The second Trump administration commenced in 2025 with a sweep of funding cuts that took both the nation and the globe by storm, including a 90-day freeze on USAID, which paused operations surrounding the United States President’s Emergency Plan for AIDS Relief (PEPFAR). A year later, two new studies released by the International AIDS Society (IAS) found that the freeze later left a devastating impact on the program.
IAS members and researchers presented information from both studies, which explore the rollback’s impacts and developments made in HIV prevention and treatment initiatives, on July 21, in preparation for AIDS 2026, the 26th International AIDS Conference (July 26-July 31) in Rio de Janeiro, where they will further dissect the reports’ findings.
“Our key finding is that implementing partners and their programs were hit from two directions,” said amFAR policy associate Elise Lankiewicz. “Some awards were terminated, while others were allowed to continue, but still required to alter programming to align with priorities of this U.S. administration.”
PEPFAR, considered the largest vow by a nation to combat a disease, has certainly felt the impact.
Launched in 2003 to champion global prevention, care and treatment efforts HIV — which, at the end of 2024, affected approximately 40.8 million people worldwide — PEPFAR works with more than 50 partner countries and has helped advance access to care to tens of millions of people.
After the Trump administration’s initial USAID freeze, only half of PEPFAR’s programs were estimated to resume in February 2025. According to the research presented by IAS members, which surveyed 166 partners across 46 countries who deliver PEPFAR programs, 52% lost at least one financial award. As a result of these reductions, more than 1,700 clinics, drop-in centers and other service delivery sites closed.
Of those who participated in the survey, 77% reported that to continue receiving funding, they were required to act in accordance with the new U.S. policy and restrictions. Organizations described similar conditions across the board: programming limited to designated life-saving activities; restrictions surrounding diversity, equity and inclusion (DEI) and gender; and requirements to end or cut down on services for populations most vulnerable to HIV.
Additionally, services that work to help advance prevention in vulnerable communities were heavily hit. Forty-three percent of respondents offering prevention services permanently cut at least one component of their programming or activities, with condom and pre-exposure prophylaxis (PrEP) resources being the most affected.
“Within PEPFAR, treatment was largely protected, while prevention and the services that reach people at highest risk were cut most deeply,” Lankiewicz said. “So the PEPFAR that survived is not necessarily the PEPFAR that existed before.”
Innovation Trumps Tribulation
Committed to turning information and science into action, scientists have not surrendered to the tribulations caused by the limitations placed on PEPFAR, and persist in driving innovation to hinder the global impact of HIV and AIDS.
“Progress against the HIV epidemic requires both scientific innovation and enduring partnerships around the world,” said Jared Baeten, senior vice president of clinical development and virology therapeutic area head at Gilead Sciences. “The data Gilead is presenting at AIDS 2026 reflect our ongoing commitment to advancing HIV prevention, treatment and cure research, with the goal of expanding meaningful choices that can help support the diverse needs, preferences and experiences of people and communities affected by HIV.”
Gilead is a biopharmaceutical company that leads research and development of antiviral drugs for HIV, AIDS, hepatitis B and C, influenza and COVID-19. At AIDS 2026, they will share the results of the 52-week open-label extension of the Phase 3 PURPOSE 1 and PURPOSE 2 trials, which evaluated the antiretroviral drug lenacapavir as an HIV prophylactic measure across geographically diverse populations through randomized blinded phases. This injection has the potential to reshape what HIV prevention looks like, as it is only taken biannually, as opposed to the oral once-daily PrEP.
PURPOSE 1 examined cisgender women in South Africa and Uganda, and PURPOSE 2 enrolled cisgender men and gender-diverse individuals in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the U.S.
“We found no new infections for the first 52 weeks of the open-label extension, both in those who continued with the lenacapavir and those who switched from oral PrEP,” said Noah Kiwanura of the Makerere University School of Public Health in Uganda, who worked on PURPOSE 1. “We also found that the drug is safe and tolerated.”
A win for Gilead and the scientists conducting testing, lenacapavir proved highly effective in PURPOSE 1, with more than 95% of eligible participants reporting they were pleased with the injection and continued their HIV prevention plans.
In PURPOSE 2, the trial previously showed lenacapavir’s high efficacy in preventing new infections. Similar to its partner trial, results from PURPOSE 2 showed that 92% of participants adhered to lenacapavir injections, opting to continue with it through 52 weeks. Although infection prevention was mostly effective in this trial, one new case was reported on open-label lenacapvir.
Makerere shared that rollout of lenacapvir in sub-Saharan Africa is ongoing, but challenges in funding and identifying who needs it still exist. Other challenges that may arise include keeping up with patients who are taking the injection and ensuring they remember when to come in for new shots. He believes community engagement is key, but U.S. administration cuts make the process of implementing this drug more difficult.
“The current funding cuts will certainly affect these implementation outcomes and phases,” Makerere said. “Unfortunately, it is too early for us to make conclusions about it, and it will… be important to actually study and find out its effect on access [and] availability, and continue the ideas to learn.”
