, thereby undermining the integrity of publicly-funded biomedical research. At the same time, hundreds of scientists, public health leaders and advocates have signed an open letter supporting former NIAID Director, Anthony Fauci and others who have come under political attack for their work, arguing that defending scientists from intimidation is essential to protecting evidence-based policymaking and the integrity of the US scientific enterprise

IMPLICATIONS: The OMB’s proposed Regulation for Federal Financial Assistance “would politicize grantmaking, dismantle merit-based peer review and severely restrict professional infrastructure necessary for quality research,” AVAC wrote in its comment. While the 500,000 submissions may not stop implementation of this regulation, they could slow the roll-out, set-up impending legal challenges and bolster congressional efforts to intervene. However, together, this all points to growing community recognition and collective action around the importance of safeguarding science now.

READ:  

• AVAC Comment Submission on the White House OMB Proposed Federal Financial Assistance Rule—AVAC
• Flood of comments on White House grantmaking overhaul is largely negative, analysis shows—STAT
• Comments Are Closed on OMB’s Grantmaking Proposed Rule. Now What?—MedPage Today
• Here’s what happens when you put politicians in charge of science—Science News

CDC Leadership and PEPFAR’s Future

The US Administration’s nominee to serve as Director of the US Centers for Disease Control and Prevention (CDC), Erica Schwartz faced questions at her Senate confirmation hearing where members pressed her on vaccine science, scientific independence and the CDC’s future under Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. Schwartz was criticized for failing to provide direct answers to questions on vaccine safety, political interference in science and CDC guidance. At the same time the hearing was taking place, 84 partners submitted a letter urging Congressional leadership to intervene after the US Department of State confirmed plans to phase out or fundamentally restructure the CDC’s role in implementing PEPFAR, including allowing more than 100 CDC awards to expire without clear replacement mechanisms and transitioning the agency to a fee-for-service technical assistance model.

IMPLICATIONS: Schwartz’s testimony and inability to provide clear responses on vaccine science and scientific independence reinforces concerns about the CDC’s future in evidence-based decision making. This, plus the potential ending to long-standing transfer of PEPFAR resources to CDC, leaves many questions about the CDC’s future role and independence. As the 84 organizations wrote, “coming on the heels of USAID’s closure in 2025, this change removes the last institutional anchor of a proven, lifesaving program. This shift will pull the plug on lifesaving treatment programs serving millions of patients today and destroy public health systems keeping Americans safe from the health threats of tomorrow.”

READ:

• She blew it. CDC Director nominee tanks in Senate hearing.—Inside Medicine
• CDC Director Nominee Pressed on Vaccines at Senate Hearing—MedPage Today
• Top Trump official out at CDC. Agency now without Chief of Staff or Acting Director.—Inside Medicine
• Experts warn that sidelining CDC threatens PEPFAR’s future—Devex
• Sign-on Letter to Protect CDC PEPFAR Programs—Partners in Health
• Project 2025 and the Federal Science Enterprise: Implementation, Congressional Response, and Impact — An 18-Month Assessment—Joel Widder Substack

Eighteen Months Later: Global Health in Transition 

Just over 18 months into the new US Administration, global health leaders continue to reflect on the human and institutional consequences of the dismantling of USAID and the restructuring of PEPFAR. While greater country ownership has been a shared goal across multiple Presidential Administrations, abrupt funding cuts and weakened technical partnerships risk undermining decades of progress. As former USAID global health leader Atul Gawande said on The New Yorker Radio Hour, “We’ll halt worsening the damage, but it’ll take joint effort to actually stop it and regain our momentum.” Chris Collins of Friends of the Global Fight similarly argues that if the Administration is serious about transitioning from donor-led programs to sustainable national systems, it must pair that vision with predictable financing, stronger country capacity and a deliberate transition plan rather than an accelerated withdrawal

IMPLICATIONS: As implementation of the US Secretary of State’s US global health strategy becomes clearer and the Administration’s bilateral health agreements moves forward, focus must shift to the practical realities of achieving it without reversing gains in HIV epidemic control or weakening broader global health security. These questions will take center stage at AIDS 2026, where multiple sessions will examine the consequences of US policy changes for HIV programs and the future of global health cooperation. See AVAC’s roadmap and resources for Rio.

