The US presidential administration released its full US FY26 budget proposal on Friday, and it includes a series of devastating cuts that threaten to roll back HIV prevention efforts in the US and globally by decades. In a cruel irony, this proposal comes just as the field reaches a moment of historic promise in HIV prevention. 

Lenacapavir (LEN), the twice-yearly injectable form of HIV PrEP, is expected to be approved by the US Food and Drug Administration (FDA) later this month, and WHO is expected to release a recommendation and guidelines in July. Named Science magazine’s 2024 “Breakthrough of the Year,” LEN for PrEP represents the culmination of decades of investment in the earliest stages of scientific innovation, from basic science to global partnerships.  

LEN for PrEP shows what’s possible when the world invests in HIV prevention. However, the NIH is initiating a new policy to prevent international research, including within the HIV clinical trial networks, other HIV clinical trials are halted, leading HIV vaccine discovery research is terminated, and PEPFAR prevention programming is defunded.  

Just how important is basic science research to product development? And how vital is the South African research infrastructure for innovation in HIV and TB? Well, as just one example, without NIH investments over the past two decades, the world would not be on the cusp of approval and introduction of LEN for PrEP. 

Join us on Wednesday, June 11 at 11am ET for an essential conversation on what’s at stake. 

The Scientific Journey of Lenacapavir: From basic science to clinical development to impact

Learn how sustained US support from NIH discovery science to South Africa’s clinical research infrastructure made the development of LEN for PrEP possible. 

Speakers include: 

• Wes Sundquist (University of Utah), on the early-stage science behind capsid inhibitors. 
• Linda-Gail Bekker (Desmond Tutu HIV Foundation), on the PURPOSE 1 trial in South Africa, where not a single HIV infection occurred. 

This couldn’t be more timely, or important! This Thursday, Dr. Sundquist, Moupali Das of Gilead Sciences and Yvette Raphael of Advocates for the Prevention of HIV in Africa (APHA) will be honored together by the American Association for the Advancement of Science (AAAS) with the Mani L. Bhaumik Breakthrough of the Year Award for their leadership in the discovery and development of LEN for PrEP. Their roles in advancing LEN as an option for HIV prevention show what’s possible with well-funded basic research, international collaborations and community-centered priorities. 

Advances like these take time, money, support, commitment and global partnerships. Defending why research matters depends on understanding its value and telling its story. The field must urgently make the case for sustained investment. Join us June 11 and see more resources to support your advocacy below. 

This week we see new developments that could reshape global health financing and US policies on science and research, including the release of the full FY26 budget, which is expected later in the day. From a potential operational collaboration between the Global Fund and Gavi to more intense threats to NGO funding, foreign aid, and vaccine guidance, this issue shares the implications of rising political pressure. Read on.

Global Fund and Gavi Collaboration

The Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi are in discussions about working more closely together and combining certain administrative and operational functions. Driven by the major cuts from the US government as well as other governments in the run-up to replenishment processes for both, these two leading global health organizations are looking to collaborate to enhance efficiency and reduce redundancies at the country level.  

IMPLICATIONS: The Global Fund and Gavi are looking to coordinate more closely and find efficiencies. This potential collaboration underscores what may be a broader trend in global health financing to maintain critical health services worldwide. 

READ: Global vaccine and health bodies could team up more to tackle US-led funding crisis—Reuters

Upcoming Congressional Hearing Targets NGOs

For US advocates and NGOs, next week’s House Subcommittee on Delivering on Government Efficiency (DOGE) hearing, “Public Funds, Private Agendas: NGOs Gone Wild”, will be one to watch. The Committee, chaired by Representative Marjorie Taylor Greene, will scrutinize the use of federal funds by NGOs. In an announcement, the Committee wrote, “NGOs have expended billions of hard-earned taxpayer dollars in pursuit of agendas that most Americans oppose… Congress must also act to shut down the pipeline that keeps this money laundering machine running.” 

IMPLICATIONS: The US Congress plays a pivotal role in shaping the future of science and research through its oversight, funding and policy making. Hearings like this can influence which initiatives are protected or targeted. AVAC and partners will monitor this hearing as part of our work to tracking threats to evidence-based advocacy, research, and decision making. 

Watch the Livestream: June 4, 2025 at 2:00 pm ET

Elon Musk Leaves White House After Driving the Efficiency Cuts 

Elon Musk is leaving his unofficial role as an advisor in the new US administration after he oversaw the gutting of federal agencies, foreign aid and fired thousands of federal workers through his Department of Government Efficiency (DOGE) initiative. Musk’s departure comes days before his temporary appointment was set to expire May 30, and follows declining sales of his Tesla brand cars and his criticism of the FY26 spending bill, which would add trillions to the national debt. 

IMPLICATIONS: Musk’s departure marks an end to a chaotic period of continuous cuts and firings by the new administration that upended global health, research funding, and foreign aid, and will take significant time and effort to repair.  

