By Henry Neondo
RIO DE JANEIRO, Brazil – Scientists gathering for the 26th International AIDS Conference (AIDS 2026) have issued a stark warning that disruptions to the United States President’s Emergency Plan for AIDS Relief (PEPFAR) are reversing decades of progress against HIV, even as researchers unveil groundbreaking advances in HIV prevention and treatment.
Speaking ahead of the conference, which opens in Rio de Janeiro on July 26 under the theme Rethink. Rebuild. Rise., researchers said the world stands at a crossroads where scientific innovation is advancing faster than ever, but shrinking global health financing threatens to keep lifesaving interventions out of reach for millions.
“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 IAS President and AIDS 2026 Co-Chair Prof. Beatriz Grinsztejn.
Among the conference’s most significant findings are two studies documenting the consequences of recent disruptions to PEPFAR, one of the world’s largest HIV programmes.
Researchers surveyed 166 PEPFAR implementing partners across 46 countries and found widespread programme interruptions. More than half of the organisations reported losing at least one funding award, while many were forced to reduce services or comply with new policy restrictions. The disruptions resulted in the closure of 1,714 HIV service delivery sites, including more than 1,000 public health facilities, with locally based organisations bearing the greatest burden.
The consequences have been particularly severe for vulnerable populations. Many organisations permanently halted services targeting key populations at highest risk of HIV infection, while shortages of condoms, pre-exposure prophylaxis (PrEP), laboratory supplies and antiretroviral medicines were widely reported.
A second study paints an equally troubling picture for children living with HIV.
Researchers analysing fiscal year 2025 PEPFAR data found that 77,163 fewer children received PEPFAR-supported HIV treatment compared with the previous year—a decline of 14.2 percent. South Africa recorded the largest reduction, with nearly 31,000 fewer children receiving treatment support, representing a 45 percent decline. Kenya was among five countries where researchers observed worrying departures from historical treatment trends, raising concerns over continuity of paediatric HIV care.
IAS President-Elect Prof. Kenneth Ngure of Kenya’s Jomo Kenyatta University of Agriculture and Technology described the findings as compelling evidence that funding disruptions are having far-reaching consequences for the world’s most vulnerable populations.
Despite the funding crisis, researchers presented encouraging evidence that long-acting HIV prevention technologies are delivering exceptional results.
Updated findings from the PURPOSE 1 and PURPOSE 2 clinical trials confirmed that twice-yearly injections of lenacapavir remain highly effective in preventing HIV infection. In the PURPOSE 1 study involving women in South Africa and Uganda, no new HIV infections occurred among participants receiving lenacapavir during the first year of the open-label extension phase. Nearly all eligible participants chose to continue using the injectable prevention option, demonstrating strong acceptance and adherence.
Similarly, PURPOSE 2, involving men and gender-diverse individuals across seven countries, reaffirmed lenacapavir’s high level of protection and favourable safety profile.
Researchers say the twice-yearly injection could transform HIV prevention globally, provided countries can overcome affordability barriers and ensure equitable access.
The conference will also showcase detailed Phase III trial results for a once-weekly oral HIV treatment combining islatravir and lenacapavir. The experimental regimen proved as effective as standard daily treatment while offering patients the convenience of taking just one pill each week. Scientists believe it could become the world’s first complete once-weekly oral treatment for people whose HIV is already well controlled.
Meanwhile, South African researchers have uncovered new evidence suggesting HIV-related immune activity may persist in the central nervous system even when the virus is fully suppressed in the bloodstream.
The study followed 79 adolescents who acquired HIV at birth and received treatment early in life. Nearly one in five participants whose blood showed no detectable virus still exhibited HIV-specific immune activity in their spinal fluid, suggesting current monitoring methods may overlook ongoing activity in the brain and spinal cord. The findings could influence future HIV cure research and long-term patient monitoring.
As delegates prepare to convene in Brazil, researchers say the juxtaposition of remarkable scientific breakthroughs and deepening financial uncertainty highlights the urgency of sustaining global investment in HIV programmes.
While science continues to deliver transformative innovations capable of ending the epidemic, experts warn that without stable financing and political commitment, millions of people—particularly in Africa—risk being left behind.