The State of HIV Prevention: Big News, Big Moves: Reflections from AIDS 2026 in Rio de Janeiro, Brazil 

By Grace Kumwenda, AVAC Regional Program Manager: Research Engagement 

AIDS 2026 in Rio was extraordinary.

Big science across HIV prevention, treatment and cure headlined from podiums; in side rooms, we had difficult conversations around greater access to available products; and throughout, ongoing tensions played out over the future of the AIDS response and the role of the US Government. And—if you are like me—there was also a lot of trying to understand some very complicated vaccine and broadly neutralizing antibody (bNAb) science and immediately asking: What does this actually mean for people and the People’s Research Agenda? What does it mean for the field and the future? Simply put, Rio did not disappoint.

Big treatment news

A first-in-class once-weekly oral combination of islatravir plus lenacapavir achieved viral suppression as effectively as daily oral antiretroviral therapy (ART) at week 48 in the ISLEND trial, another exciting indication of where longer-acting and less frequent HIV treatment is headed. We also heard important data on long-acting treatment for adolescents. In the LATA study, injectable cabotegravir (CAB) and rilpivirine administered every eight weeks performed better than daily oral tenofovir disoproxil, lamivudine, dolutegravir (TLD) at 96 weeks, and the overwhelming majority of adolescents said they found injections easier than daily oral pills. That matters because long-acting treatment cannot only be designed for adults who already navigate health systems better than youth; adolescents and others who struggle with daily adherence also need to be part of this innovation story.

Then came the bNAbs 

The CAPRISA 012C results readout was a powerful reminder that science does not always move in a straight line. A prevention trial evaluating two bNAbs together—CAP256-V2LS plus VRC07-523LS— administered subcutaneously every six months was reported to be safe but did not reduce overall HIV incidence. Unexpectedly high levels of viral resistance seen in the trial population raised important questions for the field, including whether it is time to pivot away from research on bNAbs for prevention.

It was disappointing that two bNAbs together did do any better than a single bNAb in Antibody-Mediated Prevention (AMP) studies a couple of years. These findings raise important questions about whether and how a combination bNAb approach can work for HIV prevention, as well as the implications for vaccine, treatment and cure research. In treatment and cure research, the bNAb story is more nuanced and, frankly, fascinating. Studies including RIO and FRESH are suggesting that bNAbs may be able to do something ART does not: in a small proportion of participants, immune control may persist even after the antibodies themselves have washed out of the body. There were also promising signals in children. In Botswana, two bNAbs kept 44 percent of children in the Tatelo study undetectable at six months after stopping ART, while early results from the ongoing Tatelo+ study using three bNAbs showed all participants remaining undetectable at week 24. But this is also where we have to manage expectations. The science is exciting, but effects are still seen in relatively small subsets of people, while resistance and incomplete HIV strain coverage remain challenges, strain sensitivity testing is complex and costly, and we still need much more evidence about who benefits and why. That is exactly why continued research matters.

Vaccine science is getting more precise 

HIV vaccine science continues to make important—if sometimes complicated—progress. The challenge has not changed: HIV is extraordinarily diverse, it mutates rapidly and it has evolved sophisticated ways of escaping the immune system. But what has changed is the precision with which scientists are now trying to solve that problem. Instead of simply asking whether a vaccine candidate produces an immune response, researchers are increasingly asking: Can we deliberately guide the immune system, step-by-step, toward producing the exact bNAbs needed to recognize many different HIV strains? Several studies presented in Rio focused on doing exactly that.

Researchers are refining sequential vaccination, where one vaccine primes very rare B cells and subsequent vaccinations guide those cells through stages of maturation toward bNAbs. Work presented on coaxing the creation of V3 glycan-targeting antibodies showed that carefully designed vaccine sequences can steer antibody responses away from non-neutralizing pathways and toward potentially protective ones. Other approaches are trying to generate antibodies against several vulnerable sites on the HIV envelope at once. That may ultimately be critical because an effective vaccine is unlikely to rely on one antibody class alone. Scientists are increasingly exploring how to induce bNAbs targeting two or three different vulnerable sites, potentially making it harder for HIV to escape.

Grace advocates for the pursuit of a preventive HIV vaccine at the AVAC HIV Cure and Prevention Research Networking Zone

New vaccine platforms are also opening possibilities. An mRNA approach designed to express HIV envelope trimers produced neutralizing antibody responses in rhesus macaques and protected a proportion of animals from SHIV challenge. None of this means an HIV vaccine is around the corner. But it does mean that vaccine development is becoming increasingly deliberate. Scientists are not simply hoping the immune system will produce the right antibodies. They are learning how to engineer and guide the immune response toward them. And despite highly effective PrEP, the case for a vaccine remains strong. PrEP only works when people can access it, choose it and use it.

A vaccine could eventually reach people who face barriers to ongoing PrEP use, people who do not perceive themselves to be at risk and communities where sustaining repeated prevention visits remains difficult and/or expensive.

So yes—we still need a vaccine.

And the MPT pipeline is getting interesting 

The multipurpose prevention technology (MPT) pipeline is another space that caught my attention at the HIV Prevention pre-conference in Rio. A removable injectable depot combining CAB with the contraceptive medroxyprogesterone acetate studied for three- and six-month durations in macaques provided complete suppression of ovulation through six months, with return to fertility shortly after depot removal and a relatively short CAB tail. And in another study, a 3D-printed, 90-day intravaginal ring containing islatravir, ethinyl estradiol and etonogestrel provided protection across 12 weekly HIV exposures in macaques. If we can develop products that respond to several needs at once—and importantly, products people actually want to use—that could be transformative. But again, the key phrase is want to use. A scientifically brilliant product that does not fit into people’s lives will struggle to achieve population-level impact.