READ:  

• Elon Musk Leaves Trump Administration Amid Rift over “Big, Beautiful Bill”—Democracy Now 
• After four months of disruption, Elon Musk signals he’s leaving government—Politico  

The Latest on Foreign Aid Cuts 

The new administration is attempting to make official major budget cuts under DOGE, including those to foreign aid. The US president will submit a $9.4 billion “rescissions” package to Congress next week, but this week, as the administration is expected to release of the full FY26 budget today, many Democrats are pushing back and asking whether the cuts are smart or legal. Sen. Patty Murray and Rep. Rosa DeLauro are warning that the Office of Management and Budget’s refusal to provide required budget details is making it hard for Congress to plan the FY26 budget and hindering the FY26 appropriations process. And House Foreign Affairs Committee Ranking Member Gregory Meeks (D-NY 5) and Rep. Sara Jacobs (D-CA 51) have asked the GAO to investigate whether the dismantling of USAID and cancellation of thousands of contracts have actually saved money. 

IMPLICATIONS: The coming weeks will be important as Congress will either reassert independence in its control over the US’ investments in science and foreign aid or rubberstamp the White House agenda.  

READ:  

• Top Democratic appropriators accuse Vought of obfuscation—Politico Pro 
• Top Democrats ask GAO to assess impact of foreign-aid cuts—Politico Pro 
• White House plans — at last — to send some DOGE cuts to Hill—Politico  

US Avoids Due Process and No Longer Recommends COVID-19 Vaccine for Certain Populations

The US administration is no longer recommending COVID-19 vaccines for healthy children or people who are pregnant. Health and Human Services Secretary Robert F. Kennedy Jr. announced this change in social media after bypassing the traditional CDC advisory process.  

IMPLICATIONS: This action could significantly undermine vaccine access, insurance coverage, and public trust in health guidance. 

READ/LISTEN: 

• RFK Jr drops Covid-19 boosters for kids and pregnant women from CDC list—The Guardian 
• RFK Sends a Message on Vaccines—The New York Times 

What We’re Reading

• Rubio’s claim that it’s ‘a lie’ that people have died from foreign-aid cuts—Washington Post
• Frontline AIDS launches Transition Initiative to secure the future of HIV services—Frontline AIDS
• An NIH Grant Is Restored, With a Catch: Cut a Study on Trans Youth—Chronicle on Higher Education
• NIH staff stage walkout during director’s town hall as tensions persist over research cuts, ideology—CNN
• African Nations Ask WHO for Increased Funding as Global Health Aid Hits Decade-Low—Health Policy Watch
• The UK should be taking the lead on international aid – not abandoning women and girls around the world—The Independent
• The White House keeps promising ‘lifesaving’ aid that’s not coming—Washington Post

Resources

• US Global Health Country-Level Funding Tracker, KFF
• An Update on PEPFAR Reauthorization, KFF
• Impact Metrics Dashboard
• Advocates’ Guide: Understanding the President’s Proposed Fiscal Year 2026 (FY26) Budget and Its Implications for Science, Research and Global Health—AVAC
• Critical Advocacy: How Civil Society is defending the HIV Response and Global Health—AVAC
• Research Matters—AVAC, HIVMA, TAG

By Mitchell Warren, first appearing on Devex.

Right now, the US global AIDS response could best be described as rearranging deck chairs while the ship drifts entirely off course.

We are not witnessing bold reform, but an intentional unraveling of America’s legacy in global health. And it’s happening without the congressional engagement that has, historically, yielded such remarkable success.

Reimagining and realigning global health programs is not inherently bad. In fact, it was a spirit of reimagination that led to the creation of the President’s Emergency Fund for AIDS Relief, or PEPFAR, the most successful global health program in our country’s history. But we were off track on global targets related to HIV before January 20. To right the ship requires a thoughtful, intentional strategy. That is not what is happening.

Before Donald Trump’s second presidential inauguration, we were lagging behind in progress toward established HIV targets due to COVID-19, among other factors. But now, we are in a parallel universe entirely.

Once Upon a Time, When Rubio Supported PEPFAR

In the original PEPFAR legislation, Congress intentionally included a direct line of accountability from the global AIDS coordinator, who oversees the program, to the US Secretary of State. That structure mattered — both for US credibility abroad and for effective, data-driven results at home.

In his hearings on Capitol Hill last week, Secretary Marco Rubio shared details around the administration’s proposed plan to restructure the State Department. These changes would marginalize the program, moving it to report to the under secretary for economic growth, energy and environment oversees. This creates an additional, wasteful, and ineffective layer of bureaucracy. It also consolidates authority under a State Department with diminishing health expertise, due to the dismantling of the US Agency for International Development, which means the intellectual capital of hundreds, if not thousands, of global health experts has been lost.

Again, realignment is not a bad thing. But there are core principles that must guide any change to PEPFAR’s structure — sustainability, local ownership, transparency, and comprehensive prevention. Once we have aligned around these principles, only then can we have conversations about the right level and structure of the program. Conversations around both principles and structure must include Congress.

