AIDS 2026 Prevention Round-up
At this year’s International AIDS Conference in Rio de Janeiro, Brazil, one message emerged above all others: the barriers to ending HIV are no longer primarily scientific; they are political. While new prevention innovations are coming to market faster than ever before, systems are not in place to ensure they reach everyone who wants to use them with speed, scale, and equity. Read below for more details and some key prevention highlights from the conference.
Innovation Without Access Is Not Innovation
Even before the conference officially opened, Merck/MSD announced voluntary licensing agreements with seven companies in four countries – including Kenya, South Africa and Uganda – for its investigational monthly oral PrEP pill, alimatravir (MK-8527). While the announcement represents an important step toward earlier access planning, advocates quickly noted that several countries involved in the clinical trials, including conference host Brazil, Argentina, Colombia and Peru, are excluded from the licensing territory. As AVAC’s Mitchell Warren noted in this Bhekisisa piece, “We don’t yet know if the medicine will work…but…adding a monthly pill to the choice of options could increase demand even more… [however] for this, we need volumes—tens of millions of doses—which we don’t yet have in the HIV prevention market.”
Activists interrupted the conference opening ceremony calling for affordable HIV prevention and treatment, patent reform and investment in cure research, chanting, “Pills cost pennies, greed costs lives.” Brazil’s Minister Padilha reinforced the broader stakes: “Defending the response to HIV is, more than ever, defending science, human rights, democracy and life.”
Community Engagement Is Reshaping R&D and Access
The Advancing HIV Prevention Science and Access preconference session offered a glimpse of how product development, delivery and access are evolving. Merck’s Rebeca Plank recognized that communities and advocates were advising on the development of alimatravir (MK-8527) from the outset, “even before the Phase 3 protocols were written.” Their input influenced the decision to generate data during pregnancy and lactation earlier in development, giving people the information they need to make informed decisions rather than waiting until after approval. Plank also highlighted Merck/MSD’s recently announced initial access plan, including voluntary licensing agreements with seven generic manufacturers while Phase 3 trials are still underway and noted that “these are the initial plans. They’re not comprehensive. They’re not final. We’re still working, working in close collaboration with communities and global health stakeholders as our Phase 3 studies continue.”
How Do We Innovate on Delivery?
At AVAC’s satellite session, Shared Pipeline; Shared Goal: Innovations in Long-Acting Antiretrovirals for PrEP, PEP and Treatment, Executive Director Mitchell Warren reflected that “16 years since we first learned that PrEP was safe and effective as a daily oral tablet, we have successfully squandered our opportunities.” He urged panelists to focus on building not only the next generation of products, but also on the programs needed to deliver them with speed, scale and equity. The Gates Foundation’s Max Lataillade outlined an integrated vision for treatment, PrEP and PEP built around longer-acting options, emphasizing that “innovation without global access or implementation does not create the impact that we want,” and concluded that “science creates the possibility, collaboration creates the impact, but communities create the future.” Panelists repeatedly called for integrated, person-centered delivery systems. Ezintsha’s François Venter warned, “The delivery systems to get prevention to tens of millions of people are not there.” Root to Rise’s Adaobi Lisa Olisa emphasized engaging communities from the very beginning, while Stacey Hannah of AVAC closed by challenging the field to move “from the pipeline to access”—better, faster and more equitably.
The Future of the HIV Response Depends on Resilient Health Systems and Community Trust
As HIV programs transition to greater domestic ownership amid a shifting donor landscape, sustaining progress requires more than scientific advances. Sessions throughout the conference focused on protecting HIV prevention and treatment services through integrated health systems, sustainable financing, strong supply chains, and maintaining uninterrupted care. During the plenary, Rethink. Rebuild. Rise., Lloyd Mulenga of Zambia’s University Teaching Hospital, said, “Transition is not a choice—it is a mandate to countries.” He called out regional equity challenges, including the consistent exclusion of Latin American countries from voluntary licensing agreements, including conference host, Brazil, from the list of countries covered by the voluntary licenses announced in Merck’s access announcement for the investigational monthly oral pill, alimatravir.
Resilient health systems require innovations that are affordable and accessible at scale. In the session, Economics of impact: Costing studies across the cascade, Samuel Cross of Christchurch Hospital presented new modeling data which suggests that alimatravir could be mass produced for about $3 per person per year if manufactured at scale (though the scale needed to reach this price was not presented). “PrEP needs to be given to tens of millions of people to have a significant effect on the HIV epidemic.” He concluded, “alimatravir for $3 a year could be the cheapest HIV prevention drug the world has ever seen… But it needs to be $3 everywhere, not just some places. Merck needs to do the right thing and extend voluntary licensing access to include all middle-income countries, especially the countries where the EXPrESSIVE trials are taking place.”
Presenters consistently emphasized that resilient health systems represent just one aspect of a strong the HIV response. In a satellite session that shared learnings from LEN implementation in Kenya, Nigeria, Zambia, Mozambique, and Zimbabwe, ministry of health representatives highlighted country-specific experiences and common implementation challenges. Despite differences in context, speakers emphasized that successful rollout depends on more than product availability—it requires meaningful community engagement, trusted communications, informed choice, and demand generation strategies tailored to local communities. These lessons informed the development of the Demand Generation Playbook introduced by Elmari Briedenhann of Wits RHI. The playbook synthesizes experiences from early adopter countries and provides a shared framework to help others design community-centered approaches that translate scientific advances into meaningful impact.
Reinforcing the call for community partnership in shaping implementation, the satellite session hosted by Global Black Gay Men Connect (GBGMC), Choosing impact: Making long-acting HIV prevention a reality for key populations in sub-Saharan Africa, hosted a discussion around what it will take to make long-acting HIV prevention a reality for key populations across sub-Saharan Africa. Access Bridge Executive Director Wawira Nyagah grounded the discussion in a question: “if a young advocate named Amani walked into a clinic tomorrow seeking LEN, would he actually be able to get it?” Through Amani’s story, Nyagah illustrated how access is shaped: through scientific innovation, voluntary licensing, pricing, product allocation, national prioritization, stigma within health services, and the availability of generic products. As both Nyagah and Mitchell Warren emphasized in Rio, the future depends on building HIV programs alongside communities—not simply delivering them to communities.
What We’re Taking Forward
As we move to the final days of AIDS 2026, Access Bridge’s Nyagah summed up at GBGMC’s Real Access: KP Community Demands for the Next Wave of PrEP satellite, “Yes, we need to rethink, rebuild, and rise. But if we don’t do it with access and with equity, then scientific innovation is not going to make the difference in people’s lives. Communities must lead the conversation on what’s next.”
And as Josephine Aseme, the first person to receive lenacapavir for PrEP in Nigeria and AVAC Advocacy Fellow alumni said during in the same session, “PrEP is about choice and our different lifestyles,” underscoring that scientific innovation alone is not enough. Access, equity and community involvement are what transform progress into impact.