August 7, 2025
The STI & HIV World Congress brought together over 1,400 researchers, healthcare providers, implementers, advocates, funders and industry representatives in Montreal last week, where they shared urgent insights, promising innovations, and calls to action. The gathering came at a pivotal moment when rates of STIs are rising globally, highlighting the importance of people-centered approaches, addressing stigma, and the need for new vaccines and diagnostics. All this amid massive disruptions caused by shifts in US policies and funding and decreased investments from other funders.
As Jeanne Marrazzo, the NIAID Director currently on administrative leave who spoke in her personal capacity said in the closing plenary, “progress is possible, but only with clear-eyed urgency and coordinated commitment.” She spotlighted promising developments in biomedical prevention, such as new drug delivery tools, vaccines and monoclonal antibodies. She also discussed the mixed results of doxycycline post-exposure prophylaxis (DoxyPEP), which showed effectiveness in men who have sex with men (MSM) and transwomen but not in cisgender women in Kenya (which Elizabeth Bukusi, Chief Research Officer at the Kenya Medical Research Institute and former AVAC Board Member shared in an earlier session).
“Reproductive age women are not gay men, and just because it works in gay men, it doesn’t mean it’s going to work in women. It’s not just an anatomic thing. It’s a behavioral thing. It’s a preference thing. It’s a reason to take the product thing, right?” Marrazzo explained. She emphasized that the real test is not whether we are able to develop tools like long-acting PrEP, vaccines, or DoxyPEP, but whether we have the systems, strategies, and coordination to ensure interventions are tailored to the needs of the people who need them most and that they reach these communities as a priority.
People-Centered Approaches
A familiar message echoed throughout the conference, one that we heard earlier in the month at the International AIDS Society meeting in Kigali, Rwanda: innovation alone is not enough. Many speakers made the case for person-centered design and delivery, recognizing that preference, access and stigma shape whether people can and will benefit from biomedical breakthroughs. WHO’s Remco Peters pointed to a range of innovation that can support person-centered care, including AI-supported models of care, peer-led services, and decentralized platforms.
At the session Achieving Health Equity in STI Care, experts from the WHO and Gates Foundation discussed how selfcare and innovation in vaginal products could reshape sexual health services, but only if women’s real preferences and lived experiences guide product design. “Women have been doing this for a long time,” said the Gates Foundation’s Sharon Achilles. “We must listen to what they actually want, whether it’s relief from symptoms, discretion, or pleasure.” (Achilles’ message was especially prescient, as just this week the Gates Foundation announced a five-year, $2.5 billion commitment to accelerate R&D focused exclusively on women’s health. It will support the advancement of more than 40 innovations in five critical, chronically underfunded areas, including STIs to improve the diagnosis and treatment of these infections and reduce the disproportionate burden on women.)
Similarly, in a pre-conference session on multipurpose prevention technologies (MPTs), partners highlighted the need for integrated, multipurpose products that reflect the complexity of women’s lives.
“Self-care interventions are an opportunity to help increase people’s active participation in their impact,” said WHO’s, Sami Gottlieb.
Stigma Persists
Stigma continued to be cited as a critical barrier that continues to undermine the STI and HIV response. In a powerful plenary, esteemed journalist André Picard of the Canadian Globe & Mail shared a personal and historical reflection on how stigma dehumanizes people, distorts public health efforts, and persists even amid medical advances. “Behind every STI is a story, a policy failure, and an opportunity to do better,” he said.
In the session, No Shame in This Game: Using Filmmaking and Storytelling To Combat STI Stigma, independent filmmaker Jolene Hernandez shared the documentary No Shame in this Game, that follows the story of seven people living with an STI, to demonstrate the possibility of living a life of full sexual self-expression, fun, and freedom.
“That’s what stigma means. When an illness affects not only your body, but your soul, & your place in society.” — Andre Picard, Globe & Mail at Monday’s plenary session
Vaccines and Equity
Equity also took center stage in plenary sessions on the STI vaccine pipeline. Helen Rees of Wits RHI in South Africa and also a former AVAC board member presented a comprehensive overview of STI vaccine development from gonorrhea and chlamydia to herpes and syphilis. While scientific progress is accelerating for STI vaccine development, particularly for gonorrhea, where group B meningococcal vaccines show cross-protection, progress is slow, fragmented and underfunded. And access and vaccine hesitancy remain critical challenges. For more information, check out STIWatch.org to track vaccine developments across eight pathogens.
Panelists during the session, WHO Research Priorities for STIs: Advancing the Global Agenda for Syphilis Research, called for urgent investment in vaccine R&D and delivery programs designed with community input. “We cannot afford a repeat of COVID or mpox, where high-income countries hoarded vaccines and marginalized communities were left behind,” Rees warned. Rayner Tan of the National University of Singapore and Lori Newman of the Gates Foundation both stressed the need for inclusive advisory boards, stronger advocacy, and sustainable financing—all key tenets of Good Participatory Practice guidelines.
New Diagnostics
Sessions on diagnostics and service delivery echoed that call. AVAC partner, Mandisa Mdingi of the Foundation for Professional Development in South Africa presented encouraging data on a new point-of-care syphilis test, that was found to be extremely effective in detecting active syphilis cases among people presenting with genital ulcers. This could improve the detection and treatment of syphilis, an infection that has led to more than 8 million new cases in 2022.
Looking Ahead
As STI rates rise and global funding falls, the path forward lies in local leadership, new funding models, inclusive policymaking, and smart integration. In data presented at the conference by AVAC and Impact Global Health, a 127% growth in STI R&D funding between 2018 and 2023 from $96m to $218m was promising, but overly dependent on US governments. This growth is likely not sustainable given recent shifts in US policies, and developers, funders, advocates, and other stakeholders must stay accountable to ensure new tools are community-centered and truly address prevention, detection, and treatment needs.
In an audience Q&A, during the plenary session, The Future of STIs in the Changing Global Health and Funding Landscape, Helen Rees emphasized the disruptive impact of the abrupt foreign aid freeze, noting her own institute had to lay off 700+ staff members nearly overnight (see AVAC’s issue brief, Why STI Funding Matters, which describes the impacts of the elimination and reduction of funding that supports STI research, testing, and prevention programming). Rees urged the audience to use this moment of devastation to rethink ways for countries to rebuild smarter. She called for innovative financing mechanisms and noted “there are a host of ways to do [it] both as governments with innovative taxation and also public private partnerships with innovative bonds and debt relief.” Rees also stressed that “if we keep putting things into weak health systems, we will not win.” So offered that we have to “leapfrog”, particularly in low middle income countries, into new technology, notably AI. She advocated for affordable self-testing, AI-enabled clinical tools, and automated data systems that can strengthen care and track disease burden more efficiently.
AVAC’s presence throughout the meeting amplified the essential role of advocacy in turning science into impact. AVAC’s Senior Program Manager of STIs, Alison Footman, speaking at the same plenary, underscored the urgency of bringing community voices to the center of strategy. “These are scary times,” she said, referencing the destabilizing effects of the U.S. foreign aid freeze. “But what remains important is ensuring that people impacted by STIs are shaping the response, not just being talked about.”
Yet, community participation at the conference was visibly lacking. Many advocates and community representatives were unable to attend due to visa issues and the absence of scholarships and sustained funding. The field must invest in community, not just as beneficiaries, but as co-creators of the response.