PEPFAR’s incontrovertible success has been possible only through bipartisan and bicameral support. The program has been upheld for more than two decades through rigorous congressional oversight. Members of Congress — Republican and Democrat — have long demanded accountability, performance, and results. And they got them.

Ongoing assessment is built into the very fabric of the program. Throughout its 20 years and across multiple presidential administrations, PEPFAR’s strategy, operations, and impact have continually been evaluated to ensure it remains successful. Each global AIDS coordinator has talked about going to Capitol Hill to defend PEPFAR’s budget. And, every year, that defense was successful, including during Secretary Rubio’s tenure on the Senate Foreign Relations Committee.

In fact, no one knows better than Secretary Rubio — who served on the US Senate Foreign Relations Committee from 2011 until his confirmation as secretary of state — what it means to be a member of the committee overseeing PEPFAR’s impressive data. Then Sen. Rubio has said of PEPFAR: “The dividends it pays from a human element are extraordinary, and you need to look no further than Africa, where millions of people are alive because the United States pays for their antiviral medication.”

HIV Treatment, Prevention and Integration into Global Health Agenda

A sustainable HIV response means saving lives, consistently, predictably, and comprehensively. PEPFAR realignment should be driven by how best to sustain impact. And sustainability should not be interpreted as strictly financial. With 1.3 million people newly infected each year, we can’t just treat our way out of an epidemic, we must also prevent.

Right now, there are nearly 40 million people living with HIV globally; more than 30 million are on lifesaving HIV treatment. Under the Trump administration, PEPFAR’s focus is solely on treatment, with no prevention treatment for anyone except pregnant and breastfeeding women. 

Sustaining impact requires that national governments don’t just own their own responses; they must also fund them. To ensure that people don’t fall out of treatment, that needs to happen in a comprehensive way. In addition to treatment and prevention, an effective strategy needs to integrate the HIV response into the broader global health agenda.

PEPFAR doesn’t need a departmental reorganization. What it requires is congressional recommitment to protecting the program’s mandate and ensuring it stays focused on what it does best: saving lives through data-driven, evidence-based health programs. PEPFAR represents a 21-year congressional legacy of bipartisan, bicameral support that has fundamentally changed the trajectory of the epidemic.

Through deep congressional engagement, we have changed the way the response to HIV is designed, funded, and monitored. And we’ve had a game-changing impact on global health security and diplomacy.

If the administration is intent on unraveling America’s legacy in global health, Congress must veto that agenda. It must preserve PEPFAR’s integrity and the US’s commitment to the goal of ending HIV as a public health threat.

We don’t need to rearrange deck chairs. We need political courage. Lives depend on it.

This May 18^th, HIV Vaccine Awareness Day (HVAD), comes as HIV vaccine science and collaboration have never had more promise — and as AVAC celebrates its 30^th anniversary. When AVAC began in 1995, we were the AIDS Vaccine Advocacy Coalition, founded to speed research and development, grounded in equity, for an HIV vaccine. As the potential of PrEP and other HIV prevention emerged, we broadened our focus to ensure progress across the pipeline of prevention research, and to advocate for delivery and access to new interventions.

HVAD 2025 comes as the US presidential administration is actively working to dismantle HIV research and demolish the architecture of global health. The entire HIV response — from basic research and clinical development to policy, programs, and global access to life-saving treatment and prevention — is now under attack, and the world runs the risk of reversing the strides made to end HIV.

These threats to the HIV response could not have come at a more critical time for prevention. Regulatory approvals and introduction of injectable lenacapavir for PrEP are imminent; the first ever ARV-based, dual-purpose product to prevent pregnancy and HIV is also poised for rollout; and a range of next-generation products, including new HIV vaccine approaches, to meet diverse user needs was being ushered through upstream development—all work that benefitted from US funding that is now in jeopardy.

To put all of this in perspective, AVAC has put together a report, HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts, highlighting the impact of US cuts on the pipeline of HIV prevention research and development. AVAC will continue to track these cuts and their impact, to amplify the damage they will cause, and to fight for their reversal.

The backbone of all these efforts is science — from basic discovery, to clinical research, to implementation projects — to which US support has been fundamental. A classic example is lenacapvir for PrEP. Without NIH-funded basic science, the capsid inhibitor, which targets the shell of the HIV virus and is the basis of lenacapavir would not have been discovered. And without long-term investments in research infrastructure in South Africa, the PURPOSE 1 and 2 lenacapavir efficacy trials would not have demonstrated efficacy so quickly and clearly. Stay tuned for our upcoming webinar in June, The Scientific Journey of Lenacapavir: From basic science to clinical development to impact to learn more about this remarkable story.

For decades, both sides of the aisle of US politics have recognized that this work brings our country prosperity, security, improved health and pride. With the quest for an HIV vaccine now in early upstream R&D, the story of lenacapavir for PrEP shows the essential importance of bipartisan political support for the NIH; the need to invest in long-term global research capacity; the power of public-private partnerships; and the essential role of community engagement and advocacy to accelerate R&D and delivery.

For more testimony about these issues, you can also watch a new video documenting the 25years of progress and leadership of the NIH-funded HIV Vaccine Trials Network (HVTN).

