AVAC vehemently opposes the decision by the U.S. Senate Homeland Security and Governmental Affairs Committee to hold Dr. Anthony Fauci in contempt for his refusal to answer questions during last week’s hearing on the COVID-19 response. Certain members of the committee have made clear their intentions to pin the shortcomings of the U.S. response to COVID-19 on others by blaming and dragging renowned government scientists and public health practitioners such as Dr. Fauci through politicized proceedings without any evidence and using conspiratorial conjecture.

“Dr. Fauci is a public health pioneer, who has saved more lives than anyone sitting in the Senate today. He has dedicated his life to public service. Because of Tony Fauci, science has moved faster, lives have been saved and communities are more engaged in every phase of infectious disease research,” said Mitchell Warren, AVAC’s Executive Director. “He is a leader, partner, ally, advocate, and friend to those who care about advancing science and ending infectious diseases in the US and around the world. The Senate must end this clear waste, fraud, and abuse of government oversight powers and taxpayer money being used to advance baseless conspiracies and politically target career public servants.”

In a letter submitted to the committee in support of Dr. Fauci, AVAC urged the committee to recognize the deep history of partnership that Dr. Fauci has forged with the HIV/AIDS community; one that has resulted in numerous biomedical innovations, domestic and international programs that have ultimately saved millions of lives – guided by the steady hand of Dr. Fauci, through numerous Presidential administrations and Congresses, regardless of political make up.

“Dr. Fauci dedicated his career to investigating and finding solutions to novel viruses and got involved with HIV at a time when AIDS was taking the lives of some of the most vulnerable, marginalized communities across our nation,” added Warren. “Throughout his career, Dr. Fauci has blazed a trail of trust-building and honest dialogue – especially with those who disagree with him.”

The latest attempt by the Senate committee to weaponize governmental oversight powers further obfuscates the shortcomings of the nation’s pandemic preparedness, especially in light of the current administration’s dismantling and defunding of the very public health and research infrastructure Dr. Fauci helped construct in his years of service with bipartisan support. Distrust in public health and issues of vaccine scepticism continue to rise as the government attempts to relitigate Dr. Fauci’s role in the COVID-19 response, instead of tackling urgent needs of healthcare access and global health security. The decision to hold Dr. Fauci in contempt places him in the hands of a Department of Justice that has been charged with pursuing perceived enemies and critics of this administration – threatening public servants like Dr. Fauci further exacerbates the brain drain of apolitical scientific experts choosing to leave or completely forgo public service careers in fear of simply following the evidence, just as Dr. Fauci has in his nearly 40-year career.

AVAC calls on Congress to halt this harassment of Dr. Fauci, whose career, track-record, and devotion to public health research and development has changed the very course of the public health at home and abroad.

“These specious attempts to relitigate Dr. Fauci’s role in the national response to COVID-19 are nothing more than the latest example of waste, fraud, and abuse of power in Washington, which is harming Americans by continuing to obscure flaws and gaps in our country’s medical countermeasure and pandemic response capabilities,” added Warren. “If the Senate cares about making this country safer they will end the targeting of scientists and public servants, reverse the cuts to publicly funded science, stand up against unlawful disruption of long-standing international research partnerships and the wanton destruction of the US Agency for International Development (USAID) and erosion of PEPFAR programs. AVAC calls on the Senate to stop the distractions and get back to the work of protecting public health.”

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