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  

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

prev next

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.

The AIDS 2026 conference in Rio de Janeiro, Brazil, starting in less than two weeks, comes at a defining moment for the global HIV response. Under the theme, Rethink. Rebuild. Rise., the conference convenes as the field grapples with funding disruptions, shifting geopolitics and the challenge of sustaining progress while translating scientific breakthroughs into equitable, community-led access. Alongside the latest research, discussions are expected to focus on scaling-up long-acting HIV prevention, strengthening health systems, advancing country ownership, sustaining the research enterprise, and ensuring the HIV response remains grounded in innovation, implementation and investment.

AVAC’s resources below aim to help those attending and those following from afar to navigate the discussion and debate in and around Rio.

Read on for resources and ways to navigate AIDS 2026.

AVAC’s Guides to AIDS 2026

HIV Prevention Session Roadmap
Explore AVAC’s curated roadmap of HIV prevention sessions and key presentations to watch throughout AIDS 2026.

AI and HIV Session Roadmap
AVAC and Audere’s AI & HIV Session Roadmap, features key conference sessions on artificial intelligence in HIV prevention, care, research and global health.

HIV Research & Advocacy Networking Zone

Resources

Resource Hubs

Resource Hub: Lenacapavir for Long-Acting PrEP
The introduction of injectable lenacapavir for HIV PrEP (LEN) is underway–in some places. While the field is moving faster than it did during the first decade of oral PrEP or the rollout of injectable cabotegravir, ensuring LEN—and future prevention options—reach everyone who needs them will require even greater speed, scale and equity. This resource hub contains all the tools, resources and insights on the latest with LEN rollout.

Resource Hub: MK-8527
Expanding prevention choice means investing in a diverse pipeline of HIV prevention options. MK-8527 is an investigational antiretroviral (ARV) once-monthly oral PrEP pill currently in Phase III clinical trials. If proven safe and effective, it could offer another important PrEP option. This resource hub provides advocates with an overview of the MK-8527, the science behind it and the latest on its clinical development. It also houses our guide to MK-8527 at AIDS 20206.

Resource Hub: People’s Research Agenda
The People’s Research Agenda (PRA) sets out a people-centered framework for equitable and accelerated R&D and product introduction. This resource hub offers an online, interactive dashboard for tracking, translating, and advocating for HIV prevention research and development (R&D). It also shows where investments align—or fail to align—with community-defined priorities, and spotlights critical gaps in the pipeline of prevention options needed to meet the diverse realities of all populations.

Pre-conferences, Satellites, Sessions and Workshops Featuring AVAC and Partners

• Pre-conference: Advancing HIV prevention science and access
  08:00 – 19:00
  Hosted by the International AIDS Society, this pre-conference features six sessions showcasing the latest advances in HIV prevention science and access—including the Global Forecast of Long-Acting PrEP Need for Key Populations (2025–2030), developed jointly by GBGMC and AVAC. AVAC board, staff and partners will also explore the science behind next-generation HIV vaccine candidates and how to translate.

Monday, 27 July

• Satellite: Shared pipeline; shared goal: Innovations in long-acting antiretrovirals for PrEP, PEP and treatment
  11:30 – 12:30 
  Organized by AVAC, this session will bring together researchers, product developers, donors, advocates and other partners to explore the future of long-acting antiretroviral (ARV) innovation for PrEP, PEP and treatment.

Tuesday, 28 July

• Symposium: bNAbs for cure: Hope or hype?
  10:30-11:30
  AVAC Board Member Marina Caskey will present in this symposium exploring the promise—and limitations—of broadly neutralizing antibodies (bNAbs) for HIV cure.

Wednesday, 29 July

• Symposium: Leadership at the tipping point: Protecting the gains and advancing progress in a new era of the HIV response
  10:30-11:30
  Moderated by AVAC’s Mitchell Warren and HER Voice Fund Ambassador Nomonde Ngema, this symposium explores the future of the global HIV response amid shifting political priorities and an evolving global health landscape.

• Satellite: Choosing impact: Making long-acting HIV prevention a reality for key populations in sub-Saharan Africa
  12:00 – 13:00
  Organized by Global Black Gay Men Connect (GBGMC) with AVAC and a number of partners participating, this session will examine strategies to sustain and expand HIV prevention for key populations as long-acting prevention options become available.

• Satellite: To fund or not to fund: Pathways and proof points to sustaining HIV prevention as part of integrated approaches and health financing reforms
  18:00 – 19:30
  Organized by PATH, AVAC, UNAIDS, WHO, Unitaid, APCOM, ICWEA, Harvard, Frontline AIDS and the Elton John AIDS Foundation, this session will examine the growing HIV prevention funding crisis and what’s needed to sustain progress.

Thursday, 30 July

• Workshop: Skills Lab: Community-led monitoring
  12:00 – 13:30
  Facilitated by the International Treatment Preparedness Coalition (ITPC), NACOSA, the Network of Journalists Living with HIV (JONEHA) and community monitoring experts, including AVAC Senior Advisor Maureen Luba, this interactive workshop will strengthen practical skills in community-led monitoring (CLM).

• Symposium: From community to innovation to scale
  16:30 – 17:30
  AVAC’s Grace Kumwenda will join community leaders, researchers, clinicians, policymakers and funders to discuss the partnerships, inclusive research and implementation strategies needed to accelerate innovation and ensure equitable access from the outset.

• Satellite: From choice to impact: Long-acting and multipurpose HIV prevention technologies
  18:00 – 19:30
  Hosted by IPM South Africa, AVAC and Access Bridge’s Kate Segal and Ascend Futures Foundation’s Chilufya Kasanda will join researchers, advocates, implementers and policymakers to examine the latest scientific advances, implementation strategies and pathways to equitable access for long-acting options and MPTs.

Friday, July 31

• Symposium: The promises of long-acting injectable PrEP for HIV prevention
  10:30 – 11:30
  Access Bridge Executive Director Wawira Nyagah share community perspectives on early implementation of injectable cabotegravir and lenacapavir, identifying remaining gaps, and discussing strategies to accelerate equitable rollout.

Follow Us

AVAC will be covering conversations and events at the conference. Be sure to follow along on social and find updates on our AIDS 2026 page.

• BlueSky: @avac.org
• Instagram: @hivpxresearch
• LinkedIn: AVAC (AIDS Vaccine Advocacy Coalition)