This HVAD, AVAC invites you to join us in the fight to protect, sustain and rebuild. The webinars and resources provided below frame the issues and include tools and key messages for your advocacy!

Webinars

• May 16 at 9am ET, Recent Advances in Eliciting Broadly Neutralizing Antibodies (bNAbs) for HIV-1 Vaccine Development
  Global HIV Vaccine Enterprise
  
  Explores cutting-edge approaches in HIV-1 vaccine development. Experts will discuss innovative immunogen design, B cell maturation strategies, and key findings from clinical and preclinical studies. Learn how translational research is shaping the next generation of HIV vaccines. Register

• May 28 at 9am ET, HIV Prevention at a Crossroads: Why we still need an HIV vaccine
  Global HIV Vaccine Enterprise and IAVI
  
  Discusses the continued need for an HIV vaccine in the context of the expanding HIV prevention landscape and uncertain geopolitical environment. Panelists and audience members are invited to explore the potential public health impact of an HIV vaccine, including related socioeconomic and equity considerations. Participants will further reflect on the rising threat to vaccine science and why investments in HIV vaccine R&D remain a strategic priority in the global HIV response. Register

• June 11 at 11am ET, The Scientific Journey of Lenacapavir: From basic science to clinical development to impact
  AVAC
  
  Join us for the compelling story of the development of lenacapavir and the critical role of US support. Wes Sundquist, from the University of Utah, will share the story of capsid inhibitor discovery; and Linda-Gail Bekker, from the Desmond Tutu HIV Foundation, will discuss the critical role of South Africa in clinical development; all of this work, backed by long-term US support. Register

Resources

• Jatt LP, Mgodi NM, Buchbinder SP, Gray GE, Kublin JG. An HIV Vaccine in the Era of Twice-Yearly Lenacapavir for PrEP – Essential or Irrelevant? N Engl J Med. 2025 Apr 24;392(16):1561-1563. doi: 10.1056/NEJMp2415893. Epub 2025 Apr 19. PMID: 40260855.
  
• HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts, AVAC’s analysis of the impact of US Government funding cuts, terminated projects, and other policy changes on the HIV prevention research and development (R&D) pipeline, and on HIV research broadly.
  
• Research Matters – Resources to Protect Research Funding, AVAC, TAG and the HIV Medicine Association (HIVMA) co-created a new resource hub, Research Matters, to support advocacy for sustained NIH funding.

Share Your Story

Additionally, AVAC and partners are collecting stories of impact—if you know someone willing to share their story about how NIH cuts are affecting their work, contact John Meade Jr. at [email protected]. This HuffPost article by Katie Edwards, from the University of Michigan, is a terrific example of a researcher sharing the real-world toll on scientists, trial participants, communities, research and public health.

Thank you for standing with us to protect science, health, and progress.

This week’s issue covers the Secretary of Health and Human Services’ defense of deep NIH budget cuts before Congress, leadership changes at WHO, and the latest update in AVAC’s lawsuit attempting to halt the US foreign aid freeze.

Importantly, this issue also includes new resources and analysis about the impact of the US administration’s short-sighted cuts on biomedical research. We at AVAC just launched a new report, HIV Prevention R&D at Risk: Tracking the Impact of US Funding Cuts, which puts the impact of the US government’s dismantling of HIV research and global health infrastructure into urgent context. And our colleagues at the Treatment Action Group (TAG), Médecins Sans Frontières (MSF), and the South African Medical Research Council (SAMRC) launched a new report detailing the specific impacts of funding withdrawal on HIV and TB research in South Africa.  

As HIV Vaccine Awareness Day approaches this Sunday, May 18, we spotlight what’s at stake as the entire HIV response—from basic discovery, to clinical research, to access, and equity—is under attack. Read on for more.

HHS Secretary Defends Proposed FY26 Budget in Front of US House and Senate

On Wednesday, Secretary of Health and Human Services Robert F. Kennedy Jr. testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies and the Senate Committee on Health, Education, Labor and Pensions (HELP) to try and defend the US administration’s proposed Fiscal Year 2026 (FY26) budget. The proposed budget calls for a nearly $18 billion cut to the National Institutes of Health (NIH). In response to questioning, Kennedy repeatedly cited the need to reduce “waste” and redirect funds toward chronic disease prevention and domestic health programs. He continually denied that the cuts to the workforce and funding have harmed ongoing clinical trials and falsely claimed that research grant terminations have resulted in no scientists losing their jobs. He signaled support for biomedical research only if it aligns with “Gold Standard science” and US national security interests. 

In advance of the meetings, US Senator Bernie Sanders (D), released a report documenting “Trump’s War on Science”. See AVAC’s new resource hub Research Matters: Resources to Protect Research Funding,  co-created with TAG and the HIV Medicine Association (HIVMA), to support researchers advocating for sustained NIH funding and see the letter AVAC and more than a dozen partners submitted to the Senate HELP Committee urging lawmakers to reject the cuts to NIH funding for HIV, TB, and STI research and highlighting the impact of these cuts on lifesaving innovation and research infrastructure. 

