In Rio de Janeiro, at the AIDS 2026 Conference, a painful paradox came into focus: humanity now possesses a drug capable of preventing nearly half of new HIV infections with just two injections per year, yet the financial architecture that would deliver it to those most in need is collapsing. The dissolution of USAID, which once underwrote nearly three-quarters of global HIV prevention, has left clinics shuttered, outreach workers dismissed, and vulnerable populations exposed. It is a moment that asks an old and difficult question — whether scientific progress, absent the will to share it, con
HIV Prevention Breakthrough Undermined by USAID Cuts, Experts Warn
Millions at risk for HIV infection globally, particularly people who inject drugs, those in poverty, and rural populations who will lose access to prevention services and innovative treatments.
The innovations exist. The funding does not.
Mark
Why does a two-injection-per-year drug matter so much more than what already exists?
Mimi
Because it removes the friction that keeps prevention from reaching the people who need it most. A daily pill requires you to remember, to have access to a pharmacy, to not face stigma every time you refill. Two injections a year? That's something you can plan for, something that fits into a life that's already precarious.
Mark
And USAID was really funding three-quarters of this work globally?
Mimi
Yes. When that money disappeared, it wasn't like organizations could absorb the loss. They closed clinics. They fired the peer workers—the people who actually know the communities and can reach people who inject drugs, sex workers, people in rural areas. You lose the infrastructure that makes any drug, no matter how good, actually reach anyone.
Mark
So the timing is just terrible—the drug becomes available right as the funding collapses?
Mimi
It's worse than that. The WHO recommended scaling up lenacapavir in 2025, knowing USAID was already being dissolved. It's like designing a rescue boat while watching the ship sink.
Mark
What about the pharmaceutical company? Can't they just lower prices more?
Mimi
Gilead already does provide discounts to low- and middle-income countries. But they exclude countries like Brazil and Mexico, calling them too wealthy. Never mind that people in those countries helped test the drug. It's a classification that serves the company's interests, not the epidemic's reality.
Mark
Is there any path forward?
Mimi
There has to be. The science works. Lenacapavir could prevent 41% of new infections in some regions. But without funding for outreach, without peer workers, without the infrastructure to actually deliver it—the drug sits in warehouses while people at highest risk never hear about it.
The Pulse
- Lenacapavir, a twice-yearly injectable that is 99% effective against HIV, has been formally recommended by the WHO and could prevent 41% of new infections in key regions — yet it remains out of reach for millions.
- The Trump administration's dismantling of USAID has stripped away 73% of global HIV prevention funding, triggering clinic closures, the elimination of mobile outreach units, and the loss of peer workers who serve the hardest-to-reach populations.
- People who inject drugs face a compounding crisis: the trusted community workers who connected them to clean syringes and health services are disappearing first, severing the human bridges that no drug alone can replace.
- Gilead Sciences offers discounted generics in low-income countries but excludes 'upper middle-income' nations like Brazil and Mexico — the very countries whose citizens participated in the trials that proved lenacapavir works.
- The 2030 goal of eliminating AIDS as a public health threat, once considered ambitious but achievable, is now described by leading experts as 'really hard' to reach under current conditions — a quiet admission that austerity is outpacing science.
In Rio de Janeiro, at the AIDS 2026 Conference, a painful paradox came into focus: humanity now possesses a drug capable of preventing nearly half of new HIV infections with just two injections per year, yet the financial architecture that would deliver it to those most in need is collapsing. The dissolution of USAID, which once underwrote nearly three-quarters of global HIV prevention, has left clinics shuttered, outreach workers dismissed, and vulnerable populations exposed. It is a moment that asks an old and difficult question — whether scientific progress, absent the will to share it, constitutes progress at all.
At the AIDS 2026 Conference in Rio de Janeiro, public health leaders confronted a defining contradiction of this moment: the science of HIV prevention has never been more powerful, and the systems meant to deliver it have rarely been more fragile.
At the center of the discussion is lenacapavir, an injectable form of pre-exposure prophylaxis requiring only two shots per year. With 99% effectiveness and a dosing schedule that removes the daily discipline demanded by pills or the frequent visits required by older injectables, it is a drug designed for the real conditions of people's lives — poverty, stigma, distance from clinics. Modeling studies suggest it could prevent 41% of new infections in South Africa, Zimbabwe, and western Kenya alone.