Innovation in ARV-based prevention is moving 

Grace advocates for the pursuit of a preventive HIV vaccine at the AVAC HIV Cure and Prevention Research Networking Zone

We are all watching closely the efficacy program for the once-monthly oral PrEP candidate now named alimatravir (AMI). What caught my attention was not only the science, but also how Merck/MSD, the developers, are thinking about the product in people’s lives: a small, discreet tablet that could potentially be delivered beyond traditional clinics, including through pharmacies, community settings and other entry points.

Access is already part of the conversation even as alimatravir is still more than a year out from phase 3 study results. MSD announced an initial access plan that includes voluntary licensing arrangements intended to support future generic production. That matters. Access cannot be a conversation we begin after approval; it needs to sit alongside product development from the beginning. And, to be fair, the access conversations around both LEN and AMI were some of the biggest—and at times hardest—conversations in Rio. Questions around pricing, licensing, manufacturing, financing speed to scale, and equity in access were not answered. But they are exactly the conversations we need to be having now, not later. Science is moving quickly, and access planning has to move one step ahead.

Rio also provided encouraging implementation data on existing long-acting prevention options. In the PURPOSE 1 open-label extension, 95% of eligible participants chose twice-yearly lenacapavir (LEN) for PrEP, with no HIV acquisitions during follow-up and 96% injection adherence. PURPOSE 2 also reported very low HIV incidence, while real-world CAB studies continued to show strong effectiveness even as questions around late injections, testing and delivery remain important. The pipeline continues to widen, with early data on 90-day dapivirine-levonorgestrel vaginal rings adding to the range of longer-acting and MPT options under development. All this data adds another dimension to an increasingly diverse prevention pipeline—one that is more responsive to people’s different prevention and reproductive health needs.

PEP also needs its own innovation moment 

And if we are talking about innovation in PrEP, then we also have to talk about post-exposure prophylaxis—PEP. PEP is one of our oldest biomedical HIV prevention interventions, yet it can still feel like the mis-placed or forgotten tool in the prevention box. We heard several times in Rio that PEP is a race against time: it needs to be started as quickly as possible after a potential exposure. But accessing it can still mean travelling to a facility, explaining what happened, navigating stigma, finding a provider who understands PEP and then completing a 28-day regimen. That hardly sounds like an intervention designed for success.

Amidst the ongoing normalization of long-acting PrEP, AIDS 2026 addressed the implications of long-acting ARVs for PEP. But how do we generate strong evidence for new and potentially better PEP products when traditional efficacy trials may be extremely difficult—or even unethical—to conduct? Researchers are now exploring innovative approaches, including zero-event trial designs, that could help us build credible evidence without relying on HIV incidence as an endpoint or traditional trial models.

But just as with PrEP, product innovation alone will not be enough. Policy and delivery have to move to address the gaps we have today. During an AVAC side meeting, we discussed the need to simplify national PEP guidelines, address gaps across different types of exposure, support differentiated service delivery, strengthen provider information and rethink how we communicate about PEP. One point from that discussion stayed with me: we celebrate someone choosing PrEP as responsible self-care, yet someone seeking PEP can still be met with judgement—as though needing PEP means they did something wrong.

That has to change.

Seeking PEP is also an act of responsibility and self-care. If we want people to use it quickly, we need to make PEP easier to find, easier to understand and easier to use—and we need the next generation of PEP products and delivery models to reflect the urgency of the moment in which people need them.

And then there is community 

Grace provides a community perspective at the session “From Community to Innovation to Scale”

If the Global Village was the heart of AIDS 2026, then community remains the heartbeat of the HIV response and the “why” behind the HIV prevention pipeline. I had the opportunity to share community perspectives during a symposium on moving from community to innovation to scale, and one thing stayed with me: we still too often imagine innovation as a straight line from basic science to clinical trials, regulatory approval, implementation and then community.

Trials such as EXPrESSIVE and PURPOSE have reshaped that line, and we need to keep pushing. Community should be there from the moment we define the unmet need, through research priorities and trial design, to access, affordability, implementation and the final question that matters most: is this intervention actually working in people’s lives? And as prevention science becomes more complex, community engagement cannot simply mean inviting advocates into technical rooms; it also means investing in the knowledge and tools that allow communities to ask difficult questions and influence decisions. That is one reason I remain so passionate about initiatives like AVAC’s Clinical Trial Design Academy.

I left Rio thinking that perhaps the biggest shift is not only in the big news about what products are being developed and evaluated in the HIV prevention pipeline. The questions need to change.

For years, the biggest question in HIV prevention was: Can we develop highly effective tools to prevent HIV? Today, we increasingly know that we can. We have daily oral PrEP, two injectable PrEP products, the dapivirine ring, condoms, circumcision, and, hopefully, in the near future a monthly oral pill, with even longer-acting products anticipated in the near future. The harder questions now are: Can people get them? Can they actually choose between them – when and where and from whom they want them? Can countries afford them? Can health systems deliver them? And are we building the systems today that will be ready for the products coming tomorrow? That is where the big moves become important.

The big move we need NOW is from innovation to impact. That means moving from products to programs at scale; clinics to community-centered delivery platforms; product-focused interventions to choice-based prevention; and scientific breakthroughs to political courage, financing, solidarity and accountability.

The science is moving. “The science delivered beyond our wildest dreams,” said Dr. Raphy Landovitz in a moving plenary session.

Now everything around the science needs to move just as boldly. We need resources, moral compass, political will and government-owned prevention programs to move the science to people.

From Rio to the People’s Research Agenda: What next? 

So where does all of this leave us? For me, Rio reinforced that the People’s Research Agenda has to keep pushing the field on whether the science will actually matter in people’s lives. 

