Kampala — For more than two decades, scientific innovation and international financing have worked together to transform HIV from a deadly disease into a manageable chronic condition for millions of people.
But today, the two pillars that have sustained the global HIV response appear to be moving in different directions.
Researchers are reporting some of the most promising advances in HIV prevention and treatment in years, including a twice-yearly injectable medicine for HIV prevention and a potential once-weekly oral treatment for people living with HIV.
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At the same time, new evidence suggests disruptions to the United States President’s Emergency Plan for AIDS Relief (PEPFAR) are already affecting HIV services in countries that rely heavily on the programme.
“Science is moving fast, giving us more powerful HIV prevention and treatment tools. But these advances cannot save lives if they never reach the people who need them,” said Beatriz Grinsztejn, President of the International AIDS Society.
“That requires robust, stable financing and steadfast political commitment.”
Funding disruptions
The scale of the challenge has emerged from two studies examining the impact of recent disruptions to PEPFAR-supported programmes.
The disruptions began in January 2025, shortly after US President Donald Trump returned to office and issued an executive order pausing foreign assistance for 90 days while government aid programmes underwent review.
A subsequent State Department directive placed stop-work orders on existing foreign assistance programmes, including PEPFAR, temporarily suspending several HIV activities.
Although exemptions were later issued for some life-saving humanitarian and HIV services, uncertainty over funding and programme continuity continued, resulting in grant cancellations, restrictions and disruptions affecting organisations delivering HIV care.
A global survey involving 166 implementing partners across 46 countries found that more than half had lost at least one funding award, while 77% had been required to restrict activities to comply with additional US policy requirements.
The disruptions contributed to the closure of 1,714 HIV service sites, including 1,010 public health facilities, 325 access points and 126 community drop-in centres.
Local organisations supporting communities most vulnerable to HIV were among the hardest hit.
Several implementing partners reported ending services for key populations at higher risk of infection. Others cited shortages of condoms, laboratory supplies, pre-exposure prophylaxis (PrEP) medicines and antiretroviral drugs.
Some organisations said they had reduced programmes or discontinued activities to maintain access to available funding.
A separate analysis highlighted the impact on children living with HIV. Researchers found that 77,163 fewer children received PEPFAR-supported treatment globally in the 2025 financial year compared with the previous year, representing a 14.2% decline.
Uganda, Kenya, Zambia, Haiti and South Africa were among countries showing possible departures from previous treatment trends.
Ramona Godbole of Heidelberg Institute of Global Health, Heidelberg University Hospital and the Clinton Health Access Initiative said the findings required urgent country-level investigation and the restoration of routine public reporting on age-specific HIV treatment data.
“These studies provide compelling new evidence that PEPFAR disruptions have had negative, far-reaching consequences, particularly for those most vulnerable people,” said Kenneth Ngure, President-Elect of the International AIDS Society.
Scientific progress continues
The funding uncertainty comes as HIV research continues to deliver major advances.
New findings from the PURPOSE studies have strengthened evidence supporting lenacapavir, a long-acting injectable medicine administered twice a year to prevent HIV infection.
Among women participating in the PURPOSE 1 study in Uganda and South Africa, researchers recorded no new HIV infections during the first 52 weeks of an open-label extension among participants receiving lenacapavir.
More than 95% of participants chose to continue using the injectable medicine, with adherence reaching 96% and no new safety concerns identified.
Noah Kiwanuka of Makerere University School of Public Health said the findings reinforce lenacapavir’s potential as a transformative HIV prevention option for women.
Researchers also confirmed the safety and effectiveness of the medicine among cisgender men and gender-diverse people participating in the PURPOSE 2 study.
“If we deliver it where it is needed most, lenacapavir for HIV prevention has the potential to help curb the global pandemic,” Grinsztejn said.
She warned, however, that affordability and access remain major challenges, particularly in regions where countries lack generic licensing agreements or external HIV financing support.
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“We must resolve these pricing barriers now to ensure the region is not left behind,” she said.
Scientists have also reported encouraging Phase III results for a once-weekly oral HIV treatment combining islatravir and lenacapavir.
The combination performed as well as standard daily antiretroviral therapy among adults whose HIV was already suppressed, offering a potential option for people who struggle with daily medication.
“Treatment needs to fit into people’s lives, not the other way around,” Ngure said.
“People living with HIV need new treatment options that offer flexibility, and a weekly pill could broaden the choices available.”
Beyond viral suppression
Despite decades of progress, researchers say major scientific questions remain. A study involving adolescents who acquired HIV at birth found persistent HIV-specific immune activity in the spinal fluid of nearly one in five participants, despite having undetectable levels of virus in their blood.
Shalena Naidoo of Stellenbosch University said the findings suggest blood tests alone may not capture all ongoing HIV activity.
The research highlights the need to consider the central nervous system in future HIV cure studies.