An effective HIV prevention response requires real-time evidence and leadership rooted in the lived experiences of the communities that are most impacted. This edition of The Impact Report highlights AVAC’s role in both:

• African Leadership Drives HIV Prevention Access
• PrEPWatch: Transforming Data into Action for PrEP Access

African Leadership Drives HIV Prevention Access

An estimated 40.8 million people globally are living with HIV, 65% of whom live in Africa. The fight to end the epidemic depends on African leadership that shapes the HIV response, informs research priorities, influences policy and funding decisions, and advances advocacy agendas that respond to community needs. AVAC has been a leading voice advocating for African leadership through mentorship and partnerships, working with the next generation of decision-makers and advocates as they drive the global movement to advance equitable access to HIV prevention.

AVAC’s history of partnership, collaboration and support of partner networks is part of a long-term vision to transition from traditional power structures towards a model in which those with lived experience and field expertise have influence and equal voice in the design and delivery of HIV prevention planning, priority-setting, and decision-making. For three decades, AVAC has developed projects and partnerships that advance these goals, including the Fellows program and the COMPASS and CASPR coalitions.

Now, Access Bridge, a Kenya-based organization incubated over a decade at AVAC, is positioned to responsively and sustainably lead country-level and regional efforts to accelerate new product introduction and access. Wawira Nyagah, Access Bridge’s Executive Director, has over two decades of experience leading global and country-led initiatives to advance HIV prevention, and has built long-standing relationships with Ministries of Health, civil society advocates, and global decision-making bodies.

PrEPWatch: Transforming Data into Action for PrEP Access

AVAC’s PrEPWatch is the trusted global repository for comprehensive, user-friendly and up-to-the-minute information about HIV prevention methods. The platform provides data, analysis, tools, and comprehensive resources that are widely used by governments, donors, and partners to inform HIV prevention policy, financing, and programmatic decisions. AVAC ensures that data are available, accessible, and now in partnership with its sister organization, Access Bridge, used to strengthen the efforts of advocates, civil society, policy makers, and funders to translate evidence into action.

Transparent data enables accountability by making gaps visible and actionable, leading to informed global advocacy and decision making that improves equity in PrEP access worldwide. The evidence collected and housed on PrEPWatch, especially through the Global PrEP Tracker, is more critical than ever as the current US administration dismantles USAID and increasingly restricts access to data. In May 2026, AVAC documented the drastic declines in PrEP initiations following cuts to PEPFAR in 2025.

On this HIV Vaccine Awareness Day, AVAC is sharing resources and perspectives on the HIV vaccine pipeline, the science behind neutralizing antibodies, the state of bNAb combinations, and the broader state of HIV research amid the destruction and devastation of science and the HIV response.  

While an HIV vaccine remains elusive, in the current environment of threats to science, vaccines and the global HIV/AIDS response, HVAD serves as an important moment to re-commit to HIV vaccine R&D and the essential role of discovery science as part of a comprehensive, integrated and sustained response. 

Read on for resources to support your advocacy. 

The People’s Research Agenda (PRA): Preventive Vaccines

AVAC and partners’ PRA outlines the path forward for HIV vaccine research and development, identifying critical gaps from the need for a shared target product profile to stronger coordination and sustained political support to accelerate progress.

HIV Vaccine Clinical Trials Pipeline

This graphic summarizes the state of HIV vaccine research, detailing the different immunological approaches in clinical trials, the specific candidates being studied, and the collaborative networks of funders and developers working toward a safe and durable vaccine.

Broadly Neutralizing Antibody Combinations

HIV vaccine research today is focused on early-stage, iterative discovery approaches designed to induce broadly neutralizing antibodies (bNAbs) and T-cell responses. This graphic provides an overview of the combinations of broadly neutralizing antibodies (bNAbs) under investigation in early clinical studies for HIV prevention. 

An HIV Vaccine—Looking into the future with Nina Russell  

Last HVAD we recorded a podcast with Nina Russell of the Gates Foundation exploring why an HIV vaccine remains essential alongside the scale up of PrEP, unpacking the science, the challenges and what it will take to achieve a durable end to the epidemic. She notes: “It’s the science that gives me the most hope…We’ve seen, over and over again, and COVID was a great example of this, that the science that’s been coming out of the HIV vaccine field has been driving innovation across sectors in global health.”

Additional Resources

• HIV-Specific Neutralizing Antibodies by Target, infographic
• Evolving Strategies for an HIV Vaccine: In conversation with Katy Stephenson, archived podcast
• Research Fundamentals: An HIV Vaccine — What’s the challenge and what’s the science?, archived podcast

What a another week: the future of PEPFAR and CDC’s global HIV role; RFK Jr.’s new “vaccine safety initiative”; the Andes hantavirus outbreak and strains on global outbreak coordination; and a timeline showing the rapid shutdown of the global HIV, TB and malaria supply chain system.