  • HIV vaccines: keep investing—but design for the real world now. We still need an HIV vaccine, and we need to stay the course. But as scientists refine sequential immunization and increasingly precise vaccine approaches, the field must also ask early what a future vaccine regimen would look like in people’s lives: how many doses, over what period, for whom, at what cost and how it could realistically be delivered at scale. 
  • MPTs: start with people’s lives, not just what science can combine. We need to develop MPTs around the lives and priorities of the people who will use them. The research question cannot only be: what products can we technically combine? It must also be: what combinations, durations and delivery forms do people actually want—and what gives them meaningful choice and control? 
  • ARV-based prevention: match the speed of innovation with the speed of access. Affordability, licensing, manufacturing, financing, country readiness and delivery must be planned alongside product development, not after approval. At the same time, implementation research must tell us how long-acting products work in the real world, including persistence, late injections, switching and what it truly takes to deliver genuine choice. 
  • PEP: give PEP the innovation and urgency it deserves. PEP needs a new research, product and delivery agenda. We need shorter, simpler and more forgiving regimens; innovative trial designs that can generate credible evidence; and delivery models that get PEP to people within hours, not after they have navigated multiple barriers in the health system. And perhaps just as importantly, we need to reposition PEP as what it is: an act of self-care and responsibility. 

Anxiety in Paradise: Highlights From the 26th International AIDS Conference in Rio de Janeiro

Following AIDS 2026 in Rio de Janeiro, TheBody reflected on the stark disparities on display. “There were all of these tensions there,” AVAC’s Executive Director Mitchell Warren said. “Between the amazing science and the difficult political and economic time we’re in. Between the opportunity of new, long-acting prevention tools and the fact that we were in a region of the world where access to them doesn’t exist. And between what could be and what currently is.”

Global Health Watch: Exec Order Changes Childhood Vaccine Recs, $2B in Faith-based Aid, NIH Restricts Policy Rx

Issue 81

This week, the US Administration announced $2 billion in global health funding for faith-based organizations; US Congress intensified oversight of PEPFAR and the bilateral global health agreements; the NIH moves to restrict policy-focused research; and – perhaps most alarmingly – the US President issued an executive order rewriting longstanding, evidence-based childhood vaccine recommendations.

US President Issues Executive Order Changing US Childhood Vaccine Recommendations 

The US President issued an executive order to overhaul the US childhood vaccination recommendations. The order bypasses the longstanding scientific review process traditionally led by expert advisory bodies including the CDC’s Advisory Council on Immunization Practices (ACIP), which has historically informed this process, before being politicized by the current Administration. The order reduces the number of vaccines recommended for all children; calls for the combined measles, mumps and rubella (MMR) vaccine to be administered as three separate shots; shifts several vaccines—including hepatitis A and B and COVID-19—to “shared clinical decision-making”; and expands exemptions for school immunization requirements. Public health leaders and clinicians immediately condemned the order, warning that it contradicts decades of scientific evidence, creates confusion and raises new barriers for vaccine access.

IMPLICATIONS: The latest executive order is another divergence from evidence-based public health policymaking and toward politically driven decision-making. Public health experts warn that replacing established scientific review with executive action could erode confidence in childhood immunization, increase vaccine hesitancy and reduce vaccination coverage, leading to more outbreaks of vaccine-preventable diseases. A New York Times article profiles Japan as a “cautionary tale” after the government modified its vaccine schedule for MMR in 1993, making the measles and rubella single shots and the mumps component entirely voluntary. Consequently, coverage of mumps vaccination plummeted, and cases then soared – resulting in deaths among unvaccinated children in Japan. The changes by the federal government also signal how vaccine policy is being developed in the US, raising concerns that scientific expertise is being sidelined in favor of political priorities, and driven by misinformation and skepticism in vaccines.

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US Administration Awards $2 Billion to Faith-Based Organizations 

The US Department of State awarded $2 billion in global health and humanitarian assistance to faith-based organizations (FBOs), the largest allocation of foreign aid to these groups in more than 20 years. Under its “America First” Global Health Strategy, the funding, a majority spread over five years, will support faith-based hospitals and clinics in 17 countries and emergency humanitarian response, with major awards going to a consortium of Christian FBOs including World Vision, Samaritan’s Purse and Compassion International. Of the $2 billion awarded, approximately $1.4 billion will be for healthcare programming primarily in Africa.

IMPLICATIONS: News of global health funding is welcome after such sweeping cuts and months of delay, but it marks a major shift in how the US is delivering its foreign aid. The Administration claims the awards reflect a more efficient, results-driven approach and were not based on religious affiliation. However, former USAID officials and global health experts question whether the decisions were guided by evidence. FBOs historically are critical partners in delivering critical care and global health programming in countries that receive US foreign assistance. However, prioritizing a smaller group of FBOs over a broader range of implementing partners, where funding has been frozen or contracts terminated, could reshape HIV prevention and global health programs, and these large FBOs have many of the same administrative and overhead costs as other international NGOs, which were heavily criticized by the Administration in closing down USAID. Concentrating resources in fewer organizations also raises questions about whether diverse, community-led approaches to HIV prevention and health equity will continue to receive the support needed to reach the populations most affected. Moreover, representatives from recipient FBOs contend that the new money does not easily supplant or replace funding lost from the cuts and dismantling of USAID, when many FBOs were adversely affected and forced to reduce programming or shutdown services.

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US Congress Continues to Take Oversight Actions on Global Health Programs

Democratic members of the US Congress continued oversight of the US Administration’s global health policies this week with new inquiries into PEPFAR and the Administration’s “America First” Global Health Strategy. California Representative Robert Garcia, the ranking Democratic member of House Oversight and Government Reform Committee, requested in a letter answers from the US Secretary of State following disruptions to PEPFAR and emerging data showing how they have contributed to the deaths of hundreds of thousands of people and the closure of at least 1,700 HIV service sites. Separately, Democratic Senator Raphael Warnock of Georgia led colleagues in a separate inquiry, questioning the Department of State’s reported requirement that African countries grant US officials direct access to sensitive national health data systems as a condition of receiving global health assistance through the bilateral memorandum of understanding (MOUs) agreements that are currently being negotiated with recipient countries. As part of the inquiry, Senate signatories requested a formal briefing from the State Department to answer these questions and provide updates on the data conditionalities present in these agreements.

