PxWire Volume 16, Issue 2

This issue showcases AVAC’s analysis of the recent PEPFAR data release, assessing how uptake of prevention programs—particularly PrEP initiations—have declined over the last year. As the field grapples with the lasting impact of the US government’s cuts to PEPFAR programs, AVAC takes a closer look at what the data show and what is still missing.

This is especially timely, given the recent announcement from PEPFAR and the Global Fund of their additional commitment to scale-up lenacapavir (LEN) for PrEP. AVAC’s recent infographic unpacks the enduring gap between current donor commitments, LEN volume capacity and potential market size. Lastly, AVAC’s newest infographic depicts the long-acting HIV treatment R&D pipeline. Coupled with research on long-acting prevention and vaccines, long-acting treatment is an important component of an integrated approach to ending HIV as a global health threat.

Read below or download a PDF version of this issue.

Progress in PrEP Uptake

  • On April 17, the US State Department released long-awaited PEPFAR data from the last quarter of Fiscal Year 2025 (FY25), representing the only data available on the status of PEPFAR programs following the US government’s drastic cuts to foreign assistance programs. Only one quarter of data, covering the fourth quarter of FY25 (July-September 2025) was released, and no data are available from the last six months of implementation.
  • While PEPFAR promoted the data release as reflecting significant progress in curbing the epidemic, the data actually reveal stark declines in HIV testing, diagnosis, and treatment. HIV prevention programs were some of the hardest hit by both cuts to PEPFAR programs and the narrowing focus on prevention for pregnant and breastfeeding women (PBFW).
  • In FY25, the number of individuals newly initiated on PrEP decreased by 41% as compared to the same quarter in FY24, with an overall decrease of 54% among all men and 53% among women who are not pregnant or breastfeeding. While PEPFAR touted a 140% increase in PrEP initiation among PBFW, the disaggregated data is historically inconsistent and not available in the latest data release; therefore it cannot be independently verified.
  • Especially worrying was PrEP initiations among adolescent girls and young women (AGYW) aged 15-24, which fell by 39% as compared to a 26% drop among women aged 25-49. AGYW previously benefited from PEPFAR’s DREAMS programs—packages of prevention services to address the high incidence of HIV among AGYW—but the number of program recipients decreased by 86% in FY25 as many of these programs were defunded.
  • Most alarmingly, the data do not include any information on HIV prevention services or PrEP initiation among key populations, including men who have sex with men, transgender people, and sex workers. This lack of data, coupled with the elimination of prevention programs for these populations, reflect an erasure of individuals at high risk for HIV that face life-threatening cuts to services.

Achieving Global 2030 Prevention Targets

The Global HIV Prevention Coalition (GPC) recently launched its HIV Prevention 2030 Global Access Framework, outlining how, by 2030, countries can ensure that 90% of people in need of HIV prevention services have access and that 90% of people living with HIV are virally suppressed. This, in combination, would lead to a 90% reduction in new HIV infections globally. “Innovations, especially lenacapavir, have added to the array of prevention choices. History will judge us harshly if we as a global community fail to meet this scientific moment,” said Mitchell Warren, GPC Co-Chair on a recent webinar. Actions must be country-led, sustainable, people-centered, and rooted in community leadership to achieve these targets.

