When I recently travelled to Rio de Janeiro for the 26th International AIDS Conference (AIDS 2026), I expected to learn about scientific breakthroughs. What I witnessed was something bigger: a growing shift in power, responsibility and innovation towards the countries carrying the greatest burden of HIV.
Approximately 7,500 delegates gathered in Rio under the theme “Rethink. Rebuild. Rise.” Across six days, more than 150 sessions, 2,400 posters and over 220 Global Village activities explored the future of the global HIV response.
Brazil’s Minister of Health, Alexandre Padilha, captured the mood of the conference when he stated: “Innovation without access is injustice.” That message echoed through nearly every major discussion at the conference.
For much of the last four decades, HIV was viewed as a dread disease. Today, the reality is very different. In Africa, approximately 82% of people living with HIV are now receiving treatment, compared with around 45% a decade ago.¹ New infections have fallen dramatically, and people who start and remain on treatment can expect a near-normal life expectancy while preventing onward transmission.²
PEOPLE-CENTRED HIV CARE
The science presented in Rio reinforced this transformation. Researchers showcased promising innovations, including once-weekly oral treatment regimens, long-acting injectable therapies administered every eight weeks, and next-generation prevention options, including twice-yearly injectable pre-exposure prophylaxis (PrEP) and monthly oral prevention medicines currently in advanced clinical trials.
Weekly. Monthly. Six-monthly. These are not the rhythms of emergency medicine. They are the rhythms of chronic disease management.
Innovations such as long-acting prevention options have the potential to further de-medicalise HIV prevention by reducing the need for frequent clinic visits and giving people greater control over their health.
The conference also highlighted an important reality: there is no single HIV patient profile. Young women continue to shoulder a disproportionate burden of new infections across Africa,³ while men remain less likely to test, enter care later and experience poorer health outcomes.⁴
This is why long-acting prevention and treatment options matter so much. Convenience is not simply a product feature. In many African contexts, it is an access strategy.
AFRICA FOR AFRICA – THE IMPORTANCE OF LOCAL MANUFACTURING
Another major theme was the growing urgency around healthcare sustainability.
Data presented at the conference painted a sobering picture. The PEPFAR Pulse study reported that more than 1,700 service delivery sites had closed following funding disruptions, primarily in Eastern and Southern Africa.⁵ PrEP initiations declined by between 31% and 64% in several regions, while condom distribution dropped by more than 50%.⁶
Against this backdrop, UNAIDS Executive Director Winnie Byanyima delivered one of the conference’s most quoted statements: “The era of relying on international aid is over.” Her message was not one of despair but of responsibility. Countries must increasingly build resilient, self-sustaining health systems.
Encouragingly, evidence presented in Rio showed that 11 African governments have increased domestic HIV budgets and 22 countries are developing long-term sustainability plans beyond 2030.⁷
The future also depends on local manufacturing. Days before the conference, Merck announced voluntary licensing agreements for its investigational monthly HIV prevention pill, alimatravir, covering 129 low- and middle-income countries. Cipla is among the companies selected to help expand future access, subject to successful clinical outcomes and regulatory approvals.
For Africa, this represents more than a licensing agreement. It signals a shift from being recipients of innovation to being partners in delivering it.
What gave me the greatest optimism in Rio was not a single clinical trial or product announcement. It was the growing confidence across governments, healthcare leaders, researchers and manufacturers that Africa can help shape the future of HIV prevention and treatment.
Much like affordable antiretrovirals fundamentally changed HIV in the early 2000s, the next chapter of HIV care will not be determined solely by scientific discovery. It will be determined by whether innovation reaches people affordably, equitably and sustainably.
Africa already holds much of the experience, evidence and urgency required to lead that journey. Increasingly, it is building the capability as well.
The science is advancing rapidly. The opportunity now is to ensure access advances just as quickly.
References
- UNAIDS. Global AIDS Update 2025. Geneva: Joint United Nations Programme on HIV/AIDS, 2025.
- UNAIDS. Global AIDS Update 2025. Geneva: Joint United Nations Programme on HIV/AIDS, 2025.
- UNAIDS. Global AIDS Update 2025. Geneva: Joint United Nations Programme on HIV/AIDS, 2025.
- World Health Organization. Addressing Gender Disparities in HIV Services. Geneva: World Health Organization, 2024.
- PEPFAR. PEPFAR Pulse Study Findings on HIV Service Disruptions. Washington, DC: President’s Emergency Plan for AIDS Relief (PEPFAR), 2026.
- PEPFAR. PEPFAR Pulse Study Findings on HIV Service Disruptions. Washington, DC: President’s Emergency Plan for AIDS Relief (PEPFAR), 2026.
- UNAIDS. HIV Sustainability and Domestic Financing Briefing. Geneva: UNAIDS, 2026.
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