CROI 2026: Science, Solidarity and High Stakes for the HIV Response 

February 24, 2026

CROI 2026 opened with a sobering message and defiant acknowledgment: progress in HIV treatment, prevention, and cure depends not only on scientific discovery, but also on global infrastructure, sustained funding, public trust, resilience, and activism that make science possible. Against a backdrop of funding cuts, dismantled programs, and growing political interference, speakers on the first two days of CROI warned that interrupting support for HIV research “is not a policy choice; it threatens infrastructures that took decades to build.” 

Day 1: Opening Session

The call to collective responsibility followed presentation of CROI’s inaugural Lifetime Achievement Award to former Director of the National Institute of Allergy and Infectious Diseases (NIAID) Carl Dieffenbach, whose leadership at NIAID was consistently rooted in partnership—championing community engagement, global collaboration, and the principle that science only succeeds when it serves and engages the people most affected.

Sharon Lewin, Director of the Peter Doherty Institute in Melbourne, Australia, delivered the opening Bernard Fields Lecture with an expansive look at Thirty Years of Persistence, Progress, and Partnerships in HIV Cure Science, tracing how decades of basic research have shaped the many cure strategies now being explored. She highlighted the central challenge of the HIV reservoir—why infected cells remain hidden despite effective treatment—and how newer approaches are working to reveal, reduce, or control them. Lewin described innovative work using mRNA to deliver Tat, a viral protein that “wakes up” latent virus so it becomes visible to the immune system, as well as advances in CRISPR-based activation and immune-mediated control. Across these approaches, her message was clear: progress toward a cure is real, but it depends on sustained collaboration and investment across disciplines and communities. 

The Martin Delaney Lecture was then presented by longtime activist Peter Staley, cofounder of Treatment Action Group and PrEP4All, who urged the field to prepare for what comes next. Tracing the shared evolution of activism and science forged during the early HIV epidemic, Staley described how advocates and researchers learned from one another, reshaping clinical trials, access programs, and ultimately the field itself. He was clear that today’s moment presents an equally grave challenge. Drawing stark parallels between past and present, Staley warned that renewed attacks on science, public health, and HIV programs—including threats to PEPFAR—are part of a broader authoritarian playbook in which dissenters and institutions are deliberately targeted. His message was unmistakable: the same collective power that transformed the HIV response in the earliest days must once again be mobilized to defend science, health, and human rights.

“Believe that the pendulum that has been swinging against us this past year will, if we fight for it, eventually swing back. You are a community that gives us miracles, with empathy as your driving force, you save lives, history will pull that pendulum back,” Staley said.

The Opening Session closed with Linda-Gail Bekker, Director of the Desmond Tutu HIV Centre and AVAC Board member, reframing HIV prevention through The ART of Prevention: People, Science, Progress. She offered a new “ABCs” for the current moment with a framework requiring scientific advances, political will, urgency and community-led action to end the epidemic: A calls on the field to Advocate, Agitate, Act, and Accelerate; B urges Bold scale-up of proven and emerging tools; and C emphasizes Creating demand, providing choice, and working with communities most affected.

Day 2: Spotlight on Cure and Prevention Science 

AVAC’s Jessica Salzwedel opened Monday by leading the first of three Community Breakfast Club sessions, this one focused on HIV cure. In an excellent session, Salzwedel and leading cure researchers John Frater, Katherine Bar and Allison Agwu helped participants break down the complex landscape of cure approaches highlighted at the conference. Salzwedel summarized cure strategies as working in two complementary ways: strengthening the body’s immune system, and directly targeting the virus by waking it up, keeping it dormant, or cutting it out. “Most often, these work together in combination,” she noted, reflecting a recurring theme across CROI sessions.

That emphasis on combination and durability carried into new prevention research presented at the conference. New PrEP research underscored the durability of new PrEP options and the importance of strong delivery systems to support their impact.