graphic from UNAIDS report graphic from UNAIDS report

Graphics: HIV Prevention 2030 Global Access Framework

PrEParing for New Products

  • On April 14, the US State Department and the Global Fund announced an increase of their original commitment of LEN for PrEP, from two million to three million people over three years.
  • Gilead has confirmed that it is not supply constrained and can supplement generic supply until it is steady, as long as they receive orders within time, based on their sixto nine-month production lead time needed. Generic supplies are expected to reach the market by the middle of 2027, but their capacity and lead times are not yet known.
  • While this is an important step, it does not go far enough to have meaningful impact on rapid scale-up of LEN, and there are no guarantees that the product will reach those who need it most, including key populations and adolescent girls and young women.
  • AVAC and Access Bridge see more potential to build the market by meeting market demand, leading ultimately to a reduced price, higher annual volumes and significantly increased impact.
  • To achieve this, key priorities over 2026 and 2027 must be advanced:
    • Global Fund and PEPFAR need to raise the floor of their commitment to reach at least four million people in two years.
    • Global Fund must ensure that they have the resources to procure these volumes and meet demand, requiring resource mobilization beyond the recent GC8 replenishment.
    • Global Fund and PEPFAR need to provide clear, transparent LEN access plans, with volumes and countries, ensuring a more comprehensive joint strategy in more countries, as well as volumes and prices with Gilead and generics.
    • All procurers must place orders for 2027 by June 2026 with both Gilead and generics to ensure uninterrupted supply and expanded global access, whether through the Global Fund or directly with manufacturers.
    • Ministries of Health must collaborate with implementation partners and civil society to ensure people-centered approaches to rollout, and to address supply and demand issues as they emerge and develop robust forecasts for 2027.
    • Generic manufacturers must specify their lead-times from order to delivery to coordinate and ensure timely procurement.
    • Gilead must urgently finalize license and supply agreements for middle-income countries, especially in Latin America and Asia.

The Latest in the HIV Research Pipeline

  • AVAC has recently begun to track the research pipeline for long-acting HIV treatment (LA-ART). This focus aligns with AVAC’s work to advance an integrated approach to ending HIV transmission, including a comprehensive agenda for the development of novel and longer-acting products beyond PrEP, inclusive of PEP and treatment.
  • A rapidly expanding pipeline for LA-ART has the potential to introduce new regimens with dosing frequencies that range from weeks to months to, eventually, years. The benefits of LA-ART include reduced drug dosing, frequency, and number of drugs, with the potential for associated decreases in the cost of medications and the burden on health systems. New drug classes could close treatment gaps in children, adolescents, and those with high viremia, comorbidities and resistance.
  • CROI 2026 highlighted the potential future LA-ART landscape beyond today’s 2-month CAB + RPV injections. The range of products in development includes novel characteristics such as new ART classes and monoclonal antibodies, new ARV combinations, delivery via oral, implantable and injectable formulations, and longer regimens—currently up to six-months.
  • Ongoing clinical research will hopefully further demonstrate whether there are trade-offs (treatment failures or resistance) between LA-ART and highly effective daily oral ART. In addition to the new long-acting products, simplified single-tablet daily regimens are also in development.

Building the Market for New Products from the Trial Stage

MK-8527 is currently in Phase III trials (EXPrESSIVE-10 and EXPrESSIVE-11) across 17 countries. To build a supportive environment around the concept of a monthly oral PrEP pill, AVAC supported the development of communications materials for use in the EXPrESSIVE-11 trial which can be adapted for future market entry. AVAC worked with local partners and MSM, transgender, and non-binary communities in 8 trial countries in Africa, Asia, and Latin America to co-create the materials, ensuring that focus populations contributed to the design. The result is a global campaign with a localized feel that is generating awareness on MK-8527 early.

English poster example
Portuguese poster example
Spanish language poster
Swahili language poster

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AVAC Year in Review 2025

2025 underscored the vital role that AVAC plays in the global health ecosystem, and why our work and our partnerships have never been more essential.

This report highlights AVAC’s role as a trusted voice, a translator of science and catalyst for action and advocacy. It reflects an organization ready for the future: supporting African leadership, strengthening bridges from R&D to delivery and preparing for a new chapter as we move forward into our fourth decade as an organization. Read the PDF below or view as a webpage.

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PxWire Volume 16, Issue 1

This issue showcases the status of access to oral PrEP with the best data available since the US foreign aid freeze disrupted PEPFAR operations beginning in January 2025. Stakeholders are digging deep to meet the moment, which includes an unprecedented opportunity to drive down HIV incidence with the rollout of injectable lenacapavir (LEN) for PrEP.

A new AVAC infographic below depicts the accelerated process for delivering LEN to date, and critical next steps. Lastly, our update on the HIV vaccine R&D pipeline documents an evolving and diverse portfolio of products, which remains essential for a durable end to HIV as a global health threat.

Read below or download a PDF version of this issue.