State Department Will End Most CDC Technical Support for PEPFAR by September 30

Science reports on new guidance issued May 5 in which the US Department of State indicates plans to end the US Centers for Disease Control and Prevention (CDC) support for PEPFAR programs in most countries by September 30, 2026, the end of the current fiscal year. This guidance notes that countries would receive PEPFAR funding directly and have the option to decide whether to contract CDC for technical assistance in a “fee for service” model for support, such as HIV surveillance, laboratory quality assurance and specimen transport. Countries receiving more than $125 million in annual US assistance would be required to pay fees for a minimum of six CDC support services out of 30 services offered.

This development further advances the US “America First Global Health Strategy,” which is built on bilateral health Memoranda of Understanding (MoUs)—five- to 10-year agreements intended to transition from US-supported health programs to country-owned models, but often require co-investment and include provisions on data sharing, pathogen access and more. The Administration’s move to end technical leadership from CDC would dismantle the long-standing integration between CDC technical staff, ministries of health and implementing partners that many credit as central to PEPFAR’s effectiveness over the past two decades—all a year after the Administration’s dismantling of USAID, the other key pillar to the past two decades of PEPFAR’s success.

IMPLICATIONS: This proposed restructuring of what is left of PEPFAR marks a major transition in its architecture and may complicate future success of the program. While greater country ownership of health and health systems has been a long-standing goal of previous and current administrations, rapid removal of the CDC technical support on top of the erasure of USAID, could weaken HIV surveillance, laboratory systems, program oversight and outbreak response capacity for HIV services, and also the broader public health infrastructure. As mike Reid explained to Science, “What if we hand over PEPFAR in a haphazard, unthoughtful way, at rapid speed, and then everything implodes? Then in 5 years, people turn around and say, ‘Look, we invested $115 billion into HIV and it never worked, we’re never doing this again.’ I think that’s the wrong story that could end up being told.”

• Trump administration cuts CDC’s key role in global program to stop HIV—Science
• House Democrats Press Trump Administration Over Withholding Foreign Assistance Funds and Defying Congressional Intent—Congresswoman Lois Frankel
• This Is What Happened When Trump Abandoned the World’s Poorest Children—New York Times
• The Hidden Risk in the State Department’s Bilateral Health Agreement Era—Lights. Camera. Equity! Substack
• America First Global Health Strategy Documents Pertaining to Plans for “State” Capture of Global Health—Emily Bass Substack

RFK Jr.’s New Vaccine Safety Initiative

An exclusive New York Times report reveals that US Health and Human Services Secretary (HHS) Robert F. Kennedy (RFK) Jr. is overseeing an initiative to examine possible links between vaccines and chronic disease. Martin Kulldorff, a former member of RFK Jr.’s restructured Advisory Committee on Immunization Practices (ACIP) and now HHS chief science and data officer is purportedly leading the effort across agencies. The initiative is reportedly focused on already disproven and unconfirmed claims linking autism and vaccines, neurological and autoimmune disorders, vaccine timing and exposure patterns and the preservative thimerosal, which is no longer used in vaccines. HHS officials defended the initiative as an effort to conduct “gold-standard vaccine research”. The cost of the initiative is unknown.

IMPLICATIONS: This new initiative will continue to advance vaccine skepticism and possibly legitimize scientifically discredited theories. The report notes, “As part of the new effort, Mr. Kennedy has tasked some government scientists with studying the health status of vaccinated children compared with those who were not vaccinated.… Researchers say that such comparison studies would be riddled with pitfalls. Vaccinated children are more likely to receive medical care than those who are unvaccinated, and are thus more likely to receive additional medical diagnoses that could be wrongly attributed to vaccines.” This initiative and its outcomes have the potential to redirect limited research funding and priorities toward questions that decades of evidence have already addressed.

• Kennedy Is Driving a Vast Inquiry Into Vaccines, Despite His Public Silence—New York Times
• RFK Jr.’s War on Science Is Really a War on Scientists—The Bulwark
• As public vaccine criticism quiets, RFK Jr. keeps safety inquiries running in background—Fierce Pharma

Hantavirus Response Tests Health System Under Pressure

Additional Andes hantavirus cases linked to the cruise ship outbreak earlier this month continue to emerge. News reports highlight concerns about transmission, outbreak response, public health guidance and global coordination. MedPage Today highlighted uncertainty over how passengers from the cruise ship were monitored and managed after disembarking and travelling home to multiple countries, as well as the limited ability of the US to coordinate with global partners following funding cuts, the dismantling of health architecture and reduced participation in multilateral health systems. Meanwhile, a viewpoint in The Atlantic suggests that airborne transmission in shared indoor spaces may play a larger role in hantavirus spread than current public health messaging focused on “prolonged close contact” suggests.