IMPLICATIONS: The escalation of these congressional inquiries reflects mounting concern in both chambers of Congress over the Administration’s continued restriction and termination of congressionally appropriated global health funding, the lack of transparency surrounding its bilateral Memoranda of Understanding (MOUs), and the need for greater accountability in how the Administration is unilaterally reshaping US global health policy and using foreign assistance as leverage. These latest requests for information also suggest that sustained advocacy by the global health community is beginning to influence policymakers, as new evidence continues to document lives lost and the erosion of global health infrastructure resulting from this accelerated restructuring. While congressional oversight alone will not reverse these policy changes, it demonstrates that coordinated advocacy is elevating global health issues and helping shape the debate around future policy.

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US Senate Blocks White House OMB Rule as NIH Faces New Policy Research Restrictions

Following the US Senate’s official vote to temporarily block the White House Office of Management and Budget’s (OMB) proposal to give political appointees greater authority over federal grant decisions (until December 11), Nature reported this week that the National Institutes of Health (NIH) has begun turning away grant applications for research where the primary purpose is to shape and inform policymaking. This, coupled with the Administration’s attempt to weaken the role of scientific review through the blocked OMB regulation, demonstrates increasing intention to politicize federal research priorities in line with political ideology and not evidence. Internal NIH documents reportedly state that policymakers are no longer considered “mission-relevant stakeholders”, placing dozens of health policy research grants in question.

IMPLICATIONS: Efforts to reshape the US research enterprise are extending beyond a single OMB proposal to influence what research is funded, who can use it and how scientific evidence informs public policy. While advocacy from the scientific community is gaining traction, the temporary block does not resolve overall concerns about political influence over research funding. And restricting support for policy-focused research would weaken the evidence base that informs decisions on HIV, infectious diseases, pandemic preparedness, and public health, making it more difficult for policymakers to respond to emerging health challenges with rigorous scientific evidence guiding decision-making that is aimed towards saving lives.

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Dr. Anthony S. Fauci Should be Celebrated as a Public Health Hero, Not Harassed and Persecuted by Anti-Science Bigots

What We’re Reading

Aids is no longer exceptional. What happens now?

Following AIDS 2026, Bhekisisa’s Mia Malan reflects on the annual conference that took place amid an unprecedented funding crisis and the dwindling political will to address HIV. As AVAC Executive Director Mitchell Warren said, “What comes out of a conference [or movement] is more important than what happened at the conference. Three to six months from now, we need to ask: are we working differently because we gathered in Rio? …I hope the answer will be clear: coming together and planning together strengthened our Aids response. That’s the measure of success.”

INCLUSION Global Study Details

Gilead, Unitaid and the US National Institutes of Health are funding 36 ongoing studies to investigate implementation outcomes, rapid initiation and real-life use of injectable lenacapavir (LEN) for PrEP in 9 countries. Gilead’s INCLUSION program (INCLUSION Global in Africa and Asia and INCLUSION-US in the United States) accounts for 26 of these studies. This table provides details on the INCLUSION Global projects planned for 2026-2028 in 7 LEN early adopter countries. For more details on all ongoing LEN implementation studies, see our map and visit the integrated study dashboard.

Accelerating policy approval and uptake of the dual prevention pill in Zambia through early stakeholder engagement

The Dual Prevention Pill (DPP), a combination of PrEP and combined oral contraception (COC), offers a novel, female-controlled option for HIV and unintended pregnancy prevention. However, new technologies like the DPP often face delays in regulatory approval and uptake due to limited stakeholder involvement early in the introduction process. This article in AIDS Care, authored by AVAC Fellow Rhoda Msiska, AVAC staff members Kate Segal and Cindra Feuer, and Newton Donkola, demonstrates how early, multisectoral stakeholder engagement could accelerate DPP approval and adoption in Zambia.

Global Health Watch: Fauci in Contempt + New NIAID Director, Senate Blocks OMB’s Grant Proposal, New CDC Director, AIDS 2026 Highlights

Issue 80

This week, the US Senate Committee on Homeland Security & Governmental Affairs voted along party lines to hold Anthony Fauci in contempt of Congress for his refusal to answer questions during last week’s hearing on the COVID-19 response testimony – while it was rumored that Steven Quay, a lab-leak proponent, is in line for Fauci’s old job. At the same time, the US Senate Appropriations Committee did step up to stop the White House OMB’s politicization of federal research grants. There’s also – finally – a new leader of the US Centers for Disease Control and Prevention (CDC). And the HIV/AIDS community is unpacking major themes emerging from the AIDS 2026 conference.

Anthony Fauci and the Future of NIAID

The US Senate Committee on Homeland Security & Governmental Affairs voted Thursday to hold former NIAID Director Anthony Fauci in contempt of Congress, raising a years-long political campaign against him just a week after he was grilled by Republican Senators for hours over the COVID-19 pandemic and its origins. Much of the scientific and public health community rallied around him after his appearance: “Dr. Fauci is a public health pioneer, who has saved more lives than anyone sitting in the Senate today. He has dedicated his life to public service. Because of Tony Fauci, science has moved faster, lives have been saved and communities are more engaged in every phase of infectious disease research,” wrote AVAC’s Executive Director in a statement. “[Fauci’s] career was built on evidence, intellectual rigor and an unwavering commitment to improving people’s lives,” wrote American Society for Microbiology CEO Stefano Bertuzzi in a letter to the committee, calling Fauci’s scientific record “the gold standard.”

