Avac Event
Join us Wednesday, May 20 for Inside the Decisions that Changed Global Health: An AVAC Conversation with Nicholas Enrich, author of Into the Wood Chipper and former global health lead at USAID. Enrich will share an inside perspective on the decisions that led to the dismantling of USAID and the foreign aid freeze and what they mean for global health today.
Official characterizations of the HIV response as “doing very good” warrant a closer look at the data. AVAC’s analysis of PEPFAR prevention figures shows PrEP initiations declined 41% in one year, with women and men each seeing drops exceeding 50%. Data on key populations remains unavailable.
Lenacapavir has the potential to reach millions — and the momentum is building. Using the current oral PrEP market as a baseline, this graphic estimates what demand for LEN could look like through 2028 and shows how current donor commitments stack up against that opportunity.
Senior Program Manager of Cure Advocacy, Jessica Salzwedel, is featured on the Journal of Pediatric Infectious Disease Society podcast discussing a recent publication on the ethics of pediatric HIV cure research, “HIV Cure Research: Ethical and Real-World Practical Considerations for Pediatric and Adolescent Populations”. The podcast discusses work born out of the PAVE Collaboratory, the only HIV cure research consortium focused on perinatal HIV.
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.
If you’d like to support AVAC in its continued work, please consider making a donation, https://donatenow.networkforgood.org/donate-avac.
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.
AVAC’s updated map of Global Fund and PEPFAR-supported LEN supply shows how quickly this breakthrough is moving and what’s possible when political will, funding, community engagement, and innovation align. But there is still so much more to do – as we wrote last week, science alone won’t get us there: the future of HIV prevention depends on speed, scale and equity.
As these advances continue to develop, AVAC will continue to help make sense of the rapidly shifting global health landscape. From World AIDS Day passing with little acknowledgment by the US government, to the LEN rollout (and South Africa being left behind), to the gutting of foreign aid and impact on HIV prevention and global health, to new bilateral health MoUs under the US “America First” strategy, AVAC has shared real-time analysis and context on the most pressing issues of December. Global Health Watch, now in its 46th week, will continue providing consistent, trusted context so you can navigate the turmoil with clarity, purpose and solidarity.
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.
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.
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.
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’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.