The Independent Uganda: You get the Truth we Pay the Price
Innovation, inclusion, and urgency define Kigali HIV conference
ANALYSIS | RONALD MUSOKE | When the 13th International AIDS Society (IAS) Conference on HIV Science (IAS 2025) concluded in Kigali after five dynamic days (July 13–17), delegates left with a mix of hope and concern—buoyed by scientific breakthroughs but unsettled by a deepening funding crisis.
With more than 142 oral presentations and over 1,400 posters—600 of them presented in person—the conference drew more than 4,000 scientists, healthcare professionals, policymakers, activists, and community leaders. This year’s conference served as a vital platform for knowledge exchange and collaboration, reaffirming the role of science, solidarity, and shared responsibility in addressing global health challenges.
However, a key thread that ran throughout the conference was the urgent concern over shrinking financial support, particularly in light of the abrupt cuts of U.S. funding for the HIV prevention programme, earlier this year.
The delegates heard that the impact has already been felt across regions. The antiretroviral therapy (ART) initiations have,for instance, dropped by 25% in a single month in Mozambique, while in Johannesburg, South Africa, testing and treatment uptake have declined by 30% over the past year. Across Latin America and the Caribbean, 87% of 40 organizations surveyed reported suspended funding.
However, during the conference, news trickled in from the U.S noting that there were efforts by the Senate to protect PEPFAR (the President’s Emergency Plan for AIDS Relief), a cornerstone of the global HIV response, from the proposed US$400 million in cuts. However, both the Senate and the House (of Representatives) must still vote on the final rescission package, and further changes could be reintroduced before the statutory deadline for action.
For many HIV/AIDS advocates, the ongoing uncertainty underscores the vulnerability of HIV programmes that remain heavily dependent on external donors. “We must stay vigilant,” said Dr. Beatriz Grinsztejn, the IAS President. “PEPFAR has been one of the greatest success stories in global health. The world cannot afford to let funding instability reverse the immense progress we’ve made.”
The IAS President-elect Kenneth Ngure echoed the need for African countries to lead. “PEPFAR is a lifeline for Africa,” he said. “Restoring this funding would mean hope for people living with and affected by HIV. But African leadership must remain at the centre of shaping our response, and we need to keep advancing conversations about sustainable financing – including stronger domestic investments and strategies to reduce dependence on global donors,” he said.
Africa’s central role
The good news is that this year’s conference highlighted African leadership, both in science and in practice. For instance, the conference introduced the Africa Cure Consortium and showcased African-led research, including breakthroughs in vaccine development and successful responses to viral outbreaks like Rwanda’s rapid containment of Marburg virus.
Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, delivered an inspiring message, noting that Rwanda had met the UNAIDS 95-95-95 targets ahead of schedule.
“Rwanda’s experience in the HIV response over the past few decades – alongside our recent pandemic response – demonstrates what is possible when countries prioritize people-centred approaches and invest in strategic partnerships,” she said. “Together, we met the UNAIDS 95-95-95 targets ahead of schedule and continue to harness cutting-edge science – including long-acting medications – to deliver more targeted, integrated interventions,” he said.
Lenacapavir revolution
Perhaps no topic dominated the halls of the IAS 2025 conference more than lenacapavir, a groundbreaking long-acting injectable PrEP (pre-exposure prophylaxis) drug. Approved by the US Food and Drug Administration (FDA) earlier this year and now recommended by the World Health Organization (WHO), lenacapavir—administered just twice yearly—has demonstrated near 100% effectiveness in preventing HIV acquisition.
And although there have been concerns about equitable access, Gilead Sciences, the drug’s manufacturer, and the Global Fund, announced a no-profit supply agreement to provide doses for up to two million people over the next three years. WHO’s new guidelines further validated lenacapavir’s potential as a powerful prevention tool.
Data from the Phase-3 PURPOSE-1 and PURPOSE-2 trials supported its safety and efficacy across diverse populations, including pregnant and lactating women, adolescents, and individuals on TB treatment. According to the study, three-quarters of participants in PURPOSE 2 preferred the biannual injection to daily oral PrEP—a finding that could significantly reshape prevention strategies.
“While an HIV vaccine remains elusive, lenacapavir is the next best thing,” said Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General, in a statement. “The launch of WHO’s new guidelines, alongside the FDA’s recent approval, marks a critical step forward in expanding access to this powerful tool. WHO is committed to working with countries and partners to ensure this innovation reaches communities as quickly and safely as possible.”