READ: 

• The Human Cost of DOGE’s War on U.S.A.I.D.—The New Yorker
• What it will take to make Secretary Rubio’s vision for global health aid transition a reality—Friends of the Global Fight
• Guess Who Owns “Country Ownership” and CDC turf?—To End a Plague … Again Substack
• Five Things I’ll Be Watching at AIDS 2026—Lights. Camera. Equity! Substack

What We’re Reading

• PrEP uptake collapses by 80pc as donor funding dries up—The Nation (Kenya)
• Taking A Shot: Is Africa Closer to Ending AIDS?—Forbes
• Global Fund proposal to scrap evaluation team draws board pushback—Devex
• Search for new Global Fund Executive Director intensifies—The Lancet
• Emails Detail Confusion in State Department over Trump Plan to Destroy Contraceptives—Washington Post
• CASPR Impact Report—AVAC
• Guideline on doxycycline post-exposure prophylaxis for sexually transmitted infections among men who have sex with men and transgender women—WHO
• First patients enrolled in record-breaking Ebola treatment trial in DRC—The Guardian
• Global Fund Approves Emergency Funding to Protect HIV and TB Services in Venezuela Following Earthquakes—Global Fund
• Faith groups urge White House to release funding for HIV/AIDS prevention—The Hill  

By Breanne Lievense, Barbra Ncube & Navita Jain

The future of HIV prevention will depend not only on scientific breakthroughs, but on advocacy to bring those breakthroughs to communities to achieve impact. With global health undergoing profound change, the way forward requires new models of collaboration that are community-led, locally owned and sustainably funded. The Coalition to Accelerate and Support Prevention Research (CASPR) offers one such model for the field as we collectively work to end the HIV epidemic.

AVAC’s newly released CASPR Impact Report: Celebrating Growth, Inspiring the Future shows what is possible when long-term investment in African leadership, partnerships and advocacy is matched with shared purpose. CASPR proved that community-led coalitions are not just a complement to scientific progress, but are central to this progress. They have proved to be essential to turning innovation into action and ensuring that advances in HIV prevention are shaped by the people and communities they are meant to serve.

CASPR was funded by the United States Agency for International Development (USAID) and designed by AVAC in collaboration with 13 partners. The project was intended to run from 2016 through 2026, but was paused in early 2025 amidst sweeping cuts to US federal funding for foreign assistance and the dismantling of USAID. During its eight years, CASPR built an Africa-led movement that connected communities, researchers, policymakers, journalists and funders to transform HIV prevention advocacy. CASPR strengthened community leadership, shaped research agendas, improved accountability and helped accelerate the translation of scientific discovery into public health impact.

CASPR built an intergenerational movement that influenced HIV policy, research and implementation. For example, CASPR partners played a pivotal role in ensuring the PURPOSE trials (studying injectable lenacapavir for PrEP) centered affected communities from trial design to results dissemination. CASPR members chaired the PURPOSE 1 global community advisory group (GCAG), held six of its eight seats and ensured young women were included on the GCAG and in the research, from the start. The GCAG also ensured the trial protocol allowed pregnant and breastfeeding individuals to remain in the trial after re-consent, and the Civil Society Caucus for Long-Acting PrEP (a CASPR-supported initiative) pushed Gilead to publicly announce a commitment to ensuring equitable access. CASPR made certain that the trials were conducted ethically and included communities, setting a standard for future clinical research.

At the same time, CASPR partners established the African Women Prevention Community Accountability Board (AWPCAB) as a network led by and for African women, advocating for sustained financial and political commitment to HIV prevention choice. The AWPCAB launched the Choice Manifesto in 2023, securing commitments and endorsements from high-level stakeholders such as Winnie Byanyima, Executive Director of UNAIDS, representatives from USAID and African ministries of health. The Choice Manifesto shifted the global narrative on choice in HIV prevention, elevating it as core to achieving equity in the HIV response. With the Choice Manifesto in hand, CASPR partners achieved significant policy wins, like the inclusion of the Dapivirine Vaginal Ring in the Zambia Consolidated Treatment and Prevention Guidelines.

