New innovations in HIV prevention could dramatically reduce the number of new HIV cases around the globe, but US foreign aid cuts will mean that those that most need the new medication will be unable to access it, according to experts at the Aids ۲۰۲۶ Conference in Rio de Janeiro, Brazil.
One year ago, the World Health Organization recommended that governments around the world prioritize expanded access to lenacapavir, an injectable version of the HIV prevention medication PrEP that requires only two injections annually. PrEP, which also comes in the form of daily oral medications and bimonthly injections, is ۹۹% effective in preventing sexually transmitted HIV for people who take it consistently.
In its announcement, the WHO noted that access to lenacapavir is limited outside clinical trials. But the organisation recommended that governments around the world prioritise scaling up availability of the injectable medication, because it could be gamechanging for populations that face considerable barriers to access for the medications that are currently available.
For people who face poverty or stigma, or who live in rural areas that are far away from healthcare services, accessing a daily pill or an every-other-month injection can be close to impossible. Lenacapavir would provide strong protection against HIV while only requiring patients to access healthcare twice annually. A mathematical modeling study from the WHO and the United Nations estimated that widespread availability of lenacapavir could prevent ۴۱% of new HIV infections in South Africa, Zimbabwe and western Kenya.
Notably, when the WHO recommended global investment in lenacapavir for HIV prevention in ۲۰۲۵, the Trump administration was already in the process of dissolving USAID, which provided ۷۳% of donor-funded resources for HIV prevention globally, according to a study in the Lancet Global Health. As of July ۲۰۲۶, multiple reports show that investment in HIV prevention has declined dramatically around the world.
“We have these major achievements in prevention. On the other hand, we are facing these major funding cuts that are affecting deeply the delivery not only of these new prevention technologies but also decreasing the number of people engaged in care, engaged in prevention services,” said Beatriz Grinsztejn, president of the International Aids Society, during a press conference at the Aids ۲۰۲۶ Conference.
Grinsztejn is also an infectious disease physician and researcher at the HIV prevention organisation Fiocruz in Rio de Janeiro.
The funding cuts not only affect the availability of medications themselves, but also the ability of organisations to reach the people who need them.
“When funding cuts came, one of the big things that’s been impacted is peer outreach workers, which are crucial to reaching people who use drugs, to building trust with people who use drugs and engaging them with services,” said Ailish Brennan, a policy analyst at Harm Reduction International.
People who inject drugs are at a particularly high risk for contracting HIV, especially if they do not have access to clean syringes. A report from the International Network of People Who Use Drugs found that organisations were most likely to respond to the loss of funding by cutting outreach services.
Brennan said that many harm reduction and HIV prevention organisations around the world were having to shut down locations, including mobile locations, which can mean clients at risk for HIV lose trust in the organisation.
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“But also just if they have to travel further they lose their local point of contact, and ultimately this means the innovations that we’re seeing, the long-acting injectables that have so much hope and opportunity, are not going to reach the people who need them most,” Brennan said.
At the press conference, Grinsztejn noted that even before the dissolution of USAID, much of Latin America had been left out of agreements with US-based pharmaceutical companies to make innovative HIV prevention more affordable.
Gilead Sciences provides generic versions of long-acting medications to low- and middle-income countries for far below sticker price, but justifies excluding countries such as Brazil, Colombia, Mexico, Peru and Argentina by classifying them as “upper middle-income countries”. HIV advocates dispute this justification, partly because people in these countries played a key role in clinical trials to test these medications.
“We do have prevention technologies that are our dream,” Grinsztejn said during the conference, adding that it should be possible to fulfill the UNAIDS long-held goal of eliminating AIDS as a public health threat by ۲۰۳۰.
Grinsztejn then added: “From my personal perspective, I think that it’s really hard that we will get to the targets given the current scenario.”
