This week, Rio de Janeiro brings together researchers, governments, civil society organizations and people living with HIV for AIDS 2026, the world’s leading conference on HIV and AIDS. The meeting comes at a time when increasingly effective tools are available to prevent and treat HIV, but cuts to international funding are weakening the services needed to deliver them. In 2025, 40.9 million people were living with HIV.
Treatment has reduced mortality and enabled millions of people to live long and healthy lives. Even so, 1.2 million people acquired HIV over the past year and 570,000 people died from AIDS-related illnesses. Almost nine million people are still not receiving treatment. Progress has also been uneven. New HIV infections have fallen sharply in eastern and southern Africa but have increased since 2010 in Latin America, eastern Europe and central Asia, and the Middle East and North Africa.
Funding cuts reach services
Funding will feature prominently in discussions in Rio. In 2024, US$18.7 billion was available for the HIV response in low- and middle-income countries, 15% less than the amount needed to meet the 2030 targets. HIV prevention is particularly dependent on international assistance.
Funding cuts and policy changes introduced by the Trump administration have exacerbated the situation at PEPFAR. Since its creation in 2003, the US programme has helped save more than 26 million lives and funds HIV prevention, testing and treatment services in dozens of countries.
Ahead of AIDS 2026, findings have been released from two studies that will be presented at the conference. Research by amfAR, the Foundation for AIDS Research, documents the experiences of 166 PEPFAR-funded organizations in 46 countries. More than half lost at least one award, while 77% were instructed to adapt their work to new policies introduced in Washington. The terminations have led to the closure of 1,714 service delivery sites and the loss of more than 16,000 jobs. Local organizations and services for key populations have been hit hardest. Organizations have also reported difficulties obtaining condoms, laboratory supplies, PrEP and antiretroviral medicines.
The second study analyses PEPFAR data on treatment services for children living with HIV. In 2025, 77,163 fewer children received PEPFAR-supported care, a decline of 14.2%. Numbers fell in 20 of the 21 countries analysed. This does not necessarily mean that all of these children stopped receiving medication, but that they were no longer receiving direct service delivery or technical assistance supported by PEPFAR.
Against this backdrop, the Global Fund to Fight AIDS, Tuberculosis and Malaria remains central to the global response. It provides 26% of all international financing for HIV and helps sustain treatment and prevention programmes in countries with fewer resources. 54 countries have announced increases in domestic funding, although many have little fiscal space. Twenty-eight African countries spend more on debt servicing than on health. Domestic resources cannot replace lost international funding overnight. As governments try to protect treatment services, prevention, testing and community-led organizations are becoming more exposed.
Effective medicines that remain out of reach
AIDS 2026 will present new data on lenacapavir, a pre-exposure prophylaxis option, known as PrEP, that prevents HIV through an injection administered every six months. It may be particularly useful for people who find it difficult to take a daily pill or attend health services frequently. The PURPOSE 1 and PURPOSE 2 studies confirm its high efficacy and have identified no new safety concerns.
Gilead has authorized six manufacturers to produce generic versions for 120 countries, but another 26 countries have been excluded. The exclusions have a particular impact on Latin America and include Argentina, Brazil, Mexico and Peru, some of which participated in the clinical trials. The Global Fund and the United States aim to provide access to lenacapavir for three million people by 2028. Unitaid is supporting another agreement to make a generic version available from 2027 for around US$40 per person per year.
For Salud por Derecho, lenacapavir illustrates the gap between innovation and access. Its potential will depend on whether it becomes available at an affordable price in all the countries that need it.
During the conference, we will also discuss alimatravir, a once-monthly pill that MSD is investigating for HIV prevention. The medicine is in phase III trials and has yet to demonstrate its efficacy. The company has just announced seven agreements to manufacture generic versions for 129 low- and lower-middle-income countries.
Salud por Derecho welcomes MSD’s decision to begin preparing for access before the final results are known. However, information is still lacking on pricing, production volumes and the terms of the licences. The agreements exclude countries such as Argentina, Brazil, Colombia, Peru and Mexico, despite rising numbers of new HIV infections in Latin America. The first four are also participating in the clinical trials.
An independent study estimates that alimatravir could be produced for US$4.49 per person per year. We are calling for a publicly disclosed price close to US$5, sufficient supply for at least six million people and transparent licences that facilitate the manufacture and distribution of generic versions. AIDS 2026 will showcase new ways of preventing HIV, but also the barriers delaying access to them. Their impact will depend on whether they are made available at affordable prices in the countries that need them.
