Sustaining HIV Gains: IAS 2025 Calls for Urgent Domestic Investment Amid Aid Cuts

Health experts and global leaders are calling on governments and civil society organizations to ramp up domestic funding for HIV/AIDS programs, warning that declining international support is threatening hard-won progress in prevention, treatment, and care.

The appeal was made on July 14, 2025, during the opening session of the 13th International AIDS Society Conference on HIV Science (IAS 2025), taking place in Kigali from July 13–17. As the world’s premier platform for sharing the latest in HIV research and innovation, this year’s conference has taken on renewed urgency in the face of widespread funding cuts.

Speaking at the conference, Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, outlined how Rwanda has been adapting to significant financial shortfalls, particularly those impacting the 10,000 Rwandans currently on PrEP (pre-exposure prophylaxis). He explained that Rwanda had to urgently reassess its health priorities to protect the most essential services.

“We categorized programs as most urgent, important, nice-to-have, and those that could be delayed. Essential services such as treatment, diagnostics, and personnel were maintained, while other activities were postponed,” Dr. Nsanzimana said. “We also leaned on technology—using remote training and mentoring—to cut costs and sustain quality care.”

To cushion the blow of lost external aid, Rwanda has increasingly turned to domestic sources, synchronizing funding with the new fiscal year. Dr. Nsanzimana emphasized that strategic integration of HIV programs within Rwanda’s broader health system over the past decade—such as the 2012 merger that created the Rwanda Biomedical Centre (RBC)—has saved money and built resilience.

“We haven’t changed our goals or targets. Our systems are stronger because we prepared years in advance,” he added, noting that Rwanda met the UNAIDS 95-95-95 targets ahead of schedule and continues to adopt cutting-edge solutions, including long-acting HIV medications.

The urgency of domestic investment was echoed by World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus. Addressing the conference virtually, he warned that sudden aid reductions were already disrupting HIV care for millions.

“These investments have led to advances in treatment, prevention, and care,” said Dr. Tedros. “Governments and donors must protect that progress by increasing domestic commitment and ensuring innovations reach the communities that need them.”

One such innovation highlighted at IAS 2025 is lenacapavir, a long-acting injectable antiretroviral shown to prevent nearly all HIV infections among high-risk populations. The WHO unveiled new guidelines recommending lenacapavir for HIV prevention, following recent FDA approval and pending WHO prequalification.

“While an HIV vaccine remains elusive, lenacapavir is the next best thing,” said Dr. Tedros. “We must ensure this breakthrough reaches communities quickly and equitably.”

Dr. Beatriz Grinsztejn, President of the IAS, described this as a breakthrough moment.

“This is what’s possible when science, industry, and communities align. Now, we need bold commitments to fund and scale these tools equitably,” she said.

Dr. Meg Doherty, WHO’s incoming Director of Science, underscored the importance of building readiness in early-adopter countries for the rollout of Lenacapavir, expected to begin in 2026, with wider generic availability anticipated by 2027.

“The challenge now is ensuring the infrastructure is in place—from supply chains to healthcare worker training—especially in clinics already strained by funding cuts,” Dr. Doherty said.

Civil society leaders added their voices to the call for action. Yvette Raphael, Executive Director of Advocates for the Prevention of HIV and AIDS, urged that lessons from past inequalities be heeded.

“It’s not enough to have these medicines available. They must be accessible. Real funding, clear plans, and trust-building in communities are essential,” she said.

Despite global progress—such as 73% of people living with HIV achieving viral suppression by the end of 2024—new data from UNAIDS shows worrying disparities. Mary Mahy, UNAIDS Director for Data Impact, warned that the funding crisis is threatening to roll back gains, especially for key populations still lacking adequate access.

IAS 2025 is not only a platform for sharing scientific breakthroughs but also a stark reminder that without sustainable domestic investment, the world risks reversing decades of progress in the fight against HIV/AIDS.

“Science has delivered the tools,” said Mahy. “Now it’s up to us—governments, donors, and communities—to ensure they reach the people who need them most.”