Progress in PrEP Uptake

  • Between the period January-September 2024 to January-September 2025, PrEP initiations fell between 13% and 66% in selected high-volume PrEP countries where ministries of health (MoH) were able to provide data.
  • Among the five countries depicted, four saw significant decline in PrEP uptake. All four relied on PEPFAR PrEP programs and were disrupted by stop work orders (SWO).
  • Brazil does not receive PEPFAR funding for PrEP and was the only country surveyed that saw an increase in initiations, up by 17%.
  • Among the same four African countries, data on initiations of long-acting injectable cabotegravir (CAB) for PrEP show a combined total of 5,709 initiations during this period. With PEPFAR’s original target of 100,000 initiations across ten African countries by the end of 2025, these data reflect an extreme shortfall of CAB uptake, caused by PEPFAR’s discontinuation of CAB procurement and programs.
  • A decline in PrEP uptake represents a serious threat to HIV prevention and to efforts to achieve epidemic control. A recent analysis in The Lancet HIV estimated that stopping PEPFAR’s PrEP programs in Africa for a year could lead to approximately 7,000 additional new HIV acquisitions, and more than 10,000 additional cases of secondary transmission in the next five years. This slowdown also makes the introduction of new options more challenging.
  • For more details on the negative impact of the PEPFAR SWO, including mitigation strategies that ministries of health and program implementers are putting in place, see our SWO Tracker.

PrEParing for New Products

  • The timeline for hitting key milestones in product introduction is moving faster for injectable LEN than for any previous PrEP products, starting from the announcement of efficacy results in Phase III trials.
  • LEN’s accelerated timeline compared to oral PrEP, DVR, and CAB reflects a field-wide effort to learn lessons from previous PrEP rollout and not repeat the mistakes of the past.
  • The developers of LEN, Gilead Sciences, leveraged the EU-M4all process, formerly known as Article 58, and WHO’s Collaborative Registration Procedure (CRP) to speed the process of regulatory review in low-and middle-income (LMIC) countries. This process allows the European Medicines Agency (EMA) and the WHO to provide a scientific opinion on products that address “diseases of major public health interest” in LMICs. EU-M4all and CRP help national regulators accelerate their review.
  • LEN has received 10 African regulatory approvals in only six months since the US Food and Drug Administration granted approval. By comparison, oral PrEP took 3.5 years for the first African approval to be granted after FDA approval, and 6.5 years to reach 10 approvals.

The Latest R&D in the Prevention Pipeline

Despite the challenges posed for research in 2025, and HIV research in particular, two notable vaccine trials launched at the start of 2026:

  • BRILLIANT 011 launched in South Africa. This HIV vaccine trial was cancelled by the US government as part of the dismantling of USAID in early 2025. The South African Medical Research Council and the Gates Foundation, however, provided fund-ing to keep the program going as a smaller, more streamlined version of the trial originally planned under USAID. This groundbreaking African-led and -funded trial is a Phase I study of a bNAb inducing candidate. Learn more about vaccine strategies here.
  • The first vaccinations for the IAVI G004 Phase I clinical trial also took place in January. This early-stage HIV vaccine trial stands out as the first germline-targeting vaccine designed to induce broadly neutralizing antibodies (bNAbs) against more than one major site on the HIV envelope—specifically both the CD4 binding site and the V3 glycan region. Most prior HIV vaccine candidates have focused on the CD4 binding site alone.

Additional developments in the R&D pipeline include:

  • Merck’s Phase 3 trials of the monthly oral PrEP pill MK-8527 – EXPrESSIVE-10 and EXPrESSIVE-11 – are now both underway. EXPrESSIVE-10 officially launched in November 2025 and has since begun recruitment at 19 sites in South Africa, with sites in Kenya and Uganda prepared to launch imminently. EXPrESSIVE-11, which launched last August, is now enrolling participants in 58 sites across 11 countries, with additional sites also launching soon.
  • Sidaction and Aidsfonds announced funding for four projects to inform cure research, investigating the biology of viral persistence, viral control, ethics in cure clinical trials and more.
  • AVAC launched its new Pipeline Tracker that is continuously updated, with comprehensive descriptions and status updates of all products in the HIV R&D pipeline.