IMPLICATIONS: The hantavirus outbreak is showing the growing challenge of public health communication, outbreak preparedness and response and international coordination in a polarized environment. Inconsistent messaging about transmission risks could undermine public trust and delay actions. At the same time, the outbreak highlights how weakened relationships between the US, WHO and international surveillance networks may hinder rapid information sharing and coordinated response during emerging infectious disease events.

• The Hantavirus Isn’t the Biggest Threat We’re Facing—The Nation
• Hantavirus outbreak should reset WHO’s default approach to airborne risk—BMJ
• Hantavirus cluster linked to cruise ship travel, Multi-country—WHO
• Hantavirus: Anatomy of a Fractured Global Response—MedPage Today
• The Close, Prolonged Contact Myth—The Atlantic
• The first US case of Andes hantavirus is confirmed. Here are answers to the next questions.—Inside Medicine

HIV and Global HIV Supply Chain Faces Uncertain Transition Under New Timeline

Author and advocate Emily Bass reports that the US Department of State is working toward a September 20, 2026 deadline to close out the Global Health Supply Chain–Procurement and Supply Management (GHSC-PSM) mechanism, which has been implemented by a consortia led by Chemonics and is responsible for end-to-end procurement and delivery of HIV, TB and malaria commodities. In a draft timeline received by Bass, most countries’ technical activities would end by September 30, 2026, despite State Department officials previously noting that transitions would be phased and supported by “failsafes.” This would leave countries with just four months to transition procurement, forecasting, warehousing, distribution and last-mile delivery functions to other systems or providers. This comes after 250 civil society organizations signed on to a letter to the US Secretary of State calling for immediate reversal of the April announcement that GHSC-PSM would be terminated by May 30, 2026 and calls to extend the Chemonics contract through 2027 as Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, Jeremy Lewin previously noted.

IMPLICATIONS: While the leaked timeline offers four months to transition and aligns with the scheduled end date (end of FY2026) of the GHSC-PSM contract, it still represents an extraordinarily compressed transition for one of the world’s largest and most complex health supply chain systems. As the 250 civil society organizations wrote, “We support countries taking up the procurement and supply chain management tasks GHSC-PSM currently carries out, but quality transition takes time and real planning.” Whether countries, implementing partners and donors can realistically replace critical end-to-end functions—including forecasting, storage, shipment coordination and last-mile delivery—without major disruptions to HIV, TB and malaria programs is highly unlikely. And the absence of dedicated funding for transition planning heightens risks of stockouts, treatment interruptions, weakened surveillance and laboratory systems, and, ultimately, poorer health outcomes and epidemic resurgence.

READ:

• New GHSC-PSM Closeout Timeline Sets FY2026 End for Most Countries—Emily Bass Substack

Targets, Accountability, and the Future of the HIV Response

At Thursdays, Multi-Stakeholder Hearing for the 2026 High-level Meeting on HIV/AIDS, AVAC’s Mitchell Warren argues that achieving impact requires the same ambitious targets that require accountability, political and community leadership and resourcing that transformed the HIV response over the last 25 years.

What We’re Reading

• A Shock to the System: Global Health After US Aid Cuts—The Aid Report, a Devex initiative
• Somebody call Hasina (Hasina Subedar, the brain behind the SA’s lenacapavir roll-out)—Bhekisisa
• 9 lessons to make SA’s anti-HIV jab roll-out work—Bhekisisa
• Along dusty roads in KZN, a push for a groundbreaking HIV prevention jab takes shape—Spotlight (South Africa)
• What Should Become of the CDC?—TheBodyPro
• NIH staffing shortage could slash number of new grants issued this year—Nature
• Virologist accused of starting COVID-19 will fight US ban on funding—Science
• FDA Chief Pushed Out in Latest Sign of Public Health Chaos Under RFK Jr.—Democracy Now
• After a week of rumors, Makary officially out as FDA head—CIDRAP
• New Partnership between SC Johnson, US Department of State and the Global Fund Could Help Protect 60 Million People from Malaria—SC Johnson
• The next WHO leader will need to be a multitasking political acrobat—Geneva Solutions
• Manitoba declares public health emergency as HIV rates rise—CBC
• The Disappearance of Key Populations: How PEPFAR’s Data Rollback Is Undermining HIV Epidemic Control—GBGMC
• A Single Infusion Could Suppress HIV for Years, Study Suggests—New York Times
• Girls in SA get free HPV jabs. Boys don’t. Find out why they should—Bhekisisa

Upcoming Webinars

The US administration again blocks key vaccine safety and effectiveness data; a hantavirus incident underscores growing strain and fragmentation in the global health system; and Zambia rejects a “trade for aid” deal tying health assistance to geopolitical and economic interests—with implications for HIV programs and global health cooperation.