CASPR also redefined how – and by whom – HIV prevention research priorities are set by ensuring that communities most affected by HIV have a direct voice in shaping the research agenda. CASPR developed the People’s Research Agenda (PRA) through a collaborative process with 138 advocates and community representatives from 23 countries. The PRA puts forward community-driven recommendations to strengthen and diversify the HIV prevention research and development (R&D) pipeline, increase investment in prevention research and guide advocacy that reflects the needs of communities from research to rollout. First launched in 2024 and updated in 2025, the PRA serves as a living accountability tool that continues to guide advocates, researchers and funders in ensuring that HIV prevention R&D remains responsive to the people it is intended to serve. It also now provides ongoing analysis of the pipeline of products in various stages of research and development.

Through CASPR, and building on and incorporating the long-standing AVAC Advocacy Fellows program, more than 700 advocates were mentored, almost 400 adolescent girls and young women were trained in HIV prevention literacy and advocacy and emerging leaders across 15 countries strengthened their capacity to influence HIV prevention research, policy and implementation.

“Before the fellowship, I never imagined I could convene high-level policy dialogues, engage decision-makers or negotiate for stronger HIV prevention responses,” said 2022 AVAC Fellow Ruth Akulu. “The fellowship built my capacity, strengthened my confidence and helped me recognize my ability to lead and influence change.” Today, Ruth is the founder and Executive Director of HopeStone Insight Uganda, a forward-thinking organization that seeks to influence economic policy to advance equitable health outcomes and access to quality healthcare.

In addition to advocates, CASPR engaged journalists as essential partners in translating HIV prevention science and fostering public trust. CASPR held over 200 Media Science Cafés, equipping hundreds of journalists across six countries with the knowledge and skills needed to report HIV prevention science accurately. Convened by local journalist organizations, cafés are informal gatherings that bring together journalists, scientists and advocates to discuss the latest HIV prevention and public health updates. The Café program supported by CASPR forged critical cross-sector relationships and facilitated accurate journalism, ultimately leading to community trust of science and R&D. Café journalists played an especially important role in facilitating trust in the wake of complicated or disappointing results, mobilizing their network within hours of results announcements to translate information for the public, ensure robust community engagement and champion continued research efforts.

CASPR succeeded because it invested deeply in local organizations and embraced shared power, co-created strategy and African leadership. CASPR demonstrated the power of coalitions for generating sustainable advocacy, but that building a coalition takes time. After eight successful years of global coalition-building, CASPR leaves five enduring lessons that will continue to shape the future of HIV prevention advocacy: 

• Shared goals create stronger, more resilient coalitions capable of sustaining collective action through changing political and funding landscapes. 
• Long-term relationships build trust, effectiveness and collective impact, enabling organizations to move beyond coordination towards genuine collaboration. 
• Diverse expertise strengthens learning, innovation and problem-solving; it drives effective advocacy anchored by the complementarity of partner strengths. 
• Documenting and communicating successes is essential for visibility, influence and sustainability. 
• Intentionally investing in young people and women builds the next generation of advocacy leaders, equipped with confidence, credibility and purpose. 

CASPR’s legacy lives in the resilient organizations and networks it incubated such as the AWPCAB and the Civil Society Caucus, which ensure communities drive HIV prevention research and access, as well as in the tools and resources created for advocates, journalists, policymakers and researchers that are still used today to translate HIV prevention research to rollout.

The foundation built by CASPR is also shaping what comes next. As new networks form and the landscape evolves, CASPR partners and other experienced civil society organizations and advocates from East and Southern Africa are engaged in discussions around what comes next for the future of HIV prevention advocacy and mentorship. Advocates are finding innovative ways to advance a renewed vision for African-led HIV prevention advocacy—one that is collaborative, resilient and designed for the challenges ahead. These initiatives are vital so that communities continue to shape the future of HIV prevention—not simply respond to it.

“One of the many things I take with me [from CASPR] is that when you invest in leadership, even when the program or the project closes, the infrastructure remains.”

Rosemary Mburu

Executive Director of WACI Health

The lesson from CASPR is clear: strong, community-led advocacy will safeguard the future of HIV prevention. Coalition models build resilience, strengthen accountability and ensure that scientific advances translate into equitable access. But these networks require sustained investment, trust and time to flourish. With the shift in global health funding, now is the moment to invest in the leaders, partnerships and platforms that have already demonstrated their impact.