Global Health Watch: First real-world PEPFAR disruption data, long-term LEN results, US foreign assistance, HIV supply chain vulnerabilities

Issue 78

July 24, 2026

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.

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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.

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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.

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What We’re Reading

CASPR Impact Report: Celebrating Growth, Inspiring the Future

The future of HIV prevention won’t build itself—it will be built by communities. AVAC’s new report celebrates what is possible when long-term investment in African leadership, partnerships and coalition-based advocacy is matched with shared purpose.

Access the Report