Continued Suppression of Vaccine Science

The US Administration continues to block publication of key vaccine safety and effectiveness data. This week, officials at the US Food and Drug Administration (FDA) stopped publication of studies on COVID-19 and shingles vaccines including the analyses of millions of US patient records that found no new major safety concerns associated with COVID-19 vaccines and confirmed the established safety profile of the shingles vaccine. Despite already being accepted by peer-reviewed journals and/or undergoing the standard scientific review, FDA officials reportedly ordered some studies withdrawn and refused to approve conference abstracts for others.

This follows last week’s decision by US Centers for Disease Control and Prevention (CDC) leadership to block publication of a Morbidity and Mortality Weekly Report (MMWR) showing that COVID-19 vaccines reduced hospitalizations and emergency visits by roughly 50% among healthy adults. Despite passing rigorous internal scientific reviews, the report was withheld over “methodological concerns”.

IMPLICATIONS: At a time of reduced vaccine confidence, suppressing findings on safety and effectiveness risks continues to fuel rising vaccine misinformation and hesitancy. And the continued politicization of vaccine science that prevents publication of validated research undermines trust and limits access to evidence that should be used to support vaccination strategies and policy. Taken together, communities that stand to benefit the most from vaccines may delay or forgo receiving vaccinations for themselves and/or their families.

READ:

• FDA Blocked Publication of Research Finding Covid and Shingles Vaccines Were Safe—New York Times
• FDA stopped publication of studies showing COVID, shingles vaccines were safe—The Hill
• Aluminum in vaccines not linked to autism, other health problems, study finds—CIDRAP

Hantavirus Amid a Fragmenting Global Health System

News of hantavirus infections aboard a cruise ship this week comes amid broader concerns about weakening global health security. Reporting on the incident underscores how even localized health threats are unfolding in a fragmented coordination environment, while analysis in The Lancet warns that the role of key institutions like the World Health Organization (WHO) are increasingly contested, citing concerns about transparency, financing, and “institutional drift”. At the same time, broader global health commentary highlights fragmentation, declining funding, and shifting geopolitical priorities as pressures threatening multilateral cooperation. Together, these dynamics are raising urgent questions ahead of the World Health Assembly later this month about whether governments will pursue meaningful reform or continue operating within a system that is increasingly complex, underfunded and politically fragmented.

IMPLICATIONS: Pandemic preparedness and outbreak response require strong surveillance, transparent data sharing, and international coordination, which are core functions of multilateral institutions like the WHO. As confidence in and support for these institutions dissipates and as financing recedes and becomes more conditional, the ability to detect and respond to emerging health risks is limited. Without reforms to strengthen WHO’s core scientific and coordinating role, clarify mandates across institutions and secure more stable and independent financing, the global health system risks becoming less and less effective, leaving countries more vulnerable with more frequent disease outbreaks.

READ:

• Hantavirus Response Shows How Trump Cuts Have Compromised US Preparedness—New York Times
• 3 Dead of Suspected Hantavirus Infections on Cruise Ship, WHO Says—New York Times
• What Is Deadly Hantavirus and How Did It Spread on a Cruise Ship?—Bloomberg
• WHO Worth Fighting For: Authors Make the Case for Ambitious Reform—The Lancet
• No One Wins If Multilateralism for Health Loses—Think Global Health

Trade for Aid: Zambia Rejects Deal with US

Zambian government officials rejected a proposed bilateral Memorandum of Understanding (MoU) with the US offering up to $2 billion over the next five years under certain terms, including access to sensitive health data and to the country’s critical minerals. The deal was rejected due to the “incorporation of terms that the Zambian government considers unacceptable.” Ghana and Zimbabwe are also reported to have rejected bilateral MoUs.

These decisions come alongside the broader shift in US global health policy, with new Global Health Security and Diplomacy (GHSD) implementation guidance outlining an “America First” transactional approach that prioritizes bilateral agreements, co-financing, and alignment with US strategic interests. Scripps News reports on this “trade for aid” theme, raising concerns that access to HIV treatment and prevention could hinge on geopolitical and/or commercial interests.

IMPLICATIONS: The Zambian bilateral MoU experience illustrates the dangers of the country-by-country, transactional model for global health and foreign assistance, which effectively will make it harder to see and measure the true scale of the HIV epidemic in the wake of funding cuts and politicization of health. Referring to the recent PEPFAR data that was released last month, AVAC’s Mitchell Warren notes that “we’re [already] seeing a decrease in people accessing prevention services, and we’re seeing a decrease in those accessing the community-based programs that were really critical because those programs have been taken offline.” This “thinning at the margins” described in HIV programs signals a deeper risk: even as treatment numbers hold, the erosion of prevention and community services could lead to increased infections over time and destabilize the effectiveness of the global HIV response.