A Deep Dive on the People’s Research Agenda

In December AVAC launched our 2025 Update to the People’s Research Agenda (PRA), a people-centered framework for tracking community priorities and progress in the pipeline of HIV prevention research and development. PRA findings include:

The Future of HIV Prevention: A People’s Research Agenda for Speed, Scale and Equity

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Featured speaker Jeanne Marrazzo of the Infectious Diseases Society of America and AVAC board member explores what the People’s Research Agenda tracks and the advocacy priorities that will shape the future of HIV prevention R&D. View the recording.

“We cannot yell it from the rooftops loud enough that new infections are going to rise and undermine efforts to end AIDS as a public health threat. But this is not a time to despair. It’s a time to fight!” – Jeanne Marrazzo

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People’s Research Agenda

2025 Update

The People’s Research Agenda sets out a people-centered framework for equitable and accelerated R&D and product introduction. It tracks the science, 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.

Read the 2025 Update

The original 2024 report is also available.

PxWire Volume 15, Issue 4

This issue provides a range of maps to help orient the field on critical HIV prevention activities: the status of delivering injectable cabotegravir (CAB for PrEP); funders and countries on track for early introduction of injectable lenacapavir (LEN for PrEP); and where new Phase 3 efficacy trials testing MK-8527 as a monthly pill for PrEP are taking place.

Read below or download a PDF version of this issue.

Progress in PrEP Uptake

  • The first supplies of CAB for programmatic use (as opposed to use in implementation studies) began to arrive in countries in 2024.
  • Currently, 16 countries are rolling out CAB for programmatic use, with the majority of supply provided by PEPFAR, and some additional quantities procured by the Global Fund.
  • Stop work orders for PEPFAR programming, issued in January 2025 by the new US administration, led to the cancellation of planned programs to offer CAB before they could start in Namibia and South Africa. Ethiopia’s CAB program was able to move forward with supplies supported by Global Fund.
  • Stop work orders disrupted ongoing CAB programs in other PEPFAR supported countries, too. They were able to resume, though in some cases at a reduced level. Global Fund supported programs were unaffected by stop work orders and are ongoing.
  • The future of PEPFAR and Global Fund supported CAB programs remains uncertain in the context of multiple forms of injectable PrEP entering the market. But lessons and insights being gathered now on delivery of injectable PrEP via these programs can be leveraged to help countries prepare for the introduction of LEN.
  • In the past quarter, CAB for PrEP received additional regulatory approval in Argentina, Chile, Mexico, and Rwanda.

PrEParing for New Products

The Latest R&D in the Prevention Pipeline

  • Seventeen countries are hosting sites for the Phase 3 efficacy trials of a monthly PrEP pill, MK-8527, being developed by Merck (also known as MSD outside of the US and Canada). Merck announced the launch of the Phase 3 trials at IAS 2025 in Kigali. MK-8527 was found to be safe and well-tolerated in Phase 2 clinical trials.
  • A long-acting PrEP pill would offer a unique new option to the existing range of PrEP options and could significantly expand use of HIV prevention, especially among young women, key populations, those facing stigma or access barriers, and those that prefer an oral PrEP option over an injectable.
  • EXPrESSIVE-10, with funding from the Gates Foundation, is expected to launch in Q4. It will enroll about 4,600 cisgender adolescent girls, young women, and other women who could benefit from PrEP across three countries in Eastern and Southern Africa.
  • EXPrESSIVE-11 launched in August 2025, and will enroll about 4,400 cisgender men, MSM, transgender men and women, and gender non-binary persons who could benefit from PrEP in 16 countries. So far, EXPrESSIVE-11 has launched at sites in Dominican Republic, Guatemala, Switzerland, and the US.
  • Merck’s commitment to stakeholder engagement to date contributes an important model of Good Participatory Practice (GPP) to the field, by putting global advocates at the forefront of planning for the program and trial design. Merck has expressed a commitment to sustain this vital engagement throughout the program and next steps.

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The Global Need for Long-Acting PrEP Among Key Populations

Forecasts of Global Demand 2025–2030

The introduction of long-acting PrEP represents a turning point in the global HIV response, especially for key populations who have historically faced persistent barriers to HIV prevention. Despite oral PrEP being introduced more than a decade ago, global uptake remains well below targets. New HIV infections are declining in some regions but are stagnating or rising in others, particularly where key populations are
underserved.