• In the first plenary of the day, Ilesh Jani of the Instituto Nacional de Saúde in Maputo, Mozambique, reviewed progress in HIV over the past 30 years, described the challenges the past year has brought, and highlighted “4 I’s” in the way forward: Integration, Inclusion, Innovation and Impact.
• In the second plenary session of the day, Wes Sundquist of the University of Utah described the HIV capsid and its importance in the development of LEN. His research collaborations, which began in the early 1990’s, led to understanding the structure, functions, and inhibition of the HIV capsid. As he shared with AVAC on a June webinar, “LEN didn’t emerge overnight. It’s the result of patient, persistent basic science—of believing we could understand a virus deeply enough to target it effectively.” He closed by reflecting on the “bench to bedside to community” journey that made LEN possible, crediting clinicians, regulators, and community activists, and warned that while the field now has “a really powerful new tool in the arsenal,” forces are blocking its use. “It will be a human tragedy,” he said, “if we don’t overcome those.”
• Data on dose selection for the investigational monthly oral PrEP candidate MK-8527 showed that a once-monthly 11 mg dose could maintain protective drug levels in at least 95% of participants, including pregnant people and adolescents, while allowing an additional week of coverage for late doses. The cumulative data from Phase I and II studies informed the dose selection in the newly launched Phase III EXPrESSIVE efficacy studies.
• Long-term follow-up of the ANRS PREVENIR study, presented by the study’s Principal Investigator, Jean Michel Molina, assessed 3,209 PrEP users in France across more than 13,000 person-years. Results showed HIV incidence of 0.11 per 100 person-years, with no significant differences between daily, on-demand, or switching regimens, reinforcing PrEP’s real-world effectiveness.
• Resistance data from the PURPOSE 1 and PURPOSE 2 lenacapavir for PrEP (LEN) trials were presented by Stephanie Cox of Gilead, which showed that across both studies, resistance was rare and occurred in the context of waning drug levels of monotherapy. Of two HIV acquisitions occurring among participants taking LEN in PURPOSE 1, one was diagnosed at Study Day 365 with the capsid resistance–associated substitution N74D, while the other acquired HIV at Study Day 670, more than a year after their final LEN dose and with no resistance observed. In PURPOSE 2, two previously reported participants developed the N74D capsid substitution, while one newly identified case developed Q67H+K70R. The five total infections across the two trials highlight that while not perfect protection, LEN is clearly a remarkably safe and effective prevention option.

What’s at Stake: Funding, Evidence and the Human Cost 

The first two days of CROI made clear that the systems needed to deliver scientific advances to the real world are at extraordinary risk. Jen Kates of KFF opened the session Sleepless in Denver: Impact of Funding Changes on HIV Care by describing a “fundamental rupture” in global HIV service delivery following the US Administration’s funding and policy changes. PEPFAR, one of the most consequential global health achievements, has saved more than 25 million lives since 2003. In a post-foreign-assistance freeze world marked by a dissolved USAID and disrupted services, Kates emphasized that concern about human impact is widespread and so should be concern for real-time data. 

New research presented during the session began to do just that. Aaron Richterman shared results from a rapid survey of AIDS Drug Assistance Programs across three US states showing that 47% of clinics reported HIV service disruptions, including medication shortages, while Lindsay Vlatru reported that 40% of clinics in KwaZulu-Natal experienced disruptions affecting an estimated 830,000 people with HIV. Speakers warned that these disruptions threaten the resilience of HIV prevention and care systems and risk long-term population health consequences. Moving ahead means closing evidence gaps and finding ways to gather real-time data on how these funding changes are affecting people’s lives.  

Speaking on behalf of communities and partners across Africa in the symposium session, Strategic and Resilient Responses to the Funding Crisis Across Africa, Solange Baptiste, Executive Director of ITPC and AVAC Board member, shared the effects of the foreign assistance freeze. “When finances pause abruptly, it’s not just a marginal adjustment, it’s really a systemic shock… where the speed and the severity of those cuts really matter.”  
 
She showed how confusion, service interruptions, and loss of trust followed. Referring to Geoff Garnett’s presentation on the impacts of funding shifts, Baptiste noted that what is really missing from national data and mathematical models “is the community intelligence” to see the full picture. Meeting this moment, she said, requires a response that is “country owned, but community driven,” and that vision must be backed by action. “Community power has to be funded, not just praised,” engagement must be “baked into the design” of programs rather than added on later, and accountability must be “bi-directional,” with communities recognized as “co-pilots and co-architects,” not just watchdogs.

Looking Ahead

Across the first two days of CROI, it’s clear that the science is advancing, the tools are within reach, and that “we share a responsibility to defend and sustain funding for international HIV programs and research,” as Nicolas Chomont, CROI Conference Chair from Université de Montréal in Canada, said in the Opening Session. As the conference continues, the challenge is not only to push the science forward, but to ensure that science can be delivered, equitably and at scale, to everyone who needs it.