IMPLICATIONS: Kennedy’s testimony confirmed the administration’s intent to permanently reshape the federal public health infrastructure. If the proposed budget is enacted, these changes could devastate HIV prevention research, halt progress on new tools like injectable PrEP, and silence inclusive science.  

READ: RFK Jr. Acknowledges Proposed NIH Cuts Will ‘Hurt’—Newsweek

WHO Restructures

The World Health Organization (WHO) announced major cuts to its headquarters and the departures of long-time leaders in response to the $1.7billion shortfall and pressure to decentralize operations. Jeremy Farrar, former head of the Wellcome Trust and current WHO Chief Scientist, will lead the largest division on Health Promotion, Disease Prevention and Control — one of the four new divisions in the organization. Sylvie Briand will replace Farrar as the new Chief Scientist. Up to 40% of headquarters staff may be laid off and its 10 divisions will be consolidated into four.

Meanwhile, UNAIDS pushed back against merger proposals and plans under WHO’s UN80 initiative Task Force, which is tasked with reforming the UN system.

IMPLICATIONS: With WHO seeking to relocate critical infectious disease programs to the Global South, these changes could open space for more regionally driven research agendas. The changes also offer a chance to refocus country-led responses.  

READ:  

• BREAKING – WHO Director General Shakes Up Agency with Brand New Leadership Team—Health Policy Watch
• WHO’s Samira Asma Reportedly Leaving Tedros’ Leadership Team – UNAIDS Scraps Merger Plan—Health Policy Watch

Judge Denies USG’s Request to Restart Foreign Aid Freeze and Orders All Payments to Resume

In the ongoing AVAC vs. Department of State and Global Health Council vs. Trump lawsuits, the federal District Court denied a motion by the government for an indicative ruling regarding the preliminary injunction that is being reviewed on appeal by the US Court of Appeals for the DC District. Last month, the government asked the court to revisit its earlier ruling, citing a new Supreme Court decision, but this week, the judge rejected the motion, reaffirming that the freeze violated the law. The court also lifted a temporary pause it had placed on processing funds for non-plaintiff organizations, which means the government must now fully comply with the injunction and resume payments to all affected programs for work completed prior to February 13.

What We’re Reading

• Scientists go silent as funding cuts escalate—Science
• ‘What do we do with uncertainty?’ A former CDC director’s advice to new physicians and scientists—STAT
• US funding cuts have crippled our HIV work – what’s being lost—The Conversation
• Scientists Hail This Medical Breakthrough. A Political Storm Could Cripple It—The New York Times
• What is Trump’s ‘most favored nation’ drug pricing policy and how will it reduce costs? Explained—The Economist
• Q&A: HIV shot ‘must reach all who ask for it’—SciDevNet
• Institutionalizing politicized science—Science
• WHO and Medicines Patent Pool announce sublicensing agreement for rapid diagnostic test technology—WHO
• Breaking: RFK Jr. says Matthew Buzzelli, a lawyer with no public health experience, is the Acting CDC Director—Inside Medicine
• Why the 1 senator who can rein in RFK Jr. isn’t calling him out—Politico
• HIV RNA Testing Appears Unnecessary for Patients Taking Oral PrEP—TheBodyPro

Resources

• U.S. Funding Cuts Threaten 39 Research Sites in South Africa Putting Scientific Advancements and Hard Won Progress Against TB and HIV at Risk—TAG and MSF
• HIV Prevention R&D at Risk—AVAC
• Advocates’ Guide: Understanding the President’s Proposed Fiscal Year 2026 (FY26) Budget and Its Implications for Science, Research and Global Health—AVAC
• Worldwide Prevention, Shared Protection: Why STI Funding Matters—AVAC
• Critical Advocacy: How Civil Society is defending the HIV Response and Global Health—AVAC
• Research Matters—AVAC, HIVMA, TAG
• Impact of NIH Grant Terminations—Association of American Medical Colleges

Save the Date!

The US President’s proposed budget for next year includes sweeping cuts to the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), US Agency for International Development (USAID) and the elimination of vital global and minority health research programs.

These cuts represent an effort to extend legally challenged cuts made by executive order earlier this year, and to codify them into law with congressional approval. If successful, they will result in the drastic cut of US federal investments in global health research, development and delivery.

This initial “skinny budget”, introduced by the President, is a proposal and not yet law. A more detailed version will be released by mid-to-late May and the US Congress will ultimately decide funding levels for Fiscal Year 2026, which begins October 1. So, advocates must speak up now to protect funding for research and programming that saves lives and livelihoods. Read on for resources to support your advocacy.