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Also available on the GBGMC website.

PxWire Volume 15, Issue 3

With the recent FDA approval of injectable lenacapavir (LEN) for PrEP and the drastic withdrawal of US investment in HIV prevention, the field must reimagine and recommit to getting PrEP rollout right this time AND to sustaining the HIV research pipeline. Research on HIV has brought numerous advances to global health, but controlling, and ultimately ending, the epidemic depends on continued investment in innovation.

This issue of PxWire looks at the scale of shuttered prevention programs for key populations (KPs), the potential market for injectable LEN, and the devastating cuts to research for an HIV vaccine.

Read below or download the PDF version of this issue.

Progress in PrEP Uptake

The PEPFAR stop work orders issued by the US government in January 2025 have devastated the HIV response worldwide, including funding for primary prevention. Sustaining the HIV response and bending the curve of incidence depends on identifying new sources of funding to maintain HIV prevention programs for KPs.

  • Guidance issued in February 2025 indicated that PrEP services funded by the US government are permitted only for pregnant and lactating people—meaning that KPs, such as LGBTQ+ individuals, sex workers, and people who use drugs, have lost access to PrEP, unless they are currently pregnant or lactating.
  • The graphic below shows key findings on the percentage of KP programs terminated by country. Most of the priority African countries for the HIV response report national KP programs are fully or partially terminated.
  • HIV incidence rates amongst KPs are higher than in other populations. Excluding this group from PrEP programming endangers whole communities threatened by HIV, disables the HIV response, and jeopardizes gains made against the epidemic.
  • Research undertaken by Global Black Gay Men Connect (GBGMC) examines the impact of US government funding cuts on KP programs in Africa.
  • Additional research done by AVAC, in the report Impact of PEPFAR Stop Work Orders, shows that KPs are the group most impacted by US government funding reductions to HIV prevention services worldwide. In some cases, such as Panama, national governments are stepping in to fill the gap.

PrEParing for New Products

Stakeholders—including Global Fund, PEPFAR, WHO, UNAIDS, Unitaid, Ministries of Health, advocates and implementing partners—have critical work to do now to ensure doses of LEN hit the ground as quickly as possible. Check out Gears of Lenacapavir for PrEP Rollout and Getting PrEP Rollout Right This Time to get the details.

  • The map shows 16 countries in Africa, Asia and Latin America that have the largest PrEP markets.
  • If total PrEP initiations continue to increase by 20% every year, which is the trend in recent years, and injectables represent 60% of initiations, as seen in implementation studies, 2026 numbers of injectable initiations could be as shown in the map.
  • The exact price and volumes of LEN per country is not yet known.
  • Of those injectable initiations, LEN is expected to be the majority, given the proposed manufacturing projections from Gilead and the stated ambition of the Global Fund to reach two million people with LEN within the first three years of introduction. Additional volumes of injectable cabotegravir would make up the rest.
  • PEPFAR, which in December committed to collaborate with Global Fund, has not yet publicly stated how LEN will fit into their more limited approach to PrEP, which has been restricted to pregnant and breastfeeding women.

The Latest R&D in the Prevention Pipeline

  • In May, NIH’s National Institute of Allergy and Infectious Diseases (NIAID) announced that funding for the Consortia for HIV/AIDS Vaccine Development (CHAVD) would end after the current grant cycle in June 2026. With only one more year of funding before the grants end, current plans for research, clinical trials and progress toward a vaccine are all at risk.
  • First launched in 2005, the CHAVDs led ground-breaking research to develop an HIV vaccine.
  • CHAVD grants currently fund two institutions as consortia leaders—The Scripps Research Institute and Duke University.
  • The quest for an HIV vaccine is gaining momentum with field-changing contributions from the CHAVDs. The institutions are currently researching vaccine designs that rely on the immune system’s broadly neutralizing antibodies (bNAbs) to protect against HIV.
  • The annual funding for the consortia—approximately $67M—represents a significant chunk of the NIH’s funding for HIV vaccine development, and also approximately 10% of all funding for HIV vaccine research globally each year.
  • NIH’s yearly grant total for the CHAVD is larger than any other individual donor’s annual giving for HIV vaccine research. The next closest donor is The Gates Foundation, which donates approximately $64M a year to this research.
  • In 20 years of research, CHAVD discoveries have resulted in new technology to combat HIV, influenza, Zika, COVID, and other novel coronaviruses. The loss of the CHAVD will have a devastating impact on the HIV response and scientific discovery.