READ:

• Zambia blasts the US over a $2 billion health deal in exchange for critical minerals—Associated Press
• As Defunded HIV Programs Thin, Uneven Resilience Emerges—Think Global Health
• Trump’s New Foreign Aid Model Sparks Feud With Zambia—New York Times
• Trump administration ties health aid to trade deals, raising fears over HIV treatment access—Scripps News
• America First Global Health Guidance Launches Fee-for-Service Coup Against CDC—Emily Bass Substack
• Africa looks inward as global health funding dries up—Devex
• Money Matters: Who funds global health — and by how much?—Devex

What We’re Reading

• Targeted termination of scientific grants and minoritised researcher status in a national survey: a cross sectional analysis—The Lancet Regional Health Americas
• NIH grant cuts disproportionately hit minority and female scientists—Nature
• Trump’s war on science takes a disturbing turn—Daily KOS
• Arrest of Fauci’s former aide sparks political persecution concerns—Chemistry Now
• It’s burning down there: How shame is keeping SA girls from looking after their sexual health—Bhekisisa
• Immigration changes are driving foreign researchers to leave the US — or not come to begin with—STAT
• Use of Gilead’s HIV prevention shot rises, but US insurance gaps remain—Reuters
• For Michael Chancley Jr., PrEP advocacy is both a personal and professional matter—Managed Healthcare Executive
• Supreme Court gives abortion pill mifepristone a 1-week reprieve from a major change—NPR
• Pandemic Talks Extended – But Colombia Appeals for New ‘Method’ to Settle Differences—Health Policy Watch
• First AI tool to detect suspicious peer reviews rolled out by academic publisher—Nature
• Where Bullets Fly, Malaria Kills—Forbes

Join AVAC and partners for the launch of STI Advocacy Hubs and the introduction of new country-led advocacy agendas from Kenya, South Africa, and Zimbabwe. This webinar will highlight the key challenges shaping STI prevention, diagnostics, and care in each country, and outline priority actions to strengthen national responses. 

Resources

• PEPFAR Country Impact Factsheets (2025)—amfAR
• PxWire Volume 16, Issue 2—AVAC

Join us Wednesday, May 20 at 10am ET for a conversation with Nicholas Enrich, author of Into the Wood Chipper and former global health lead at the US Agency for International Development (USAID). Inside the Decisions that Changed Global Health will provide Enrich’s inside perspective on the decisions that led to the dismantling of USAID and the foreign aid freeze and what they mean for global health today.

This important conversation comes 16 months after the US Presidential Administration issued a deeply cruel executive order freezing nearly all foreign assistance, halting billions of dollars in already-approved funding under the bad-faith claim of a “90-day review”. What followed – including AVAC’s lawsuit against the US Department of State challenging the legality of the aid freeze – has been a drawn-out, chaotic disruption that stopped life-saving work across the globe, shutting down USAID and other valuable organizations, and harming lives, health, and livelihoods.

Please join us for this important conversation.

On the heels of the recent PEPFAR data release, a New York Times article by Stephanie Nolen, AIDS Creeps Back in Parts of Zambia, a Year After US Cuts to HIV Assistance, this week serves as an illustration of the consequences of the US policy decisions on lives. It shows what the policy shifts, funding disruptions, and data gaps covered in this issue, look like in Zambia: strained clinics, interrupted HIV services, and uncertainty for patients and providers relying on PEPFAR.

Recent PEPFAR Data Masks Deeper Disruptions

Continued analysis of PEPFAR data released by the US Department of State last week points to a much more nuanced and complicated narrative about the state of the HIV response. A Vox Future Perfect piece dissects the latest figures, covering July–September 2025, which the administration presents as a picture of continuity and efficiency: treatment numbers appear stable, and prevention among pregnant and breastfeeding women appear to make a targeted gain. But the article, alongside independent analyses by KFF, amfAR’s Brian Honerman and co-authors, Jirair Ratevosian, and AVAC, makes clear that this snapshot obscures deeper disruptions. Critical gaps in testing, prevention and workforce capacity are minimized, or left out entirely, to create a distorted picture of a resilient program.

The Vox analysis also calls out the absence of a full year of data. While the Department of State cited reporting and implementation challenges, previous datasets that were posted then subsequently removed in January 2026, tell a different story. Analyses by amfAR and the International AIDS Society of those unreleased figures reveal far sharper disruptions across testing, prevention and service delivery, particularly in the wake of the January 2025 foreign aid freeze. Taken together, the evidence suggests that the final quarter may represent the most stable period of an otherwise deeply destabilizing year—masking the scale and severity of the broader setbacks that may inevitably emerge farther down the road.

