During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF is launching Rio Briefs — a series of stories from Rio on how HIV prevention is changing today and what these changes mean for people in Eastern Europe and Central Asia.
The series will look not only at new medicines, research and global strategies, but also at the real lives of people facing stigma, migration, instability, language barriers, complex health systems and unequal access to services.
The first Rio Brief focuses on the pre-conference “Advancing HIV prevention science and access”. Its central message is simple and sharp: innovation in HIV prevention changes nothing if it does not reach people.
The pre-conference “Advancing HIV prevention science and access” set the tone for the conversation from the start. The future of prevention no longer looks abstract. It has very concrete forms: long-acting medicines for PrEP, injectable options, the prospect of monthly oral prevention, new approaches to PEP, multipurpose technologies for HIV prevention and reproductive health, service delivery models outside clinics, community engagement and community-led monitoring.
But the main conclusion from the first day was not that there are more innovations.
The main conclusion was that innovation alone protects no one.
A medicine works only when a person can actually use it. When they know this option exists. When they are not afraid to seek a service. When the service is nearby. When the price does not turn prevention into a privilege. When a health worker does not stigmatize them. When the system does not push them out because of documents, migration status, language, poverty, fear or experiences of discrimination.
This is where the most important conversation about HIV prevention in 2026 begins: not only what we can offer, but who will actually be able to use it.
The world cannot afford to stand still
One of the strongest messages of the first day was that the global HIV response has effectively stalled. In the opening session, a representative of the Gates Foundation noted that for several years the world has remained at around 1.3 million new HIV acquisitions each year, alongside hundreds of thousands of AIDS-related deaths. Against the background of cuts in international assistance, the situation may get worse before it starts to improve.
This means we are not simply “a little behind”. We risk losing time that has already been paid for with people’s lives, health and trust.
When global conferences speak about long-acting prevention tools, it often sounds like a story about the future: new medicines, new dosing schedules, new possibilities. But for people who today cannot receive even basic counselling, testing or prevention without fear and judgment, that future may still remain behind closed doors.
Access is therefore not a technical detail.
Access is the central question of prevention.
Choice is not a slogan. It is a condition for effectiveness
One of the key threads of the pre-conference was that HIV prevention is entering an era of choice.
Daily oral PrEP is no longer the only scenario. Increasing attention is being paid to long-acting formats: injections every few months, the prospect of yearly prevention, a monthly tablet, new approaches to PEP and multipurpose technologies that could address both HIV prevention and reproductive health needs.
This could truly change the rules of the game.
But only if choice exists beyond paper.
Choice is not a list of products in a presentation. It is the ability of a specific person to choose what fits their life. Not an ideal model of behaviour. Not the expectations of a system. Not a clinic timetable. Real life — with work, children, migration, unstable housing, violence, stigma, lack of money, dependence on a partner, the risk of status disclosure, lack of transport or the inability to attend a health facility.
For some people, a daily pill is a convenient option. For others, it is impossible because it may be seen at home. For some, an injection every few months means freedom. For others, it is a barrier because it requires regular clinic visits. For some, a monthly tablet may be a simpler and less visible solution. For others, the most important thing is anonymity, speed, a mobile service or support from someone from their community.
Prevention does not work when the system considers a product convenient.
Prevention works when a person can fit it into their life.
Long-acting medicines do not mean automatic access
Long-acting prevention tools bring a great deal of hope — and that hope should not be dismissed. They can reduce the daily burden, support people who find it difficult to take pills every day, lower the risk of interrupting prevention and open new possibilities for countries where health infrastructure is overstretched.
But it is important not to fall into the trap of technological optimism.
Long-acting does not mean automatically accessible.
If a new medicine exists but is too expensive, that is not yet access. If it is included in guidelines but health workers are not trained to offer it, that is not access. If it is available in the capital but does not reach regions, that is not access. If it is available to “convenient” groups but not to sex workers, people who use drugs, trans people, men who have sex with men, migrants, adolescents, or people without stable documents or insurance, that is not access.
If a person does not know that they have a right to prevention, that is also not access.