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  • CHANGE: In response to the unfolding crisis, more than 1,500 people from civil society organizations around the world have launched CHANGE—Community Health & HIV Advocate Navigating Global Emergencies—a coalition formed to support urgent action: [email protected]
  • Subscribe to Global Health Watch: AVAC’s weekly newsletter dedicated to breaking down critical developments in US policies and their impact on global health, at avac.org/global-health-watch
  • Fight For Our Lives” Emergency Townhall: Impact of the Trump Administration Foreign Aid Freeze on KP & LGBTQ Communities, Ongoing convening, Register here

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Long-Acting PrEP Market Assessment for Key Populations

Global Access and Readiness

This market assessment supports countries, donors, implementing partners, and advocates in making informed decisions about the introduction, scale-up, and equitable delivery of long-acting PrEP among key populations and other priority groups.

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Also available on the GBGMC website.

Getting PrEP Rollout Right This Time

Lessons from the Field

Thirteen years after oral PrEP’s introduction, global uptake remains slow, with just over 9 million initiations—falling short of UNAIDS’ 2025 targets. While HIV infections are declining in some regions, others are experiencing increasing epidemics. Despite challenges, lessons from oral PrEP and CAB rollout have strengthened health systems for scaling up longer-acting PrEP.

AVAC undertook a qualitative landscaping analysis to identify actionable lessons and recommendations across seven countries—Brazil, Kenya, Nigeria, South Africa, Vietnam, Zambia, and Zimbabwe—exploring themes of:

  • Successes and challenges with daily oral PrEP introduction and scale-up and what can be done differently for new PrEP products.
  • Public health system readiness for the introduction and scale-up of new PrEP products.
  • Considerations for improving and accelerating PrEP regulatory approval, normative guidance, demand generation, stakeholder engagement, and health systems strengthening.

This analysis, conducted across seven countries before the January 2025 US foreign aid freeze, identifies urgent actions to sustain momentum. US foreign aid cuts are severely impairing PrEP delivery, jeopardizing remarkable progress made in the last 20 years. In the wake of this disruption, it is vital that efforts to mobilize and sustain an effective HIV response learn from the past and reach UNAIDS’ targets for 2030 by incorporating these insights into future planning.

Visit PrEPWatch for the full report and individual country profiles.

Advocates’ Guide: Understanding the President’s Proposed Fiscal Year 2026 (FY26) Budget and Its Implications for Science, Research and Global Health 

The US administration’s proposed Fiscal Year 2026 (FY26) budget marks a sweeping rollback of federal investment in health, research, and global development. For advocates, researchers, and implementers, this proposal demands urgent attention and action.  

This initial “skinny budget” is a proposal and not yet law. A more detailed proposal will be released by mid-to-late May and the US Congress will ultimately decide actual funding levels for FY26, which begins October 1. So, advocates must speak up now to protect funding for research and programming that saves lives and livelihoods. 

Here’s what advocates need to know and do: 

Big Picture: A Dramatic Retrenchment 

The budget proposes $163 billion in cuts to non-defense discretionary spending, including a 26% reduction to the Department of Health and Human Services (HHS)— the department that oversees the US National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). These cuts are completely offset by an increase to defense spending and reflect a shift toward the elimination of science and programming tied to diversity, equity, inclusion (DEI), gender, and climate, and a redirection of funding toward defense and “America First” priorities—priorities that put the perceived interests of the US and its citizens over other national and global issues. 

Detailed Analysis and Implications

Health and Biomedical Research 

The proposed cuts to HHS would gut federal support for health and biomedical research, dismantling key programs at NIH and CDC. They threaten progress on infectious diseases, health equity, and pandemic preparedness—undermining decades of scientific gains and leaving communities vulnerable. 