An expanding arsenal of long-acting solutions
Beyond lenacapavir, the IAS 2025 conference showcased an expanding toolbox of long-acting HIV prevention and treatment innovations. For instance, on show was the MK-8527, a once-monthly oral PrEP pill from Merck that is now advancing to Phase 3 trials in Africa. On the other hand, the injectable cabotegravir (CAB-LA) has shown high adherence in real-world trials among adolescent girls and young women in Zambia.
It is on this basis that a new licensing agreement between the Medicines Patent Pool and ViiV Healthcare has paved the way for affordable, generic production of CAB-LA in 133 countries.
“Expanding our licence with ViiV Healthcare to include long-acting cabotegravir for HIV treatment marks a significant step forward for equitable access,” said Esteban Burrone, the Director of Strategy, Policy and Market Access at the Medicines Patent Pool.
“As the first full long-acting HIV treatment regimen, now recommended by WHO, it answers a long-standing call from communities for an option that would maintain viral suppression without the need for daily medication.”
“This expansion shows that innovation and access not only should – but also can – go hand in hand. We now look forward to working closely with our generic licensees to accelerate the development of an affordable, quality-assured version that will serve as an important tool in the HIV treatment toolbox,” he said.
Strides in paediatric and adolescent care
There were also presentations on HIV/AIDS research focusing on children and adolescents. For example, the ODYSSEY trial offered insights into predictors of treatment failure in children starting antiretroviral therapy (ART), supporting more targeted approaches.
One promising strategy involves administering broadly neutralizing antibodies (bNAbs) early in life to prevent vertical transmission. According to researchers, pairing long-acting bNAbs with immune modulators like N-803 can alter viral rebound dynamics, opening new avenues for viral control. The approach has proved safe in infants and is expected to undergo further investigation.
Meanwhile, an intervention in Zimbabwe using digital adherence tools improved viral suppression in at-risk youth, pointing to the value of technology in mental health and adherence support. Yet, challenges remain. A study in Zambia found that one-third of adolescents living with HIV exhibited suicidal behaviour, largely due to stigma, anxiety, and depression.
Tech-driven health innovation
This year’s conference also spotlighted how digital innovation is reshaping HIV service delivery. In Nigeria, AI-powered mobile X-ray vans have been expediting TB diagnosis and integrating services at the primary healthcare level. In South Africa, clinicians are using an AI-driven toolkit to better serve adolescent girls and young women.
Across Kenya, Malawi, and Ghana, blockchain is improving adherence and securing pharmaceutical supply chains. Canada’s MARVIN chatbot is supporting self-management and adherence for people living with HIV. These tech-enabled tools are creating more efficient, person-centred care, especially in underserved areas.
Community voices and call to action
Advocates across the globe echoed a unified demand: equitable access to innovations. Yvette Raphael, the Executive Director of Advocates for the Prevention of HIV and AIDS, issued a compelling reminder that “long-acting drugs can only transform lives if people can actually get them.” “We must not repeat the mistakes of the past—new medicines must not be a privilege for the few,” she said.
Delegates reiterated that innovation must be accompanied by clear national plans, community trust building, and adequate financing. Without these, even the most promising tools will fall short of their potential.
A shared responsibility for the road ahead
The UNAIDS Executive Director, Winnie Byanyima, said: “We are seeing a massive interruption in international financing that is creating systemic shocks. “However, our AIDS response was created in crisis–it is in our DNA to face crisis and to fight our way out of crisis. Countries are resilient, we do not give up and we continue to stand with governments and communities as they commit to finish the fight to end AIDS.”
She added, “We must protect what we’ve achieved, and continue fighting to end AIDS—through resilience, partnerships, and a commitment to equity.” The Kigali conference also served not just as a moment of reflection, but of recommitment. The launch of the WHO guidelines, historic licensing agreements, and the collective call for action proved that even amid uncertainty, momentum is building.
Looking ahead
As the curtains closed on IAS 2025, a sense of urgency remained—but so did hope. From long-acting injectables to artificial intelligence, from community activism to adolescent-focused care, the path forward appears clearer than ever. Going forward, onto next year’s IAS conference in Rio de Janeiro, the talk there will no doubt be shaped by the conversations, discoveries, and bold commitments made in Kigali.
