Experts gathered at the Aids 2026 Conference in Rio de Janeiro highlighted the potential of lenacapavir, an injectable HIV prevention medication requiring only two annual doses, to dramatically reduce new infections worldwide. The medication, which has demonstrated 99% effectiveness in preventing sexually transmitted HIV among consistent users, addresses a critical gap for populations facing barriers to current prevention options, including those experiencing poverty, stigma, or limited healthcare access in rural areas.
A mathematical modeling study estimated that widespread lenacapavir availability could prevent 41% of new HIV infections in South Africa, Zimbabwe and western Kenya. The WHO recommended global prioritization of the medication approximately one year prior to the conference, recognizing its potential as transformative for hard-to-reach populations who struggle with daily oral medications or bimonthly injection schedules.
However, the implementation of these advances faces significant obstacles. USAID, which previously provided 73% of donor-funded resources for HIV prevention globally according to a Lancet Global Health study, has been dissolved, resulting in dramatic declines in prevention investment as of July 2026. Beatriz Grinsztejn, president of the International Aids Society and infectious disease physician at Fiocruz, emphasized that funding cuts are hampering delivery of new prevention technologies and reducing engagement in care services.
Beyond medication availability, the cuts are affecting organizational capacity to reach vulnerable populations. Ailish Brennan, a policy analyst at Harm Reduction International, noted that peer outreach workers—essential for building trust with people who inject drugs—have been among the first casualties of budget reductions. Mobile outreach locations are closing, forcing at-risk individuals to travel further for services and potentially eroding organizational trust. This infrastructure loss threatens to prevent innovative long-acting medications from reaching those with the greatest need.
Additionally, geographic disparities persist in drug access agreements. Several Latin American countries classified as upper middle-income remain excluded from generic pricing programs offered by manufacturers like Gilead Sciences, despite their populations’ participation in clinical trials for these medications. Grinsztejn acknowledged the difficulty of achieving UNAIDS’ 2030 AIDS elimination goal under current funding and access conditions.
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