Annual Letter 2026
Annual Letter
Rethinking the HIV response
Published on 28 January 2026
After a turbulent year for HIV and global health, 2026 opens with an urgent need to rethink the HIV response. The challenges we face demand more than incremental change. They require us to rethink how we work, rebuild what has been weakened and rise to meet a rapidly shifting global context.
We enter this year with a new IAS Strategy that charts a path through and beyond the turmoil, grounded in science and equity. Inaction will further erode hard-won progress. Bold, decisive leadership can protect it and move us forward as we rethink how the HIV response is financed, delivered and led.
1. Rethinking financing
HIV funding and global cooperation have been declining in recent years. Then the suspension of US foreign aid in early 2025 ruptured traditional funding models for the HIV response and widened existing gaps. Bilateral funding agreements, such as those recently initiated by the US, may provide some relief but they come with high transactional costs.
This is what needs to happen for sustainable financing of the global HIV response:
Rethink debt repayment
There is an urgent need for countries to rely less on donor funding and more on domestic financing. But this is not a simple matter, given the historical external debt of many high-HIV-burden countries. More than half of the population of Africa lives in countries that spend more on debt and interest payments than on healthcare or education. Several things must happen: global financial institutions must prioritize finding agreement on debt restructuring; donor countries must support this process; and African governments must channel the debt relief into their health systems.
Build equal partnerships
Even as domestic financing increases, a global approach remains essential. This means shifting from neocolonial aid and reliance on the US or any big donor that unilaterally sets the terms and conditions. It means countries – including civil society – being able to negotiate the terms of foreign aid and ethics being maintained at all times in all settings. It means continuing to advocate for full funding of multilateral instruments such as the Global Fund, which saw its replenishment fall far short of its target – these instruments pool resources, distribute power more equitably and reduce donor dominance.
Spend smart and innovate
We have to rethink how remaining resources are used. We must also explore new sources of funding, including establishing innovative public-private partnerships and community-level mechanisms.
What the IAS will do
In line with the IAS Strategy, we will bring together key global players to align for strong messaging, political advocacy and action. We will work with partners in high-burden regions and where the epidemic is growing to support data-driven advocacy and amplify calls for action. We will also empower advocates to utilize our convenings for political commitment and adequate funding, and we will support their efforts.
2. Rethinking service delivery
The funding crisis has disrupted and reduced HIV services and intensified existing barriers, including stigma. The consequences fall hardest on communities already most affected by new HIV acquisitions and AIDS-related deaths. These include men who have sex with men, sex workers, trans people, people who inject drugs, people in prisons and other closed settings, children, migrants, adolescent girls and young women, and Indigenous Peoples.
This demands decisive action:
Support countries in rethinking their HIV programmes
Many countries, facing impossible choices about who receives life-saving services and who does not, require technical support in remodelling HIV service delivery and reprioritizing allocation of remaining resources.
Explore cost-effective and digital innovations
Service providers in various settings have been adopting discreet, user-administered and AI-supported innovations, such as telemedicine, online ordering, digital self-screening and vending machines for HIV commodities, to reach more people. Pharmacy-based, nurse-led and peer-provided PrEP are increasingly available.
Put people first
There is a strong push to integrate HIV into primary care services to ensure sustainability and support person-centred care, including integrated chronic care management using differentiated service delivery models for HIV and non-communicable diseases, like hypertension and diabetes mellitus. It will be crucial to support this transition through rethinking and rebuilding primary care in ways that are acceptable and safe for key and vulnerable populations. In addition, there is an urgent need to address challenges with primary care user fees and healthcare worker training to ensure stigma-free and affordable care.
What the IAS will do
Guided by our strategy, we will support policy makers, funders and service providers in adopting latest evidence and good practice in differentiated service delivery to reach all people in need effectively and in linking HIV and other services to meet the needs of every person. We will also utilize our convening platforms to share evidence on effective stigma-free service delivery and the value of decriminalization.