IMPLICATIONS: Incomplete or selectively framed data can shape policymaker perceptions, donor decisions and country-level planning, which could potentially justify further cuts or an urgent need to surge resources to counteract devastating actions stemming from the foreign aid freeze and stop work orders. And as Vox reports, “For years, one of PEPFAR’s strengths was its system that generated unusually granular public data about where the program was functioning well and where it wasn’t. That made it possible to spot problems and course-correct, part of what made PEPFAR so successful and helped save more than 25 million lives. Now that picture is much thinner… And it is unclear whether this kind of detailed HIV-specific reporting will continue at all under the terms of its America First Global Health Strategy.”

• What really happened after Trump slashed HIV funding—Vox
• AIDS Creeps Back in Parts of Zambia, a Year After US Cuts to HIV Assistance—New York Times
• What the Latest PEPFAR Data Reveal and Why It Matters—AVAC

US Lawmakers Challenge President’s Plan to Redirect Global Health Funds to Cover Costs of Dismantling USAID

A group of 17 US senators issued a letter demanding that the US Presidential administration reverse its plan to withhold $19 billion in congressionally-appropriated foreign assistance and spend down the funding as Congress directed. Led by Sen. Brian Schatz, Democrat of Hawaii, Ranking Member of the Senate Appropriations Subcommittee on State and Foreign Operations, the group highlights the administration’s plan to redirect $3.2 billion of the $19 billion away from lifesaving programs, including programs to combat HIV/AIDS ($330 million), malaria ($250 million), maternal and child health ($320 million) and global health security ($650 million) to instead cover the costs associated with abruptly terminating USAID and foreign assistance awards.

IMPLICATIONS: The dispute signals a deepening constitutional and policy clash over Congress’s power of the purse and the future of US global health leadership. If Congressionally-appropriated funds continue to be withheld or redirected by the administration, critical programs face continued disruption. This undermines years of investment and erodes trust with country partners and implementing organizations. Beyond the human impact, this move risks normalizing the diversion of Congressionally-appropriated funds for purposes unauthorized by Congress and sets a precedent that could destabilize future domestic and global health funding. These questionable budgetary maneuvers being tested in the global space, could also justify being used to scale back funding on domestic issues, including HIV.

• Schatz Leads Group Of 17 Senators In Demanding Trump Administration Comply With Law, Use Foreign Assistance Funding To Support Global Health, Food Aid, Help Save Lives As Congress Directed—US Senator Brian Schatz
• Senate Dems Accuse Admin of ‘Impoundment’ Over USAID Funds—Talking Points Memo
• Scoop: USAID tells Congress it has $19B to spend on closing out awards—Devex
• He Couldn’t Cut the Global Health Budget—But He’s Found a Loophole—Health Security Policy Academy

Countries Push Back on America First Health Agreements

Ghana has become the latest country to reject its bilateral memorandum of understanding (MoU) with the US as part of the America First Global Health Strategy. The West African nation, joins Zimbabwe which rejected its terms with the US, while Zambia continues to face pressure to open its mineral sector in exchange for foreign assistance. A new analysis in Think Global Health tracks the rollout of the MoUs, which transitions US support from traditional aid to cofinanced partnerships requiring greater domestic spending by national governments. The analysis finds wide variation in expectations and raises concerns about whether countries can meet these commitments or sustain essential health programs. The tracker also highlights limited transparency and uncertainty about the long-term impact on health outcomes.

IMPLICATIONS: The structure of the bilateral MOUs signals a fundamental reorientation of US global health engagement—from partnership-based public health investment to strengthen mutual global health security cooperation, to a paradigm of conditional, transactional, interest-driven agreements. Tying health assistance to resource extraction, data access or political alignment risks undermining trust built with impacted communities, weakening multilateral cooperation on global health and fragmenting long-standing health systems. Early consequences are already visible.

• Aid cuts and a failed deal: Zimbabwe’s frontline health care under strain—Devex
• Exclusive: Ghana rejects proposed US health aid deal, citing data concerns, source says—Reuters
• Ghana Rebuffs US Health Deal – But South Africa and Zambia Struggle Without Aid—Health Policy Watch
• Why Ghana rejected US health aid deal over sensitive data sharing concerns—Graphic Online
• African Leaders Declare End Of Aid Era At Nairobi World Health Summit, But The Data Tell A More Complicated Story—Health Policy Watch
• Tracking the “America First” Bilateral Health Agreements—Think Global Health

