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.
Today marks one year since AVAC and the Journalism Development Network worked with the Public Citizen Litigation Group to sue the US President, the State Department, the US Agency for International Development (USAID), and others, seeking emergency relief from a sweeping freeze on foreign assistance issued by the incoming administration that abruptly halted life-saving global health and development programs. A parallel case was brought by Global Health Council and partners and assigned to the same District Court judge, underscoring the broad concern across the global health community.
Twelve months later, these cases have come to symbolize a much larger question: whether the executive branch can override Congress’s constitutional authority over federal spending and dismantle decades of bipartisan foreign policy with the stroke of a pen, and whether the courts and Congress will fulfill their responsibilities to serve as checks on unbridled executive power.
The past year has laid bare the real-world consequences of unchecked executive action, threatening lives, destabilizing global partnerships, and undermining the United States’ credibility as a reliable partner.
An early ruling in AVAC’s case successfully unlocked nearly $2 billion in US government payments for work already completed, affirming that the executive branch cannot refuse to spend money appropriated by Congress. But over the course of 2025, appeals by the administration, ultimately backed by the US Supreme Court, ran down the clock on $4 billion in already-appropriated funds for the 2025 fiscal year, allowing them to expire.
While the Supreme Court’s ruling did not resolve the underlying constitutional questions, the decision was narrow and the Court left open the opportunity for further argument on the merit of the questions involved. In November 2025, a joint statement to the District Court requested to pause the cases, awaiting the outcome of other relevant court decisions.
The AVAC and GHC cases remain active, but lawsuits alone cannot restore what was lost—or undo the long-term harm caused by the sudden dismantling of global health systems.
The actions by this administration demand more than concern. This moment demands public accountability, sustained Congressional oversight, and durable legislative safeguards. Global health and equity require champions willing to fight for lives and livelihoods, and for what’s right. We cannot accept this as the new normal, and we must insist that Congressional authority, democratic governance, and the lives they protect still matter.
This month, AVAC marked our 30th anniversary. Over three decades, the HIV field has evolved dramatically—but what we do, and why we do it, has remained constant: standing for science, equity, and community leadership, and ensuring evidence drives decisions that affect people’s lives. We’ve been able to do this work because of your partnership and support, and we are deeply grateful.
Last week, we also released the 2025 update of the People’s Research Agenda (PRA), which tracks the science, highlights where investments align—or fail to align—with community priorities, and identifies critical gaps that must be addressed to ensure the prevention pipeline meets the needs of diverse populations. After ten months of disruption and uncertainty across biomedical research and global health, we hope this agenda helps share a path forward, one that will demand sharper priorities, smarter investments, and a balanced portfolio focused on real epidemic impact.
At the same time, we are seeing real progress. In just the past month, people in Brazil, Eswatini, South Africa, and Zambia began receiving the first doses of lenacapavir for PrEP (LEN) through early implementation programs outside the US, with additional deliveries of LEN planned for Eswatini, Zambia, Kenya, Lesotho, Mozambique, Nigeria, Uganda, and Zimbabwe.
As we enter our fourth decade, your support makes it possible for AVAC to keep tracking the science, elevating community priorities, and delivering real-time analysis when it matters most. If you’re able, we invite you to consider making a year-end gift to sustain this work.
Thank you for being part of this work, and for standing with AVAC.
The Future of HIV Prevention Depends on Speed, Scale and Equity
When the US Food and Drug Administration approved lenacapavir (LEN) fro PrEP, it offered something rare in public health: a genuine turning point. We now have one of the greatest opportunities and scientific breakthroughs that we’ve had in HIV in 44 years: a twice-yearly injectable that showed near-complete protection against HIV in major trials. Science has given us a breakthrough. What happens next is up to us.
But as AVAC Executive Director Mitchell Warren recently noted on ABC News and CNN, this moment of possibility is colliding with a moment of profound danger. The US administration’s proposed cuts to HIV prevention programs could reverse decades of progress in research, care, and rollout of new options. If that happens, even the most powerful tools like LEN will fall short. This is not a theoretical concern. It’s a warning, and one we must urgently act on.
We cannot let cruel international policy allow historic gains to collapse just as a new, highly effective prevention option arrives. That is why rolling out LEN — to all countries that need it — with speed, scale, and equity must be our uncompromising priority. If we do this right, we can change the trajectory of the epidemic — but only if we act at the pace the science demands.
Speed means national programs must approve, adopt, and distribute LEN now — not after years of bureaucratic drift or pilot-project hesitation. People at risk cannot wait.
Scale means strengthening and funding the infrastructure to make LEN widely available — across entire systems and communities.
Equity means ensuring LEN reaches the people most affected by HIV — including and prioritizing those historically sidelined, discriminated against, or left behind — not just the communities that are easiest to reach.
Without speed, we lose momentum. Without scale, we limit impact. Without equity, we repeat the failures of the past.
We are in a golden moment, where innovation, evidence and opportunity align. But proposed funding cuts could undo everything. These aren’t abstract numbers on a page. These cuts would shutter clinics, slow prevention, restrict treatment, and roll back the very systems that allow new tools like LEN to reach people. Watch this powerful call-to-action from APHA Executive Director and longtime AVAC partner Yvette Raphael at the recent UNAIDS meeting.
As Mia Malan recently reported in Bhekesisa, the US government recently announced that it would, join the Global Fund to buy LEN for African countries with high HIV infection rates. She reports, “the Trump administration revealed its support was a “market-shaping initiative” with the goal to increase LEN production and uptake, and, in effect, bring down the price of the jab as fast as possible, so that countries could eventually buy the medicine themselves. But they left South Africa — with the largest market for LEN, because it has the highest number of new HIV infections in the world — off the list.”