3. Rethinking prevention and access
Long-acting HIV prevention breakthroughs, such as injectable lenacapavir (LEN) and cabotegravir, as well as monthly oral PrEP on the horizon, have brought the goal of ending the HIV pandemic into clear sight. But innovation and progress are constrained by limited resources and skewed access, exacerbated by funding cuts and geopolitical shifts.
Getting long-acting technologies to every person who needs them rests on adequate funding, coordination, global leadership and, in the case of injectables, a trained healthcare workforce. These are some central requirements:
Attain widespread regulatory approval and integrate long-acting options into national plans
In June 2025, the US FDA approved LEN for HIV prevention. And in July, the World Health Organization added injectable lenacapavir to its recommended PrEP options, urging governments, donors and health partners to roll it out immediately in national programmes.
Establish pricing that people and governments can afford
Even if the long-term health and economic benefits of long-acting prevention technologies are clear, governments will only choose to roll these out if prices are affordable today.
Rapidly expand licensing agreements for production
We welcome Gilead’s two-million-dose agreement for LEN rollout and the move towards generic manufacturing. However, more is needed to make a real impact, including bringing middle-income countries into licensing agreements.
Conduct broader studies into LEN and other long-acting options
Efficacy is established. The response needs industry and donor-funded studies into public health benefits, real-world coverage, user preferences and delivery models.
What the IAS will do
As set out in the IAS Strategy, we will support policy makers and programme implementers to act fast on latest evidence on prevention technologies and their rollout. We will equip health service providers with knowledge and tools to support informed prevention choice. And we will work with communities and policy makers to advocate for improvements in affordable access to, and create demand for, diverse HIV prevention options.
None of this rethinking can be done without sustaining science and protecting communities.
Sustaining science
Politicization and misinformation have whittled away public trust in evidence-based interventions. As funding cuts undermine research capacity, particularly for early-career researchers, the HIV response could lose a generation of scientists, clinicians and implementation experts. There is also uncertainty regarding the future of key institutions.
From this grim reality emerges the urgent need for:
- Credible, transparent science communication and trusted intermediaries
- Resources to train, retain and support early-stage investigators and foster exchange between different generations of scientists working on HIV
- Credible parties to sustain accountability and essential functions, such as epidemiological data, in the global HIV response
What the IAS will do
At the IAS, we will continue to support the search for an HIV vaccine and a cure by strengthening research capacity and leadership in lower-resource settings. We will leverage our convening platforms to foster innovation across research and knowledge generation. And we will support the development of research agendas to stir scientific effort towards critical evidence gaps.
Protecting communities
In an effective HIV response, communities define and shape priorities and enforce accountability. The aid crisis, however, translates into serious funding declines for civil society organizations, with an undermining of community‑led monitoring, independent oversight and rights‑based, community‑based services. Further, new bilateral agreements between the US and individual African governments under the America First Global Health Strategy threaten to sideline community actors from decision making and service delivery.
Global, regional and national stakeholders must work together to keep communities at the centre of the HIV response. This includes:
- Protecting and promoting community-delivered care and community‑led monitoring
- Safeguarding civil society spaces
- Advancing community leadership in planning, implementation and review of HIV programming and research
What the IAS will do
We will bring together governments, multilateral agencies, donors and community leaders to ensure that communities are equal partners, not peripheral implementers. We will use our convening platforms to showcase evidence on community‑led approaches and support advocacy for their funding and protection. And we will work with partners in high‑burden settings to strengthen data‑driven, community‑led advocacy that informs political and financial decisions.
Working together to Rethink. Rebuild. Rise.
The HIV response has provided a model of collaboration among key actors across policy, financing, service delivery, science and communities. The IAS remains uniquely positioned to unite these actors, support the generation and application of evidence, and provide spaces to address challenges.
In the year ahead, the IAS will convene, enable, advocate and empower to help secure sustainable financing, promote an evidence-based response, and protect the role of communities. We look forward to seeing you at AIDS 2026, the 26th International AIDS Conference, in Rio de Janeiro, Brazil, where the global HIV community will come together to Rethink. Rebuild. Rise.
Beatriz Grinsztejn
President, IAS
Birgit Poniatowski
Executive Director, IAS