• PxPulse Live: Critical Advocacy—How Civil Society is defending the HIV Response and Global Health, AVAC’s newest podcast episode maps out connections to economic justice and explores where advocacy must focus now. Featuring Asia Russell of Health Gap and Amanda Banda of the COMPASS Coalition in conversation with AVAC’s Director of Communications Kenyon Farrow.
• Advocates’ Guide: Understanding the FY26 Proposed Budget and Its Implications for Research and Global Health, AVAC’s Advocates’ Guide provides a snapshot of the impact of these cuts on biomedical research and programs that support health and development, and frames priorities for advocacy.
• Worldwide Prevention, Shared Protection: Why STI Funding Matters, AVAC’s brief on cuts to vaccine development for sexually transmitted infections and the broader STI landscape of research, testing and prevention in the US and globally.
• Science in the Crosshairs: Research Advocacy in a Time of Crisis, The Choice Agenda webinar exploring what these attacks mean for communities, researchers, and implementers. The conversation covers actionable advocacy strategies for fighting back. Moderated by Matthew Rose from the Human Rights Campaign, and features Sybil Hosek from University of Illinois – Chicago, Riko Boone and Lizzy Lovinger from TAG, John Meade from AVAC, and Nyaradzo Mgodi from University of Zimbabwe Clinical Trials Research Centre.
• Research Matters: Resources to Protect Research Funding, AVAC, TAG and the HIV Medicine Association (HIVMA) co-created a new resource hub, Research Matters, to support researchers advocating for sustained NIH funding. These tools include an Advocacy Toolkit to help move our collective efforts forward. Please share this link with any researchers who have received NIH funding—we will continue to update the hub with resources to support continued advocacy for biomedical research.
• AVAC and partners are collecting stories of impact—if you know someone willing to share their story about how NIH cuts are affecting their work, contact John Meade Jr. at [email protected]. This Huffington Post piece by Katie Edwards at the University of Michigan is a terrific example of a researcher sharing the real-world toll on scientists, trial participants, communities, research and public health.

Thank you for standing with us to protect science, health, and progress.

This week the proposed US Fiscal Year 2026 budget was released by the White House and would slash funding across the entire federal government, gutting the National Institutes of Health (NIH) and other agencies in the Department of Health and Human Services, and further reduce foreign assistance. In addition, a hostile critic of the US Food and Drug Administration (FDA) is appointed to lead its Center for Biologics Evaluation and Research, which oversees vaccines amongst other things. Also, the UN is looking at significant cost-cutting, with UNAIDS looking to shed more than half its staff, along with reports of possibly folding it into WHO. Read on for more. 

Join us later today for Science in the Crosshairs: Research Advocacy in a Time of Crisis, a webinar unpacking what these changes mean for communities, research, and advocacy, and how we can fight back.

FY26 Proposed Budget and Implications for Research and Global Health

The US presidential administration proposed a Fiscal Year 2026 (FY26) “skinny budget” that would drastically cut global health, HIV prevention, and biomedical research. While only a topline framework submitted to Congress (since Congress has the actual “power of the purse”), the budget proposes $163 billion in cuts to non-defense discretionary spending, including a 26% reduction to the Department of Health and Human Services (HHS), the department that oversees the US National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and FDA. The proposed budget would cut the NIH by nearly $18 billion, continue to gut USAID’s global health work, and eliminate research and programs on gender, DEI, and climate.  

IMPLICATIONS: This proposed skinny budget is an effort to embed into the formal budget process the cuts made by recent Executive Orders, which are being currently challenged in multiple court cases. If this proposed skinny budget is approved by Congress and becomes law, it would further decimate the infrastructure needed to accelerate science and innovation, hamper delivery of HIV prevention, stall progress on new tools like injectable PrEP, and weaken global preparedness for future pandemics. This is a profound retreat from science and equity.  

FIGHT BACK: Join us later today for a critical conversation, Science in the Crosshairs: Research Advocacy in a Time of Crisis where we will discuss the escalating threats to health research and equity-centered science. This webinar will explore the implications of the proposed FY26 budget and what these attacks mean for communities, researchers, and implementers, and will identify actionable advocacy strategies to fight back. 

READ:  

• Trump budget proposes unprecedented, ‘reckless’ cuts to foreign aid—Devex  
• Trump’s Reagan Moment on HIV/AIDS — Ratevosian Substack

Secretary of Health and Human Services will appear before Senate HELP Committee  

Secretary of HHS, Robert F. Kennedy Jr., will appear before the US Senate Health, Education, Labor, and Pensions (HELP) Committee on May 14 to discuss the FY26 budget proposal for the Department of Health and Human Services. 

AVAC and more than a dozen partners submitted a letter to the Senate HELP Committee for the record urging lawmakers to reject the cuts to NIH funding for HIV, TB, and STI research and highlighting the impact of these cuts on lifesaving innovation and research infrastructure. 

READ/WATCH:  

• Hearing on Fiscal Year 2026 Department of Health and Human Services Budget—Senate Help Committee 
• US Health Secretary Kennedy to testify before Senate panel May 14—Reuters

Potential Merger of UNAIDS and WHO

A confidential memo from the UN80 Initiative Task Force outlines proposals to restructure the UN system in response to budget pressures. This includes a potential merger of UNAIDS into the World Health Organization (WHO). The proposal frames this merger as a strategy to create a more “unified and efficient global health authority,” as UNAIDS faces deep financial uncertainty following the loss of US funding. In addition this week, UNAIDS announced that it will layoff more than 50% of staff in a massive restructuring. UNAIDS now plans to reduce the current number of staff from 608 to approximately 280 over time, according to a communique from the UNAIDS cabinet, seen by Devex. 