Warren spoke with Malan about this misguided decision, saying “If you want to build large volumes of a product, whether it’s lenacapavir or Coca-Cola — because we know that large volumes will lower prices — you make sure you start off with the biggest market, because that’s how you will shape the market the fastest and most meaningfully. So South Africa is the place where you’d want to be. Economically, because that’s how you will build the market the quickest. Epidemiologically, because that’s how you will prevent the most new infections. Practically, because that’s the country with the most mature HIV prevention medication market in the world.”
It makes no sense to celebrate the arrival of a breakthrough PrEP option while simultaneously dismantling infrastructure required to deliver it. We cannot allow ideology take over epidemiology. And we cannot end HIV with half-funded programs and half-hearted commitments. We cannot end HIV by retreating just as we need to push forward. We cannot end HIV if we abandon the global leadership that have made decades of progress possible.
This is the paradox we face: extraordinary scientific promise shadowed by political short-sightedness. To realize LEN’s potential we need urgency, not hesitation. Governments must rapidly integrate LEN into national guidelines, commit domestic funding, and remove regulatory and logistical bottlenecks. Global donors, especially the US government, must protect and expand HIV investments, not shrink them. Scaling LEN requires resources, commitment, and sustained political leadership. Community organizations must lead rollout strategies, ensuring they are people-centered, stigma-free, and grounded in lived experience. And advocates must insist that LEN is rolled out now.
If we get this right, LEN will be a global prevention pillar: accessible, trusted, and transformative.
Let’s be clear. Every funding cut can represent at minimum, a delay. Every delay in rollout is a missed chance to prevent infections. Every un- or underfunded clinic is a barrier to access. Every policy is a choice to be inclusive or leave someone behind. No one should face risk of HIV simply because innovations didn’t move fast enough, weren’t scaled broadly enough, or weren’t delivered equitably.
We must act like the future depends on our choices, because it does. Science alone won’t get us there. Speed, scale, and equity will.
Sexually Transmitted Infections: ‘Self-testing’ versus ‘self-collection’: the critical role of consistent language in the field of STI diagnostics
This editorial from AVAC’s Alison Footman and colleagues makes the case for precise and consistent language around self-testing and self-collection. because clarity impacts policy, expectations, and access.
AVAC Input for Recompetition of the NIAID HIV/AIDS Clinical Trials Networks
AVAC’s formal input submitted on the re-competition of the NIAID HIV/AIDS Clinical Trials Networks. The recommendations were informed by the People’s Research Agenda (PRA), a comprehensive framework developed through consultations with over 130 community representatives across 23 countries.
Late today in AVAC v Department of State and Global Health Council v Trump, the Supreme Court of the United States granted the US Presidential Administration’s request to stay an injunction that would require the Administration to obligate $4 billion of foreign assistance funds before they expire on September 30, as required by law. The Court’s ruling temporarily grants the Administration’s request to pause a lower court order that the government spend the funds. With just four days until September 30, those funds, which otherwise would have saved lives and advanced global health and national security, will remain unspent.
“With this ruling, the Supreme Court has given the Administration a free pass to run out the clock on the disbursement of foreign aid that Congress appropriated. Since foreign aid was frozen on the first day of this Administration, we have seen thousands of clinics close, hundreds of thousands of communities lose access to essential services and medications, and thousands of lives lost,” said Mitchell Warren, executive director of AVAC, a plaintiff in the case. “This ruling will translate into further devastation, put future global health responses at risk, and set a dangerous precedent that undermines Congress’ constitutional power of the purse.”
“But this is beyond foreign assistance; the Court’s decision is a chilling one for anyone who cares about the US Constitution. While their ruling is only preliminary and should not be read as a final determination on the merits, it is terribly misguided and potentially implies that the Administration can disregard Congressional power of the purse and now seemingly impound Congressionally appropriated funds whenever it wants,” added Warren.
In a powerful dissent, three Supreme Court justices led by Justice Elena Kagan issued a warning that the stakes in this case are far too significant to be decided through the Court’s emergency docket without full briefing or oral arguments, underscoring the extraordinary nature and far-reaching consequences of the Administration’s unlawful actions. “Deciding the question presented thus requires the Court to work in uncharted territory. And, to repeat, the stakes are high: At issue is the allocation of power between the Executive and Congress over the expenditure of public monies,” Justice Kagan wrote in her dissent. “The standard for granting emergency relief is supposed to be stringent. The Executive has not come close to meeting it here.”
Supporting RECs/IRBs to Review the Enrolment of Pregnant/Lactating Individuals in HIV Prevention Trials using International Ethical Guidance
Appearing in the journal Research Ethics, this article written by AVACer Breanne Lievense and partners provides ethics recommendations to be included in future research on pregnant and lactating individuals.
Manifestations and Lived Experiences of Structural Racism for Racial and Ethnic Minority Communities Affected by HIV Across the United States
Structural racism shapes the lived experiences of racial and ethnic minority communities through political disempowerment, inequitable access to resources, and intergenerational trauma. This study provides support for the argument that the HIV and COVID-19 epidemics will not be adequately addressed without urgent action on the various ways in which structural racism manifests in the US. Given the troubling trend toward stifling discussions on race and racism, now is the time to accelerate, not subdue, national, state, and local discourse on structural racism and intersectional oppression. Now is time for bold, transformative actions.
