PrEP Initiations by Country Worldwide

AVAC tracks global PrEP use by conducting quarterly surveys of ongoing oral PrEP demonstration and implementation projects, and collecting data from manufacturers and government agencies. This graphic shows data on PrEP initiations around the globe. For more trends in oral PrEP uptake, visit PrEPWatch.

The Votes Are In

What’s next for the US’ role in global health and HIV prevention?

In the days, months and years ahead under a new US presidential administration, advocacy for choice, freedom, science, and rights will require intentional strategies to protect hard fought gains in HIV treatment and prevention and in global health generally, and to safeguard policies and programs that advance it. What to do?

For a start, listen to AVAC’s newest PxPulse podcast. Jen Kates, Senior Vice President, Director of Global Health & HIV Policy at KFF, a nonpartisan health policy research organization and AVAC’s Director of Policy, Suraj Madoori lay out the challenges and the priorities in 2025 and beyond.

As the field prepares for new US leadership, advocates must take stock, identify allies, work in solidarity and seize opportunities. In the months and years to come, AVAC will be there, offering tools, analysis, and perspectives to support our collective work to advance HIV prevention and equity in global health.  

The Trump administration will likely have a fundamentally different worldview about US engagement in global health and in development. One that is much more isolationist, much more transactional. Why should the US be engaged in these programs? What is in it for us? And I think the challenges that will come up there, is where or will the US continue to play a leadership role diplomatically, financially, because the US is the largest funder of all global health programs.

Jennifer Kates
SVP and Director of Global Health & HIV Policy at KFF

There’s such a vibrant advocacy community outside the United States who want to engage their own governments in mobilizing domestic resources for HIV, who want to share their stories to Congress about the impact of PEPFAR and other lifesaving programs. That is a lot of untapped advocacy and a lot of North-South collaboration that will be so important to get us through at least the next two years into the midterms, if not the entire four years of this new administration.

Suraj Madoori
Director: Policy & Advocacy, AVAC

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Let’s Unpack Analytical Treatment Interruption

Join AVAC’s Jessica Salzwedel on Instagram Live as she breaks down one strategy being explored in HIV cure research.

This Week at AVAC: US election, new LEN resources, STI pipeline and PrEP service delivery

As we continue to grapple with the results of the US presidential election and what this means for our work and for global health evidence- and rights-based policies and programs generally, we wanted to share a range of new tools and resources you may find helpful in your advocacy for choice, science and rights.

Injectable Lenacapavir for PrEP

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Additional LEN Resources

Webinars on the STI Pipeline, Advances in Research Ethics, and Money for the DVR and More!

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In Case You Missed It

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And stay tuned for a new PxPulse podcast featuring Jen Kates of KFF and AVAC’s Suraj Madoori, The Votes Are In: What’s next for the US’ role in global health and HIV prevention. The podcast hits airways November 14.

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Understanding Anal Pleasure and Health for Clinicians, Behavioral Health Specialists, Peers & HIV Workers


Forty years into the epidemic, people are still seeking accurate, reliable information about anal play that isn’t just about HIV and STI prevention. They want to understand how to engage in ways that maximize pleasure and reduce harms beyond infectious disease. Often, they end up encountering harmful myths rather than facts, and then learn by ‘trial and error’.

This 90-minute webinar is appropriate for HIV and STI clinicians, behavioral health workers, social workers, case managers, peers and anyone else with a responsibility for delivering or referring to HIV services like treatment, PrEP, testing and support services.

Participants learned the rationale for why addressing anal pleasure and health is essential in HIV service settings as well as ways to respond to frequently asked questions, including via a new client- and worker-facing website.

Recording I Slides I Resources

Speakers included:

  • Bryan Kutner, PhD, MPH, Albert Einstein College of Medicine
  • Samuel Anyula Gorigo, Hoymas (Health Options for Young Men on HIV/AIDS and STIs) Kenya

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Join the Fight Against HIV: Discover the latest breakthroughs

Are you passionate about medical breakthroughs and advocacy? Don’t miss out on this pivotal community event where leading scientists and dedicated advocates gather to discuss with you the latest strides in HIV cure research.