Following the hearing, Health and Human Services Secretary (HHS), Robert F. Kennedy Jr. (RFK Jr.) appeared in media interviews targeting Fauci and pushing misinformation on vaccines and medical information, all while preparing to appoint Steven Quay, a pharmaceutical executive and prominent advocate of the COVID lab-leak theory (and longtime Fauci critic) to lead NIAID, the agency Fauci and then Jeanne Marrazzo directed for nearly four decades and which oversees $6.5 billion in annual research funding. Quay was not even among the finalists interviewed for the role, but Kennedy selected him nonetheless, according to Politico. Quay—a physician and pathologist—could become the first NIAID director drawn from the pharmaceutical industry rather than academia or the NIH, despite lacking formal training in infectious diseases.

IMPLICATIONS: Quay’s expected appointment would mark a major shift in the leadership and direction of NIAID, which is arguably the world’s most influential biomedical research agency. This, along with the Senate Committee’s decision to hold Fauci in contempt of Congress signals that alignment with the Administration’s ideology is more important than scientific expertise in setting US research priorities and public health policy. Together, the message is clear: if you dare to challenge political ideology, it has consequences. This will likely have a chilling effect on researchers and scientists reluctant serve in government and speak out during health crises.

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US Senate Blocks White House OMB’s Grant Proposal Temporarily

This week US Senators on both sides of the political aisle moved to temporarily block the White House Office of Management and Budget’s (OMB) proposal to give political appointees greater authority over grant decisions and weaken the role of scientific peer review. In a stopgap spending bill released by Senate appropriators, Democrats and Republicans joined in adding a provision that would prevent the OMB rule from taking effect until at least December 11, while Congress negotiates broader government funding measures. The proposal was originally slated to go into effect on October 1, but opposition from appropriators, including Senate Appropriations Chair Susan Collins, slowed the path forward.

IMPLICATIONS: This development suggests that months of public opposition and advocacy from the advocacy and scientific community may be beginning to influence policymakers. The Senate’s intervention is one of the first signs that resistance to the OMB proposal extends beyond the scientific community and into both parties in Congress. However, the delay is only temporary, and, if implemented, the rule could fundamentally reshape the US research enterprise by injecting political considerations into grantmaking, weakening peer review and undermining the international collaborations that drive progress against HIV, emerging infectious diseases and other global health challenges.

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US Senate Confirms New Centers for Disease Control and Prevention Leader

The US Senate confirmed Erica Schwartz as the next director of the Centers for Disease Control and Prevention (CDC), after a year without a confirmed leader. Schwartz is a former deputy surgeon general and chief medical officer of the US Coast Guard. During her controversial confirmation hearing, she agreed to uphold scientific integrity and transparency, but did not challenge or speak to RFK Jr.’s position on vaccines and other controversial health policies.

IMPLICATIONS: Schwartz will take over the agency, which has seen a major reduction of its workforce, political battles over vaccine policy and mounting public health threats. While her appointment to the leadership post may bring some stability, many public health leaders question whether she is able to lead an independent CDC outside of the Administration’s political pressure as RFK Jr. continues to attempt to reshape federal health policy. Will Schwartz defend scientific evidence, particularly on vaccines, infectious diseases and outbreak preparedness? That is the question the many advocates and leaders are waiting to answer.

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International AIDS Conference Wraps Up: Rising Above to Meet the Moment

The International AIDS Conference (AIDS 2026) concluded last Friday. It was marked by extraordinary scientific progress and growing political and financial uncertainty. New data showed the consequences of the US Administration’s retreat from global health leadership, with nearly 2,000 HIV service sites closed and prevention programs for key populations severely disrupted following cuts to PEPFAR and other foreign-aid programs. While delegates applauded Merck’s decision to license its investigational monthly oral PrEP pill, alimatravir, to generic manufacturers before Phase 3 trials are complete, leaders warned that supply shortages threaten the rollout of injectable lenacapavir for PrEP (LEN) and called attention to the exclusion of Latin America in access agreements despite its central role in clinical research. Other major advances in prevention, treatment and cure, including innovative community-based and pharmacy delivery models for long-acting prevention and news of two more patients with HIV and cancer were cured following stem cell transplants for cancer treatment were presented showing the promise of new technologies, but the conversation focused on whether they can be developed and deployed feasibly and at scale.

IMPLICATIONS: AIDS 2026 underscored a stark reality: the greatest barriers to ending HIV are increasingly political rather than scientific. Across sessions on prevention, vaccines, cure research, artificial intelligence and service delivery, one theme emerged repeatedly: innovation alone is not enough. As AVAC’s Mitchell Warren shared in a commentary, translating scientific breakthroughs into public-health impact will require sustained political commitment, financing, supply chains and delivery systems that can move with speed, scale and equity. As governments cut funding and retreat from longstanding partnerships, the conference made clear that communities are not merely beneficiaries of the HIV response, they are its leaders, and the future of the epidemic will depend on their ability to shape the research, policies and programs that come next.

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What We’re Reading

Aspen clinches deal to produce new once-a-month HIV tablet

A licensing agreement was recently inked between Aspen and Merck, granting Aspen rights to develop, manufacture and commercialise new anti-HIV drug alimatravir. South Africa also announced that three local pharmaceutical manufacturers have been shortlisted to make Gilead’s six-monthly HIV prevention shot lenacapavir (LEN). The news comes as pressure mounts on Gilead Sciences to expand access to LEN. At AIDS 2026 in Brazil last week, Gilead took flak for making only 3 million doses of LEN available over three years, with AVAC estimating that 5 million doses a year are needed to make a significant impact on the epidemic.

Beyond AIDS 2026: AVAC’s Top 10

Our team compiled a list of AVAC’s top 10 takeaways from AIDS 2026. These topics sparked discussions and ideas among our team and AVAC’s larger partner network, and will carry our work well into the future. 

1. The implications of US government cuts 

The implications of the US administration’s efforts to dismantle its longstanding role as the global leader in the HIV response are coming into focus – and it’s not a pretty picture. 