But the infrastructure needed to deliver that promise is eroding. USAID, which funded 73% of global HIV prevention efforts, has been effectively dismantled by the Trump administration. By mid-2026, the consequences are concrete: closed clinics, eliminated outreach programs, and the loss of peer workers — the community members who build trust with people who use drugs, distribute clean syringes, and serve as the human connective tissue between vulnerable populations and health services. Experts warn that without these workers, even the most innovative treatments will never reach those who need them most.
Beatriz Grinsztejn, president of the International AIDS Society and a physician at Fiocruz in Rio, captured the collision plainly: breakthrough prevention technologies exist, but funding cuts are simultaneously shrinking the number of people engaged in care. She noted a further inequity — Gilead Sciences, which manufactures lenacapavir, excludes 'upper middle-income' countries like Brazil, Colombia, and Mexico from its discounted generic access, despite the fact that people in those nations participated in the clinical trials that proved the drug's efficacy.
The UNAIDS target of eliminating AIDS as a public health threat by 2030 remains official policy. Grinsztejn said it should be achievable. Then she paused and added that, given the current landscape, she personally finds it very hard to believe the targets will be met. The tools exist. The will, and the funding, do not.
In Rio de Janeiro this week, public health experts gathered at the Aids 2026 Conference to discuss a paradox that has come to define the current moment in HIV prevention: the tools exist to transform the epidemic, but the money to deploy them is vanishing.
The centerpiece of this contradiction is lenacapavir, an injectable form of PrEP—pre-exposure prophylaxis—that requires only two shots per year. The drug is 99% effective at preventing sexually transmitted HIV in people who take it consistently. A year ago, the World Health Organization formally recommended that governments worldwide prioritize expanding access to it. The mathematics are compelling: modeling studies suggest that if lenacapavir were widely available in South Africa, Zimbabwe, and western Kenya, it could prevent 41% of new HIV infections in those regions alone.
The appeal is obvious to anyone who understands the barriers that keep people from prevention. A daily pill demands discipline and access to pharmacies. A bimonthly injection requires regular clinic visits. For someone living in poverty, or in a rural area hours from the nearest health facility, or facing the stigma that surrounds HIV prevention in their community, these requirements can be insurmountable. Lenacapavir collapses the burden: two visits to a clinic per year, and you are protected.
But as the WHO was making this recommendation in 2025, the Trump administration was already dismantling USAID, the US foreign aid agency that had been funding 73% of global HIV prevention efforts. By July 2026, the impact is unmistakable. Investment in HIV prevention has plummeted worldwide. The cuts are not abstract. They are showing up as closed clinics, shuttered mobile outreach units, and the elimination of peer workers—the people who build trust with those at highest risk, particularly people who inject drugs.
Beatriz Grinsztejn, an infectious disease physician and president of the International Aids Society, spoke at the conference about the collision between breakthrough and austerity. "We have these major achievements in prevention," she said. "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." Grinsztejn works at Fiocruz, an HIV prevention organization in Rio de Janeiro.
The loss of peer outreach workers is particularly consequential. These are the people who meet people who use drugs where they are—literally and figuratively—who distribute clean syringes, who build the relationships that make engagement with health services possible. When organizations lose funding, they cut outreach first. A report from the International Network of People Who Use Drugs documented this pattern. Ailish Brennan, a policy analyst at Harm Reduction International, explained the cascade: "When 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."
There is another layer of inequity at work. Gilead Sciences, which manufactures lenacapavir, does provide generic versions to low- and middle-income countries at steep discounts. But the company excludes countries classified as "upper middle-income," a category that includes Brazil, Colombia, Mexico, Peru, and Argentina. Grinsztejn pointed out the absurdity: people in these countries participated in the clinical trials that proved the drug works. Yet they are locked out of affordable access.
The UNAIDS goal has long been to eliminate AIDS as a public health threat by 2030. Grinsztejn said it should be possible. Then she paused. "From my personal perspective," she added, "I think that it's really hard that we will get to the targets given the current scenario." The dream exists. The funding does not.
Notable Quotes
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.— Beatriz Grinsztejn, president of the International Aids Society
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.— Ailish Brennan, policy analyst at Harm Reduction International
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