IMPLICATIONS: The merger would fundamentally reshape global HIV governance. It could shift the focus from civil society and multi-stakeholder advocacy and community leadership of UNAIDS to a more technocratic, health-systems-oriented approach under WHO. Such a move risks sidelining civil society voices and undermining the rights-based, equity-driven response that has been central to HIV progress for decades. 

READ:  

• Exclusive: Full Text of UN80 Task Force Pitch for Streamlined UN; UNAIDs Merger with WHO—Health Policy Watch 
• UNAIDS will lose more than 50% of staff in restructuring—Devex

Vinay Prasad to Lead US FDA Center for Biologics Evaluation and Research

Dr. Vinay Prasad, an oncologist and professor at the University of California, San Francisco, was appointed as the director of the US Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research (CBER). CBER oversees the regulation of vaccines, gene therapies, and other biologic products.  

IMPLICATIONS: Prasad has been critical of expedited reviews for vaccines and other biologics in the past. His appointment could slow approval of new innovations and shift the agency toward more ideologically conservative regulatory standards.  

READ:  

• Vinay Prasad tapped to run FDA center that regulates vaccines, gene therapies—STAT  
• FDA Commissioner Marty Makary taps Vinay Prasad to head up CBER—Fierce Pharma

New Plaintiff Joins AVAC vs. Department of State Lawsuit 

A new plaintiff, The Center for Victims of Torture, has joined AVAC’s lawsuit challenging the US government’s foreign aid freeze. Their inclusion underscores the urgent harm being caused to organizations as funding remains delayed or denied. Since April 23, the government has processed 59 payments for work completed before February 13. Seventy-nine payments remain outstanding. The government says these are more complex and is targeting May 15 as a deadline completion. They also note receiving 47 new payment requests from plaintiffs recently. 

READ: Center for Victims of Torture Joins Lawsuit Challenging Halt to Foreign Aid Funding—Center for Victims of Torture

What We’re Reading & Watching

• Inside the Bloodbath at the NIH—The Nation
• Trump’s NIH Axed Research Grants Even After a Judge Blocked the Cuts, Internal Records Show—ProPublica
• USAID Cuts Could Sever HPV Prevention—Think Global Health
• Borders on the Insane: New NIH policy on funding foreign scientists stirs outrage—Science  
• New NIH Foreign Subaward Structure Enhances Integrity, Accountability, Oversight, and National Security of NIH Funded Research—NIH
• HIV Testing and Outreach Falter as Trump Funding Cuts Sweep the South—KFF
• Europe Makes a Pitch to Attract Scientists Shunned by the US—The New York Times 
• The Road to Lenacapavir, a Breakthrough HIV Treatment—AAAS
• My New Deadline: 20 years to give away virtually all my wealth—The Bill & Melinda Gates Foundation
• Gender-Based Violence in Kenya and U.S. Foreign Aid—Think Global Health
• Surviving on Hope: Sex workers face HIV resurgence as ARVs, condoms vanish—Daily Nation (Kenya)
• In Historic First, the Global Fund Procures African-Made First-Line HIV Treatment—The Global Fund

Resources

• PxWire Volume 15, Issue 2—AVAC
• Worldwide Prevention, Shared Protection: Why STI Funding Matters—AVAC
• Politics and Global Health: The Need for a New, Resilient Architecture—AVAC
• Research Matters—AVAC, HIVMA, TAG
• The Trump Administration’s Foreign Aid Review: Status of PEPFAR—KFF  
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR

In Case You Missed It

Long-time partner AND fierce advocate, Yvette Raphael, is being recognized as part of the AAAS Mani L. Bhaumik Breakthrough of the Year Award for lenacapavir.

Thanks to Yvette, the African Women Prevention Community Accountability Board and so many others, lenacapavir is now a real option for HIV prevention. Now we must translate this breakthrough and this award into action.

Learn more.

The threats and actions to decimate US biomedical research and global health continued this week as the world marked 100 days of the new administration. A proposed $9.3 billion rescission package would codify unprecedented cuts to NIH, USAID, and global health programs. At the same time, a draft NIH policy may halt funding for research outside the US threatening thousands of global collaborations.

As AVAC and partners push back—including at Wednesday’s Senate Appropriations Committee—this moment demands urgent advocacy to protect lives, science, and global stability. Read on for the latest, including new resources and opportunities for defending research, and watch and listen to a powerful new podcast, featuring AVAC’s Mitchell Warren on what it will take to rebuild prevention and global health leadership.