Lawmakers Push Back on Expanded Global Gag Rule

A group of Congresspeople in the US House of Representatives introduced the Protecting Human Rights and Public Health in Foreign Assistance Act, a bill designed to block the US administration’s expanded Global Gag Rule (formally known as the “Protecting Human Flourishing in Foreign Assistance Policy”). Historically, the Global Gag Rule prohibited foreign nongovernmental organizations which receive US family planning funds from providing, referring, counseling or advocating for abortion, even with their own non-US resources. In January 2026, the administration expanded the policy to cover additional funding streams, institutions and issue areas, extending beyond family planning to include gender-affirming care and Diversity, Equity, Inclusion (DEI) initiatives. More than 80 organizations have endorsed the legislation to block the expanded Global Gag Rule describing it as an unprecedented effort to impose ideologically-driven restrictions across global health and development partnerships.

IMPLICATIONS: Evidence from past iterations of the Global Gag Rule shows detrimental impact across health systems—reducing access to contraception, increasing unintended pregnancies and abortion rates, and weakening integrated services, including HIV prevention, maternal health and care for LGBTQI+ communities. Advocates note that this latest expansion risks amplifying those harms by restricting how countries and organizations use their own funds and fragmenting partnerships that underpin effective service delivery. These restrictions may in turn drive key populations further underground and fracture service delivery.

• Shaheen, Rosen Lead Bicameral Legislation to Overturn Trump Administration’s Expanded Global Gag Rule—Foreign Relations Committee
• A Dangerous Shift in Maternal Health Policy—TIME
• Protecting Human Rights and Public Health in Foreign Assistance Act 2026 Social Media Toolkit—Take action and show your support

What We’re Reading

• In 2 years the Global Fund will cut SA’s grant by a quarter. In 8 years it will be gone—Bhekisisa
• Why America’s HIV epidemic hasn’t ended—Vox
• Securing NIH awards is getting more competitive — and confusing—STAT
• After pulling vaccine study, Bhattacharya criticizes long-running CDC publication—Science
• PEPFAR’s Dr. mike Reid Resigns on Substack: Equity, Authoritarianism, & the Future of Global Health—A Shot in The Arm podcast
• Critics slam Trump’s purge of National Science Board: ‘Wholesale evisceration of American leadership in science’—LA Times
• National Science Board Members Dismissed—Washington Post
• Key US science panels are being axed — and others are becoming less open—Nature
• We detected Aids through a federal early warning system. Trump has decimated it—The Guardian
• RFK Jr. is holding up $600M in vaccines for poor countries—Politico
• The US CDC on the brink—The Lancet
• Offline: President Trump—it is not too late—The Lancet
• Growing use of guest editors has turned some journals into a ‘playground of bad science’—STAT
• Russia’s internet blackout affects HIV services—Lancet HIV
• Exclusive: Here’s the Covid-19 vaccine paper the CDC censored—Inside Medicine
• What happened to Covid?—STAT
• Newly Approved HIV Treatment Option Is No More Than Fine — and Shows Just How Good HIV Treatment Is Today—NEJM Voices
• DoxyPEP halves overall syphilis cases, with possible indirect benefits for women—Aidsmap
• Health experts and partners launch Zim’s first STI advocacy agenda—CITE.org

The International Conference on HIV Treatment, Pathogenesis, and Prevention Research (INTEREST), will take place 12-15 May in Dar es Salaam, Tanzania, covering new advances in HIV prevention, treatment, cure, and vaccine research and development (R&D); implementation science; and how science is being translated into impact through an African-led HIV agenda.

AVAC has compiled resources and highlights to support participation and engagement.

AVAC Infographics

For those presenting at INTEREST (as well as anyone interested in tracking the field), AVAC’s latest infographics on the HIV R&D and delivery pipelines are available in an easy-to-use slide format – including lenacapavir for HIV PrEP (LEN) volume commitments, the current landscape of prevention options in development, and the impact of US funding cuts with new data from PEPFAR. We hope these are useful for presentations and discussions at the conference and beyond.

Join AVAC, Access Bridge and Partners at These Sessions of Interest

If you are in Dar es Salaam, be sure to join sessions in which AVAC, Access Bridge, and our partners are involved.

Posters (Wednesday, 13 May and Thursday, 14 May)

• HIV Prevention Research and Development at a Tipping Point: Insights from the 2025 People’s Research Agenda Update by AVAC’s Grace Kumwenda
  
  Identifying key priorities for the HIV prevention research agenda moving forward and informing global advocacy and engagement in R&D in response to the evolving HIV prevention landscape, including recent scientific advances and growing threats posed by funding and political disruptions.

