The withdrawal of US funding for global HIV programmes was a defining theme at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver in February. Researchers and advocates grappled with both the immediate damage and the longer-term outlook. Here are five key stories from the conference.
Veteran activist Peter Staley delivered a sombre account of 2025 as an ‘annus horribilis’ for HIV science – and issued a call to arms. He described the dismantling of USAID, the freeze on PEPFAR funding, the cancellation of hundreds of research grants, and the appointment of an AIDS denialist as Secretary of Health as a co-ordinated assault on decades of progress. Staley was critical of scientists who had scrubbed words like ‘equity’ from their grant applications to avoid cancellation –”it looked like acquiescence” – but pointed to genuine resistance from US scientists and activists. Drawing a parallel with the bleakest period of the epidemic in the early 1990s, he argued that the pendulum would eventually swing back – but only if people fought for it.
The scale and nature of disruption to HIV services following the withdrawal of US funding is becoming clearer, even as the data systems that would normally capture it have themselves been dismantled. A rapid survey of clinics and programmes across 32 countries found widespread disruption, especially in laboratory services, adherence support, patient tracing, record management staffing and other operational requirements. These ‘silent’ functions ultimately impact clinical care even when medications remain available.
Even before US funding cuts, PrEP coverage was far too low in most countries to make a meaningful dent in HIV incidence – and the cuts have made things much worse. Around 42 people need to be on PrEP to prevent one HIV infection per year – a benchmark that only Australia, Denmark, Norway and the UK were close to achieving by the end of 2024. Even countries with large numbers of PrEP users were far off the target – the US had 15 PrEP users for every one new infection and South Africa had five people on PrEP for every new infection. In Africa, the PEPFAR cuts have since reduced PrEP numbers drastically – by 28% in South Africa, by 58% in Zambia and 98% in Nigeria.Â
HIV incidence among transgender women in the US remains high, with stark disparities by race and ethnicity and strong links to poverty, homelessness and lack of health insurance. The findings from a longitudinal cohort, which followed over 2500 trans women across the US for two years, underline the need for tailored, gender-affirming prevention – including wider access to long-acting injectable PrEP, used by only 4% of PrEP users in the study.Â
A community-based intervention combining quarterly home visits, home-based HIV testing and a range of prevention options cut HIV incidence by 70% over two years in rural Kenya and Uganda. Participants could choose between oral PrEP, the dapivirine vaginal ring and PEP supplied in case of future need, and switch between options as their needs changed. The incidence reduction was driven primarily by a fourfold increase in prevention uptake, rather than improvements in treatment coverage, which was already high among the 84,000 participants. In the current climate, successful prevention programmes like these are under threat.