NIH is Cut by $17.9 billion losing HIV and global health research 
  • Preserves $28 billion of the $46 billion for NIH overall, but excludes HIV prevention, global health, and health equity research.  
  • Reorganizes NIH into 5 “realigned” institutes, removing focus on climate, gender, racial equity. 
  • Eliminates the Fogarty International Center and the National Institute on Minority Health and Health Disparities. 
Centers for Disease Control and Prevention (CDC): Cut by $3.59 billion 
  • Eliminates Global Health Center and National Centers on environmental health, injury prevention and chronic disease prevention. 
  • Eliminates DEI programs and shifts the burden for pandemic prevention and response. 
Agency for Healthcare Research and Quality: Effectively eliminated 
  • Cited as redundant; targeted for work on climate and gender. 
National Science Foundation (NSF): Cut by $4.9 billion (56%) 
  • Eliminates funding for work seen as ideologically objectionable (e.g., broadening participation and racial equity in STEM). 

Global Health and Development

At a time when the USG should be expanding access to new technologies, the proposed FY26 budget guts foreign assistance funding, threatening pillars of the global HIV response: the President’s Emergency Plan for AIDS Relief (PEPFAR) and US contributions to multilateral initiatives, such as Global Fund and GAVI. The ideological targeting of family planning and gender-related programs will further weaken interventions to address HIV, which have been shown to work best within a comprehensive package of health and social services.  

Global Health Programs: Cut by $6.23 billion

  • Defunds NGOs providing family planning, impacting maternal and child health providers. 
  • PEPFAR preserved only for existing treatment programs and programs for the prevention of mother-to-child transmission (PMCT) , and specifically excludes primary prevention and PrEP, except for pregnant and lactating populations. 

USAID Development Aid: Cut by $8.33 billion 

  • USAID is eliminated with the limited number of existing programs moved into the State Department. 
  • Eliminates DEI, climate, and gender-related programming. 
  • Creates new “America First Opportunity Fund” to replace foreign assistance grants with loans that prioritize US interests over humanitarian needs. 

Centers for Disease Control and Prevention (CDC)

Health Resources and Service Administrations (HRSA): Cut by $1.73 billion

  • Ryan White HIV/AIDS Program activities not deemed core are eliminated. 

Substance Abuse and Mental Health Services Administration (SAMSHA): Cut by $1.065 billion 

  • Eliminates harm reduction and regional substance use program grants. 

Offices of Minority & Women’s Health 

  • Moved under a new, less visible structure. 

New Initiative: “Make America Healthy Again”

  • $500 million focused on lifestyle over treatment. 

What This Means

  • HIV Prevention R&D and global implementation is at risk. Cuts to NIH and USAID directly threaten support for clinical trials, community engagement, and biomedical innovation. 
  • Equity-centered research threatened. Eliminating institutes focused on minority and global health severely undermines inclusive science and jeopardizes future impact. Inclusion is not just a nice to have, it’s integral to achieving impact 
  • PEPFAR protections are narrow. Only existing beneficiaries are covered; scale up and innovation are excluded, compromising the imminent introduction and potential impact of injectable lenacapavir for PrEP. Funding for HIV prevention is also eliminated, except for pregnant and lactating populations. 

Advocacy Priorities

  • Monitor the full FY26 budget release for agency-level detail and justification. 
  • Engage Appropriations and other relevant Committees via coalition efforts (e.g., FAPP, GAPP, GHTC, SHF). 
  • Mobilize your community to contact your Senators and Representatives to let them know you oppose these cuts.  
  • Share your stories from researchers affected by cuts—particularly those whose work is globally focused or funded by NIH/USAID. 
  • Stay up to date with budget briefings and mobilization opportunities. See AVAC’s ‘Research Matters’ resource, which shares guidance and a toolkit for researchers to advocate for continued funding.

This budget is a threat to decades of progress in science, equity, and health—but it is also an opportunity to speak with clarity and urgency about what is at stake. Advocates must ensure that the future of HIV prevention, global health innovation, and equitable science is not written by politics, but by people, evidence, and impact.