Credit: amFAR

First, amfAR released a report providing the first concrete detail on the impact of PEPFAR cuts: surveying 166 organizations in 46 countries, they found that nearly 2,000 service sites had been forced to shutter.

Almost no organizations were able to fill the funding gap with other donors. Services for key populations (KPs) were “decimated”: among implementing partners, 73% stopped at least one KP service and 67% stopped outreach services.

Prevention overall took a huge hit: almost half of respondents stopped activities like condom or PrEP distribution. Two-thirds reported interruption of PMTCT and nearly one in four stopped providing prevention of mother-to-child transmission services entirely. As AVAC’s Navita Jain told POZ, when foreign aid funding was frozen, “We were in year eight of a 10-year project, really getting momentum going and accelerating prevention research, and the cuts had a massive effect, with no guidance provided or a plan for a way forward.”  

As widely reported, first by former AVACer Emily Bass, and then by most major media outlets, a US State Department official displayed a mislabeled map of African countries, with African government officials in the room. As Jirair Ratevosian said, the map “should never have made it onto the screen, especially during a presentation about partnerships with African governments,” but more importantly, it’s a disappointment “that this mistake became one of the conference’s biggest media stories. Because AIDS 2026 produced important science, serious policy analysis and real progress on issues ranging from PrEP delivery to global aid transitions.”  

2. Prevention innovation includes speed, scale and equity…

One of the most exciting developments arrived days before the conference, when Merck/MSD announced seven direct licenses to generic manufacturers to produce their investigational monthly pill for HIV prevention, known as alimatravir, while Phase 3 clinical trials are still enrolling.

The announcement reflects responsiveness to advocates’ longstanding calls to accelerate access to PrEP options, and deep engagement with advocates throughout the clinical trial program. Since 2012, each successive PrEP introduction has gone faster than the previous one, yet the time to market and to public health impact remains too slow.

Granting licensing agreements to generic manufacturers while clinical trials are still enrolling, before it is known if the product is effective, should significantly reduce the time to market for the product. The current timeline gives the field ample opportunity to work with ministries of health, donors, communities, and Merck to plan for broad access to the monthly PrEP pill, which lends itself to innovative delivery models – from pharmacies to community-based distribution approaches.

3. …but too often, Latin America is still left behind  

It is cruel irony that Brazil was host country to the conference, a key site for clinical trials of cabotegravir, lenacapavir and alimatravir, but has been left out of voluntary licenses for all three products.

While Merck/MSD shared information about a memorandum of understanding with Fiocruz to manufacture alimatravir for the region, the timing and next steps remain unclear: “Now is the time to plan for even speedier and wider access if alimatravir works,” said Access Bridge Executive Director Wawira Nyagah. “This must include pricing transparency from Merck and their generic licensees, accelerated investments by donors to design and implement integrated programs that offer the monthly pill as part of choice of product and service delivery models that actually reach people who need it, everywhere. This should be based on public health imperatives; not on World Bank country classifications or geographical location. Anywhere the HIV epidemic is increasing must be included, full stop.”

4. Innovative delivery and community involvement are expanding access… 

AIDS 2026 showcased exciting models for HIV prevention service delivery that are removing barriers to access, reducing stigma and burden on healthcare systems. In São Paulo, vending machines delivering HIV tests, PrEP and PEP are available in subways, normalizing widespread access to HIV prevention.

Sri Lanka and the Ukraine have introduced mobile PrEP delivery programs, and in Kenya and South Africa, pharmacy delivery is reducing the load on health clinics following the drastic cuts to PEPFAR service delivery programs. The recently launched SCALE-IT project in Zambia is implementing a model for community-based delivery of PrEP options, including injectable PrEP, with more information expected soon. As we look ahead to alimatravir, the potential for a monthly PrEP pill opens the door to innovative delivery models. While alimatravir trials are still enrolling, AVAC has called on the stakeholders to ensure models are well-conceived and planned, adequately funded, and set up for success. With this timeline in hand, there’s no excuse for getting it wrong.

5. …but supply issues pose a serious threat to LEN rollout. 

From countries across the globe, the same message echoed across AIDS 2026: there is demand for LEN now and the current supply is not enough. While recent commitments from PEPFAR and the Global Fund are encouraging, demand is rapidly outpacing supply across the globe – and there is an urgent need from donors to address bottlenecks and place more orders.

Access Bridge’s Nyagah reinforced this point: “People are being offered products that fit their lives, but the systems are not growing fast enough to supply it.” If supply issues are not urgently addressed, the field risks losing the demand, community trust, and current progress in LEN uptake that we have collectively worked so hard to achieve. For more on this topic, Jon Cohen’s recent piece in Science provides a deep dive into the challenges facing LEN rollout in South Africa and Zambia amidst the current political and funding landscape.

6. The urgency of vaccines: advancing the science, deepening our understanding  

At a plenary session, Sandhya Vasan described why a vaccine is still needed, even with expanded PrEP options like lenacapavir, echoing AVAC’s recent commentary on the scientific challenges and emerging insights in the vaccine field and what’s in the research pipeline. Vasan highlighted long-standing partnerships with communities as foundational to vaccine research and vaccine confidence, as well as the need for continued investment and support for upstream vaccine research.

Community engagement was on full display at the HIV Cure & Prevention Research Networking Zone, where one of the best-attended sessions was the People’s Research Agenda Think Tank on HIV vaccines. AVAC’s resources on preventive vaccines and bNabs explain the science behind vaccine research.

In addition, the CAPRISA team announced results from the CAPRISA 012c Phase 2 trial examining a potential combination of two broadly neutralizing antibodies (bNAbs) as prevention. The trial found that a six-monthly combination of the CAP256 and VRC07 bNAbs was safe but did not provide protection against HIV acquisition in young women in South Africa and Zambia. As AVAC Executive Director Mitchell Warren noted, “We had hoped that combining two bNAbs in this study would provide greater protection than a single antibody, but sadly it did not.” Antibody research has always been about more than product development – research shared at the conference continues to deepen the understanding of HIV and the immune system and will continue to inform the next generation of vaccine and cure strategies. 