Rescission Package Looms

The US presidential administration is preparing to send Congress a rescission bill that seeks congressional approval to cancel $9.3 billion in already-appropriated funds, including massive cuts to the NIH, the State Department, and USAID. The bill would make recent cuts official—taking back congressionally approved government funding. (The process of “recission” in the US budget process is described in more detail here.) The impact would further dismantle critical programs, including support for HIV treatment and prevention, and vaccine delivery.  

Separately, leaked budget documents show plans by the administration to slash NIH’s FY2026 budget by more than 40%, consolidate or eliminate several institutes, and permanently eliminate grants tied to equity and transgender care. It was reported on Thursday that the President will release the full budget on Friday. At a Senate Appropriations Committee hearing this week (see below), Committee Chair Susan Collins, a Republican, called the proposed cuts “very troubling” and warned they would undermine US global leadership in biomedical research.

READ:  

• NIH under siege—Science  
• Collins says Trump’s research cuts ‘must be reversed’—Politico  
• Trump’s Rescissions Would Complete the Decimation of U.S. Global Health Leadership—Public Citizen

Research Matters: Senate Appropriations Committee and NIH Funding

At this week’s Senate Appropriations Committee hearing, Biomedical Research: Keeping America’s Edge in Innovation, lawmakers and witnesses, including the Chief Executive Officer of American Association for the Advancement of Science (AAAS) and Executive Publisher of, Science, Sudip Parikh, pushed back against the threats of further cuts and warned of the devastation of NIH cuts on US scientific leadership, health equity, and economic competitiveness. Democratic Senator Patty Murray, Vice-Chair of the Committee, stressed that slashing funding undermines efforts to develop cures, vaccines, and breakthrough therapies. AVAC and the Federal AIDS Policy Partnership (FAPP) Research Working Group submitted a written statement to the Committee, urging Congress to reject future funding cuts to the NIH and recognize the importance and impact investments in biomedical research have had on lives and livelihoods.

READ:  

• Collins and fellow GOP senators speak out in opposition to Trump’s cuts to biomedical research—STAT  
• Research Matters – Resources to Protect Research Funding—AVAC  
• Written Statement: US Senate Hearing on Biomedical Research—AVAC and FAPP 

WATCH: 

• Biomedical Research: Keeping America’s Edge in Innovation—Senate Appropriations Committee hearing

NIH Poised to Halt Foreign Research Funding

Internal memos suggest a new policy is expected from the NIH, which would suspend funding for research outside the US. Some NIH staffers have indicated that they have been instructed to pause funds on both new and renewing grants that include research outside the US. The policy could apply to all international collaborations—not just those in “countries of concern”, like China and North Korea—and would impact a wide range of research. According to an exclusive story in Nature, it is unclear when the policy would take effect, and whether it would apply to all research funds to non-US institutions or only ‘subawards’. In 2023, about 15% of NIH grants included foreign partners.

IMPLICATIONS:  

Former NIH Director Francis Collins warns the policy could have “tragic consequences,” given the shutdown of USAID and deep NIH budget cuts. Epidemics and diseases like HIV, TB and malaria require global data and partnerships. This new policy would decimate the US’ ability to conduct or support clinical trials and data collection in the countries and communities who need support the most. This would be a stark retreat from decades of US leadership in global science—and could cost millions of lives.

READ:  

• Exclusive: NIH to suspend funds for research abroad as it overhauls policy—Nature

What We’re Reading & Watching

• WATCH: Resilience and Realignment: Preventing Global Infectious Disease with AVAC’s Mitchell Warren—A Shot in the Arm
• Trump blew up the global fight against AIDS. Can it recover?—Nature
• The end of AIDS is in sight: don’t abandon PEPFAR now—Nature (editorial)
• Will US science survive Trump 2.0?—Nature
• How Trump’s HHS Cuts Are Another Attack On Trans People—Huffington Post
• Scientific Integrity Under Threat: The Role of the IDSA, PIDS, and SHEA Journals in an Evolving Political Landscape—Clinical Infectious Diseases
• How public health has been upended in Trump’s first 100 days—Washington Post
• RFK Jr.’s HHS Orders Lab Studying Deadly Infectious Diseases to Stop Research—Wired
• Bribes and Rationing of AIDS Medicine in Zimbabwe as Trump’s Aid Cuts Bite—Health Policy Watch
• How this Limpopo NGO prepared itself for Trump funding cuts—Bhekisisa
• Three ways to help the developing world survive the end of aid—The Guardian (opinion)
• Supreme Court Heard Arguments on Preventive Health Care Coverage. How’d It Go?—POZ
• KFF Health Tracking Poll April 2025: Public’s View on Major Cuts to Federal Health Agencies—KFF
• The Gates Foundation Grapples With the Age of Donald Trump—The New York Times

Resources

• Politics and Global Health: The Need for a New, Resilient Architecture—AVAC
• Research Matters—AVAC, HIVMA, TAG
• The Trump Administration’s Foreign Aid Review: Status of PEPFAR—KFF
• Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do—KFF
• Tracking the Freeze: Real-Time Impact on Key Populations—GBGMC
• The Best Investment You Didn’t Know You Made: How NIH Funding Fuels Innovation and Economic Growth—amfAR