A new era in the fight against HIV

On 1 December, recognised globally as World AIDS Day, the World Health Organisation (WHO) called on governments and global partners to urgently expand access to new WHO-approved tools—most notably lenacapavir (LEN)—to drive down new infections and counter the severe disruption caused by recent foreign aid cuts.

Despite significant financial setbacks, the global HIV response in 2025 had shown remarkable momentum with the introduction and WHO approval of twice-yearly injectable lenacapavir for HIV prevention. LEN, a long-acting and highly effective alternative to daily oral PrEP, had been hailed as a transformative option for people facing stigma, structural barriers, or difficulties with adherence to regular medication. In July, WHO issued new guidelines recommending LEN as an additional PrEP choice, marking a major milestone in prevention efforts.

However, this progress unfolded against a challenging backdrop. Sharp, sudden reductions in international funding had disrupted HIV prevention, testing and treatment programmes worldwide. Community-led services—especially PrEP initiatives and harm reduction programmes for people who inject drugs—were scaled back or shut down entirely in several countries.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, warned that the global HIV response had reached a critical juncture. "We faced significant challenges with cuts to international funding and prevention stalling," he said. "At the same time, we had significant opportunities, with new tools capable of shifting the trajectory of the epidemic. Ensuring access to these tools must have been the top priority for all governments and partners."

Under the World AIDS Day theme "Overcoming disruption, transforming the AIDS response", WHO urged a dual-track approach: renewed solidarity and investment in innovations that protect and empower the communities most affected.

Data from 2024 illustrated the scale of the challenge. Global HIV prevention efforts had stagnated, with 1.3 million new infections, disproportionately affecting key and vulnerable populations. Almost half of all new infections (49%) occurred among sex workers, men who have sex with men, transgender women, people who inject drugs, and their sexual partners. Risk levels remained extremely high: sex workers and transgender women faced a 17-fold increased risk of acquiring HIV, men who have sex with men an 18-fold risk, and people who inject drugs a 34-fold risk. These disparities were fuelled by stigma, discrimination, and legal and social barriers that limited access to essential health care. Globally, 40.8 million people were living with HIV, and 630,000 people died from HIV-related causes.

The consequences of foreign aid cuts were already evident. The AIDS Vaccine Advocacy Coalition estimated that by October 2025, 2.5 million people who had used PrEP in 2024 had lost access in 2025 due solely to donor funding reductions—threatening hard-won progress toward ending AIDS by 2030.

Yet the year also signalled powerful momentum for innovation. WHO prequalified lenacapavir for prevention on 6 October 2025, leading to regulatory approvals in South Africa, Zimbabwe and Zambia shortly afterwards.

WHO stressed that ending the AIDS epidemic depended on fully integrated, rights-based and community-centred approaches within primary health care systems. Despite funding setbacks, the resilience and leadership of affected communities continued to offer a clear path forward. By strengthening health systems, increasing domestic investment and protecting human rights, countries could safeguard progress and ensure no one was left behind.

Source: World Health Organisation