7. Cure took another step forward 

Two case presentations at the conference shared two more patients with HIV and cancer were cured following stem cell transplants for cancer treatment.

As AVAC’s senior program manager for HIV cure, Jessica Salzwedel says, “Thirteen people have now been cured via stem cell transplant. Every cure is an exciting step forward, but we must stay focused on the inequity of all 13 of these occurring in high-income countries – and ensure that our work expands access to cure information, research opportunities, and solutions.” 

Cure strategies must go well beyond the science: efforts must include confronting the stigma of HIV and expanding research advocacy and engagement, especially in Africa.  At pre-conference and conference sessions, along with a session at the HIV Cure & Prevention Research Networking Zone, attendees explored promising elements of the “kick and kill” strategy, gene editing technologies, the role of broadly neutralizing antibodies in “control” strategies, and how community members can get more involved.  

8. Harnessing the power of AI for HIV while centering communities in the response

Many sessions explored the promise of AI to strengthen design and delivery of HIV programs, while highlighting potential pitfalls if we neglect to prioritize transparent regulatory frameworks and partnership with communities in the design, use, and oversight of AI systems.

ITPC Executive Director and AVAC Board member Solange Baptiste noted the urgency of approaches to AI that are human-centered: “We need a community governance layer built into the AI ecosystem…one that ensures communities help shape priorities, oversee the implementation, identify harms and hold systems accountable throughout the AI lifecycle.” The final plenary of the conference for the first time included a presentation on AI by Global Fund’s Izukanji Sikazwe, highlighting the dangers when the right innovations fail to scale and balancing the concept of AI as a partner with the risks AI can bring. For more insights from AVAC on the evolving discussions around AI, check out our quarterly AI and HIV Newsletter and Advocates Guide to AI and HIV Programs.

9. Partnerships power the HIV response by advancing community-centered priorities 

As the field faces devastating funding cuts, strong partnerships between national, regional and global advocates are more important than ever. AVAC’s partnerships underpinned so much of the critical work discussed at AIDS 2026: to ensure key populations are not left behind, to advance community-led monitoring and community-based delivery, and translate choice into impact.

In each case, success was made possible by bringing together diverse stakeholders with the singular goal of developing innovative, community-centered approaches to the HIV response. As AVAC’s Warren reflected following the conference, “Communities are the leaders of AIDS programming. All over the conference they led plenaries, symposia, abstracts. These are not recipients, they are leaders who are driving the conversations.”

10. Communities are the heart of the AIDS response, and the Global Village is the heart of the AIDS conference.  

In conversations, meet-ups, and protests coordinated across the Global Village, the power of advocates and coalition-based advocacy was a key theme of the conference. AVAC’s HIV Cure and Prevention Research Networking Zone brought delegates, researchers, advocates, and community members together for interactive discussions, expert-led sessions and networking conversations.

The Zone featured the “HIV Funding Saves Lives” quilt created by COMPASS and the Global Advocacy Data Hub to convey the impact of funding cuts on communities. Attendees signed the quilt, adding their voices to the demands for HIV funding to be restored. As advocates look ahead, connections built at the Networking Zone will strengthen for future coalition-based advocacy.

AIDS 2026: Rising Above to Meet the Moment 

The World Must Act with Speed, Scale and Equity

By Mitchell Warren, Executive Director, AVAC 

One of the most memorable moments for me at AIDS 2026 wasn’t a scientific presentation. It wasn’t a late-breaking abstract, or a standing-room-only session. It was a conversation with a ministry of health official from one of the first countries preparing to introduce lenacapavir (LEN) for HIV prevention. We weren’t discussing whether people wanted the product. We weren’t debating whether it worked. We were talking about running out.

Countries preparing for rollout of this groundbreaking prevention method – one that provides near-perfect protection from infection – are already worried they won’t have enough supply to meet demand.

For decades, the HIV field has worried about generating demand for prevention. At AIDS 2026 in Rio, we confronted a very different challenge: the demand is building. The question now is whether the world is prepared to meet it.

This was a conference defined by something arguably more important than any single scientific breakthrough. It was the recognition that as a field, we must confront the pressing challenge of political will and moral decision-making. As Raphy Landovitz asked in a stirring plenary session: do we have the courage, partnerships, and urgency to fight for science, which remains under attack?

After this week in Rio, I believe we absolutely have the courage, and the conference theme – Rethink. Rebuild. Rise. – provides a roadmap for how we turn it into impact.

Slides presented at AIDS 2026 by AVAC partner Access Bridge during a session on the promise of long-acting PrEP

First, we must rethink what success looks like. For years, success in HIV prevention meant developing new products to prevent new infections. Today, though, success means ensuring people can actually get the option that best meets their needs – how do we deliver this extraordinary range of options?

The range of HIV prevention options has grown in ways we only dreamed of a decade ago: beyond condoms which remain as essential today as they were at my first AIDS conference 30 years ago, we now have injectable PrEP which provides near-perfect protection in clinical trials and is becoming more widely available; a vaginal ring that provides a unique female-initiated option; and a monthly oral PrEP pill is in late-stage trials (and accelerated access planning).

But more options do not automatically mean more choice. Choice is not simply a shelf full of medicines. Choice is a health system capable of delivering them. It is procurement systems that can purchase multiple options instead of one. It is healthcare workers trained to welcome diverse individuals and counsel people without bias, rather than steering everyone toward the same intervention or the one the health provider thinks is best for them. It is financing that rewards access instead of rationing it.

In Rio, I heard government representatives, implementers, and community advocates ask operational questions about choice that would have sounded impossible just a few years ago. How do we effectively forecast demand and introduce multiple long-acting options? How can we ensure speed, scale and equity across environments, from rural clinics to urban hospitals? How can we simplify delivery and offer PrEP where people want it, and not just where systems want them?