Meet Two People Cured of HIV: Hear their stories, learn about their journeys, and discover the breakthroughs in medical science that made their cures possible. This is a unique opportunity to gain insight into the advancements in HIV and the hope it brings to many.

Explore Cutting-Edge Research: Get insights into the latest advancements towards finding a cure for HIV. Hear directly from the experts who are at the forefront of this critical work.

Engage in Thought-Provoking Discussions: Participate in conversations that matter. Share your thoughts a cure for HIV and learn from others who are just as committed to this cause.

Network with Like-Minded Individuals: Connect with those who share your dedication to making a difference. Build relationships that could shape the future of HIV advocacy and research.

Be Inspired to Take Action: Leave feeling motivated and equipped with new knowledge to contribute to the fight for a cure for HIV in meaningful ways.

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PrEP Initiations in Latin America, 2019-2024

Latin American countries account for 306,000 cumulative PrEP initiations in the Global PrEP Tracker as of Q2 2024, which represent 4% of the global total. Since 2019, PrEP initiations across the region continue to increase at a steady rate, with Brazil reaching about 194,000 cumulative PrEP initiations (63% of regional total) since the inception of its National PrEP Program. Read more in PxWire.

PrEP Approval Status in Latin America, 2024

Since 2019, rates of HIV acquisition in Latin America have been trending upward, from 110,000 annually in 2019 to approximately 120,000 in 2023. At the same time, Latin America has taken strides to combat this trend, from increasing PrEP initiation rates to preparing for longer acting PrEP products, such as injectable cabotegravir (CAB) and lenacapavir (LEN). Learn more in PxWire.

PxWire Volume 14, Issue No. 4

PxWire is AVAC’s quarterly update covering the latest in the field of biomedical HIV prevention research and development, implementation and advocacy. Each issue includes updates, emerging issues and upcoming events. A PDF version of this report is also available.

Progress in PrEP Uptake

The HIVR4P 2024 conference, hosted this year in Lima, Peru, put a spotlight on PrEP delivery in Latin America. Since 2019, rates of HIV acquisition in the region have been trending upward, from 110,000 annually in 2019 to approximately 120,000 in 2023. At the same time, Latin America has taken strides to combat this trend, from increasing PrEP initiation rates to preparing for longer acting PrEP products, such as injectable cabotegravir (CAB) and lenacapavir (LEN).

  • At least 15 Latin American countries have approved oral PrEP. Brazil and Peru also approved CAB for PrEP, and it is under review in Chile, Mexico, and Colombia.
  • Four countries and one territory in the region, Argentina, Brazil, Mexico, Peru, and Puerto Rico, have trial sites participating in the PURPOSE 2 trial, which showed LEN reduced HIV incidence by 96% compared to a background incidence, with 2 incident cases among 2,180 participants receiving LEN.
  • Latin American countries account for 306,000 cumulative PrEP initiations in the Global PrEP Tracker as of Q2 2024, which represent 4% of the global total.
  • Since 2019, PrEP initiations across the region continue to increase at a steady rate, with Brazil reaching about 194,000 cumulative PrEP initiations (63% of regional total) since the inception of its National PrEP Program.

Latest Trends in PrEP Uptake?

Find the latest trends on 2024 data in AVAC’s Global PrEP Tracker. Watch for the next update on November 22.

PrEParing for New Products

  • On October 2, Gilead Sciences announced six licenses to generic manufacturers in Egypt, India, and Pakistan to produce and market lenacapavir (LEN) for PrEP in 120 countries.
  • What’s new about this announcement? This marks an increase in speed, as compared to generic licenses for injectable CAB for PrEP. Gilead awarded these licenses even before submitting LEN for PrEP for regulatory approval in any country. Gilead’s license applies to 120 countries, which is more than the 90 countries covered by the generic license for CAB for PrEP. However, CAB for PrEP’s license also allows for generic supply in countries without patent barriers—by the time generic CAB for PrEP is available, this will be an additional 51 countries. Many countries with high HIV incidence have been left out of Gilead’s licensing deal; notably Argentina, Brazil, Mexico, and Peru, countries in which the PURPOSE 2 Phase III trials took place. In addition, Gilead’s licenses are more restrictive than ViiV’s, in terms of where generics can be marketed.
  • The timeline for generic LEN for PrEP to come to market is expected to be significantly shorter than for CAB for PrEP. Bioequivalence (BE) testing for LEN, which demonstrates a generic product works in the body in the same way as the originator product, is likely to be six months, versus the 18 months for CAB for PrEP, because of differences in the drug formulation. The rapid granting of voluntary licensing by Gilead also contributes to this shorter timeline.
  • Generic regulatory approval submission for LEN for PrEP may begin as early as the second half off 2026, two years after Gilead announced positive trial results. Generic CAB for PrEP is on track to submit for regulatory approval around the same time, approximately six years after the announcement of trial results.