• Getting PrEP Rollout Right This Time: Lessons from the field by Access Bridge’s Catherine Verde Hashim, presented by Wawira Nyagah
  
  Learn from experts how we can improve and accelerate PrEP introduction at every step along the product introduction pathway. Access the full report: Getting PrEP rollout right this time

• Community Led Research on HIV Treatment, Pathogenesis and Prevention among People who use Drugs in Tanzania by Kwame Juma of Tanzania Network of People Who Use Drugs (TaNPUD) and COMPASS
  
  Description forthcoming!

Mini-Oral Abstract (Friday, 15 May)

• Global Forecast of Long-Acting PrEP Need for Key Populations (2025-2030), by Catherine Verde Hashim presented Wawira Nyagah; 12:00-12:24
  
  Understand the need for long-acting PrEP amongst key populations globally and explore which countries have the highest need.

What We’re Watching

The INTEREST 2026 program includes a full list of sessions, including the following, which AVAC is tracking closely (note: all times are local Tanzanian time):

Tuesday, 12 May

• Opening session with welcome addresses from conference chairs, including AVAC Board member Nyaradzo Mgodi, 9:00-10:45
• Special Session 1: Building Africa’s End to End Vaccine R&D and Manufacturing Ecosystem: Achieve Africa’s Vision, Progress, and Roadmap to Sovereignty, 16:15- 17:00

Wednesday, 13 May

• Session 7: HIV Prevention I: Cure and Vaccine, 8:30-9:15
• Session 8: HIV Prevention II: Broadly Neutralizing Antibodies and Gene Therapy, 14:25-15:10
• Session 9: HIV Prevention III: New Prevention Technologies, with AVAC Board members Nyaradzo Mgodi and Linda-Gail Bekker, 16:35-17:20

If you are attending INTEREST 2026 and would like to connect, reach out to the AVAC and Access Bridge teams at [email protected] and [email protected]. And stay up to date on the latest news from AVAC via our newsletters or on LinkedIn.

Newly released data from the President’s Emergency Plan for AIDS Relief (PEPFAR) were meant to reassure, but a deeper look tells a more concerning story. AVAC’s latest blog post and graphics provide a more nuanced analysis: “Reduced prevention today means higher HIV incidence in the future. That effect is not yet visible in the current data, but it is a well-understood dynamic in public health.”

Independent reviews and analyses of the data show consistent declines across testing, diagnoses and prevention, including steep drops in PrEP, the DREAMS program for adolescent girls and young women and key population programs. Notably, KFF’s analysis provides comparisons across five years of data, providing critical context on PEPFAR performance over time.

See the AVAC resources below that put this all into context.

Steep Decline in PEPFAR PrEP Initiations

PEPFAR-supported PrEP initiations are down by 41% in one year, with men and non-pregnant or breastfeeding women seeing drops exceeding 50% — and key populations absent from the data altogether. These trends reflect broader disruptions across the prevention cascade: fewer people are being tested, diagnosed and connected to prevention.

A Warning, Not Reassurance

AVAC Policy Director Suraj Madoori and Executive Director Mitchell Warren unpack what the new PEPFAR data mean for the future of HIV prevention. “PEPFAR’s success has long depended on a continuous flow: people are tested for HIV, diagnosed and then linked to treatment if they are living with HIV or offered prevention if not,” they write. “When testing declines, as it is under PEPFAR right now, the entire cascade is disrupted.” None of this diminishes PEPFAR’s extraordinary achievements. On the contrary, it underscores what is at stake. The path forward requires a more balanced reading of the evidence.

What this Means for the Rollout of New HIV Prevention Innovations

The data come at an especially heartbreaking moment of scientific promise: highly effective long-acting prevention options like injectable lenacapavir for HIV PrEP (LEN) are finally available and offer the potential to transform how HIV is prevented. But innovations depend on strong delivery systems—robust testing, community engagement, and functioning prevention programs, along with strong data systems, to ensure innovation has impact.

For the latest on PrEP use and initiations, explore AVAC’s PrEPWatch Global PrEP Tracker. And for in-depth look at the situation in South Africa, check out this article from Bhekisisa: Our anti-HIV jab will be rolled out in 6 weeks. But funding cuts hollowed out the system needed to deliver it.

Prevention Disrupted: The Impact of the PEPFAR Stop-Work Orders on PrEP

Since January 2025, AVAC has tracked the severe impact of the PEPFAR stop-work orders on PrEP, with many countries suspending or significantly reducing their ability to provide PrEP services.

View the latest from AVAC’s Impact Tracker, now updated with the recent PEPFAR data release.

These resources point to a clear conclusion: the current moment is not one of stability—it is one of risk. PEPFAR’s extraordinary legacy shows what is possible when prevention, treatment, data, and community leadership work together. But the front end is weakening. Without urgent action to restore prevention, ensure transparency in data, and prioritize key populations, the global HIV response risks backsliding—just as new tools are poised to make progress possible.