We must think big. In a matter of months, a once-in-a-generation opportunity will present itself as generic lenacapavir becomes available, and this highly effective prevention option, hopefully, becomes more accessible. Governments, donors, manufacturers, and global procurement agencies should be planning for millions of people—not thousands—to access long-acting PrEP. Importantly, we also heard in Rio how the new interest in LEN is actually motivating people who had not come forward to test and are found to already be living with HIV. The novelty of LEN is becoming a catalyst for universally testing and connecting all people with the products and services they need – whether or not they are living with HIV.

The HIV response has always moved fastest when those most affected have shaped research questions, demanded accountability, challenged institutions, and insisted that innovation reach the people who need it most.

As countries begin introducing long-acting prevention, community leadership becomes even more important. Communities that trust delivery systems, prevention methods and messages are much more likely to accept new methods. And ultimately, it will be communities that tell us whether products are truly accessible, whether health systems are delivering meaningful choice, and whether equity is more than just a conference slogan.

The “HIV Funding Saves Lives” quilt, created by COMPASS and the Global Advocacy Data Hub to convey the impact of funding cuts on communities

Second, we must rebuild. Rio was also the first global AIDS conference that had data presentations about the impacts of the dismantling of USAID and the dramatic restructuring of U.S. foreign assistance.

Since then, prevention programs have been diminished, services for key populations have been interrupted, research has been halted, partnerships have been strained. Organizations have closed their doors. Communities are feeling those consequences every day. Jerop Limo, an AVAC advocacy partner and adolescent HIV programming expert, summed it up perfectly in the recent POZ piece on the impact of funding cuts, “People are disengaging from healthcare spaces and missing appointments. This is not the system we had, the one that was working.”

The release of UNAIDS’ United to End AIDS special report and a companion KFF-UNAIDS analysis show the challenge of translating scientific progress into the impact needed to end AIDS as a public health threat by 2030. The report shows HIV financing entering one of its most precarious periods in decades, with international assistance declining 18% between 2024 and 2025. Donor government funding fell by $2.1 billion in 2025—the largest annual decline since global HIV funding began scaling up. This is not just a warning. It’s not just a ‘cautious stabilization of where things are. It is an alarm bell that we have to change how we do what we do, and how we fund what we do, if we want to succeed.

As colleagues from Duke and Friends of the Global Fight underscore, rebuilding cannot mean returning to the systems that existed before.

We can’t go back, but we also can’t stay still. We have to build something new.

The good news is that new opportunities and promising signs are emerging. Countries are assuming greater ownership of their HIV responses. Regional institutions are stepping forward. New partnerships are forming, and new institutions are stepping up to lead.

Across conversations in Rio, there was broad consensus that sustainability of the HIV response cannot remain overly reliant on any one country government and the whims of its leadership. A broad coalition of countries, communities, philanthropy, industry, and global institutions working toward shared goals must equally share responsibility for the future of the HIV response.

In fact, hosting the conference in Brazil was a powerful reminder that political commitment to universal HIV services can achieve a lot. But even Brazil cannot introduce every new prevention technology without strong partnerships. Manufacturers must be willing to expand access, multilateral organizations must be willing to commit to volume guarantees and investments that meet demand, and donors must prioritize and be willing to invest in what’s required to ensure equitable rollout.

Raphy Landovitz’s plenary highlighted the critical choices the field has ahead of us to ensure we meet this moment.

Lastly, we must rise to meet this moment. After every setback, whether political or scientific, the global HIV community has found a way to turn adversity into action, setbacks into solidarity, and uncertainty into progress. That was on display more than ever in Rio, where we were reminded that disappointment also moves science forward.

One of the week’s significant scientific presentations came from the CAPRISA antibody study. The results were disappointing: the trial found that a six-monthly combination of two broadly neutralizing antibodies (bNAbs) was safe but did not provide protection against HIV acquisition in young women in South Africa and Zambia. Researchers concluded that while the antibody combination demonstrated strong potency in laboratory studies, it did not achieve antibody levels needed for protection in people.

With this study, we had hoped that combining two bNAbs would provide greater protection than a single antibody, but sadly it did not. But antibody research has always been about more than product development. The CAPRISA 012c study continues to deepen our understanding of HIV and the immune system, and will continue to inform vaccine design, cure research and the next generation of prevention strategies.

Every carefully conducted study answers important questions. Every unexpected result helps redirect investments toward more promising approaches. That is how scientific progress works.

AIDS 2026 convened at a pivotal time: we now have just four years until 2030—the deadline for global HIV targets and the Sustainable Development Goals.

By the end of this year, we should know whether long-acting PrEP is reaching people at scale. By the International AIDS Society conference in Geneva next July, we should know whether generic lenacapavir is expanding access, whether research investments are holding, whether community-led programs have been restored, and whether countries are closing the equity gap. If those indicators are moving in the wrong direction, we must change course in real-time.

The legacy of Rio will be determined by whether we seize this extraordinary moment. Even as we rethink and rebuild things, we must ensure that we center communities, follow their lead, and rise up to support the populations that need this work more than ever. And just like a well-conducted clinical trial, a conference should answer some questions and raise new ones:

Will donors and governments purchase enough lenacapavir to meet demand instead of limiting access? Will pharmaceutical companies accelerate voluntary licensing and affordable pricing so new innovations reach everyone, everywhere without years of delay? Will donors invest boldly enough to match the science? Will countries protect community-led organizations and programs for key populations, recognizing that these are not optional additions but essential pillars of an effective response? Will researchers continue pushing the boundaries of vaccines, antibodies, cures, and long-acting treatment, even when some studies disappoint?

The science has never been stronger, communities have never been more ready, and the need has never been more urgent. Rio reminded us that ending HIV is no longer limited by what we know, it is limited only by the courage to act.