Product Updates

  • CAB for PrEP has been approved in Cote d’Ivoire, Kenya, Myanmar, Namibia, and Ukraine. See AVAC’s Planning Matrix for more!

The Latest R&D in the Prevention Pipeline

Launched at HIVR4P in Lima, Peru in October 2024, the People’s Research Agenda (PRA) is a collaboratively developed framework for aligning the needs and priorities of affected communities with the agenda for HIV prevention research. 130 advocates from more than 20 countries contributed to the framework, which offers guidance on both research conduct and what products to develop.

PRA priorities include:

  • Support a choice-based prevention agenda with clear and realistic target product profiles that reflect the current and future landscape of HIV prevention. Begin with the end in mind by identifying and anticipating trial design issues (feasibility, cost, size, regulatory pathways) and implementation science questions so that the timeline from evidence to impact and to widespread access is as short as possible. Initiate access planning during efficacy trials to ensure expeditious rollout.
  • Center and invest in social and behavioral science that explores end users’ needs and preferences, informs target product profiles, and identifies and addresses social and structural barriers in HIV prevention.
  • Maintain advocacy across product categories to fill important gaps in a comprehensive HIV prevention toolbox. We must make newly efficacious products accessible, and vaccines, bnAbs, implants, and other products in early-phase development will also play an important role for a sustainable end to the epidemic.

Key considerations:

  • Invest in continuous learning so that advocates and communities where research is planned are equipped to weigh in on complex and evolving trial designs and approaches.
  • Novel trial designs using external controls are important in developing new prevention products. However, they must meet the rigorous standards of randomized controlled trials (RCTs) to ensure they provide reliable answers to key research questions without compromising quality.
  • Trial designs must address the needs and concerns of highly impacted communities.
  • Products moved into trials should be ones that fill community-informed gaps, such as improving upon existing prevention methods with innovations in cost, mode of delivery, duration or level of protection and other parameters.
  • Participants should be supported to clearly understand how novel design elements, such as run-in or opt-out phases, may impact their involvement.
  • Ensure that regulators are prepared to review and react to the data generated by future trials, especially if it is a novel design.

The PRA is a living document—emerging priorities, challenges and opportunities will be reflected in ongoing updates. Please share your thoughts, reflections, and comments by emailing Grace Kumwenda at [email protected]. For more information on the People’s Research Agenda visit avac.org/peoples-research-agenda.

Prevention Playlist

AVAC develops a wide range of resources to inform decision making and action. Check out the latest:

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True Choice in HIV Prevention Involves More than Product Options: Novel strategies in service delivery

The Choice Agenda and presenters from Brazil, Kenya, and South Africa discussed novel strategies for the delivery of HIV prevention interventions. All HIV prevention products have their “Achilles Heels.” Differentiated service delivery supports reaching a wide range of potential users and can overcome challenges with product attributes. Offering different strategies can also make the interface with health care easier and more community friendly.

Speakers:

  • Ines Dourado, Universidade Federal da Bahia
  • Catherine Verde Hashim, AVAC
  • Catherine Martin, Wits RHI
  • Katrina Ortblad, Fred Hutch
  • Adriano Queiroz, City of São Paulo Municipal Health Secretariat
  • Daniel Were, Jhpiego

Thanks to WHO for providing live simultaneous Ukrainian translation and to PAHO for providing live simultaneous translation in Portuguese and Spanish.

Video Recording and English Audio / Ukrainian Audio / Portuguese Audio / Spanish Audio / Slides / Resources