That is why conversations about generic medicines, affordability, registration, procurement, training, guidelines, supply and community-based service delivery are not a “second stage” after science. They are part of the same response, if we are truly talking about impact.
Because a medicine that does not reach people does not change the epidemic.
A monthly tablet: a new opportunity, but not a magic solution
The pre-conference paid particular attention to the prospect of monthly oral PrEP. Rebecca Plank from MSD presented data on a medicine being studied as a potential monthly tablet for HIV prevention. Her presentation highlighted an important point: the very idea of “long-acting oral prevention” seemed unfamiliar only a few years ago, but it may now become a distinct direction in prevention.
Why does this matter?
Because taking a tablet once a month may be easier for some people than taking one every day. It may be less visible. It may be easier to deliver through different channels, not only through clinics. It may better suit people who do not want, or are unable, to regularly engage with the health system.
But here too, the central question remains the same: how quickly, fairly and without stigma will this prevention reach the people who need it?
The MSD presentation also referred to initial access plans, including voluntary licensing agreements with generic manufacturers for low- and middle-income countries. This is an important step. But initial plans do not yet guarantee that a person in a specific country, city or community will be able to receive the medicine on time, safely and without humiliation.
PEP: a tool that remains underused
PEP is often overshadowed by PrEP, but for many people it can be critically important. PEP works after a potential exposure to HIV, and time is decisive. It is prevention that is literally racing against the clock.
Andrew Mudragira from the Infectious Diseases Institute in Uganda emphasized the complexity of research in this area: people need to be reached very quickly after a potential exposure, and adherence to a full course of PEP remains a challenge. The presentation also noted that updated guidance supports task sharing and community delivery.
This is extremely important.
PEP cannot be a service that people discover by accident. It cannot be accessible only to those who know the right door, the right words and have enough strength to explain their situation to an unfamiliar doctor.
It must be fast, understandable, stigma-free and truly accessible: through health facilities, pharmacies, crisis services, sexual and reproductive health programmes, services for people who have experienced violence and organizations that people already trust.
If a person spends precious time after a risk exposure looking for information, dealing with shame, fear, travel or explanations, it may not be the medicine that fails them.
It may be the system.
Multipurpose technologies: prevention must see a person’s whole life
A separate part of the pre-conference focused on technologies that can address several needs at once — for example, HIV prevention and prevention of unintended pregnancy.
This is an important direction because people do not live with only “one medical need”. A woman does not enter a system only as an “HIV risk”. She has a sexual life, reproductive plans, relationships, experiences of violence or control, and a need for autonomy, privacy and safety.
That is why multipurpose technologies may matter not only from a medical point of view. They may better reflect people’s realities, especially those of women and girls, for whom HIV prevention, reproductive health, safety and control over their own bodies are often inseparable.
But this again brings us back to choice.
Any new technology must be not only effective in a study. It must be acceptable, accessible, understandable and controlled by the person themselves. This is especially important when it comes to women, who too often face medical decisions made without them.
Key populations cannot be “added later”
Another important emphasis of the day was that the need for PrEP among key populations remains very high. If countries want to have a real impact on HIV acquisition, they cannot plan prevention as if key populations are a footnote at the end of a strategy.
Sex workers, people who use drugs, trans people, men who have sex with men, people in prisons and other closed settings, migrants, and people without stable access to the health system are not “hard-to-reach groups”.
Often, they are groups that systems have simply not learned to reach without control, stigma or punishment.
This needs to be said honestly.
If new prevention tools are introduced through the same narrow doors that already do not work for many people, we will get new technologies with old inequalities. More modern medicines, but the same exclusions. More choice for those already closer to the system, and less for those who need it most.
That is why long-acting PrEP for key populations is not only a procurement issue. It is a question of rights, trust, decriminalization, community-led services and meaningful community involvement in planning and monitoring.
Prevention cannot be effective if the people it is designed for do not have influence over how it is implemented.
A medicine on a shelf prevents nothing
One of the strongest ideas of the day came during the discussion on the role of communities: a product that simply sits on a clinic shelf prevents nothing.
This sentence should be repeated whenever we talk about new medicines, new research, new strategies and new financing models.
Because there is always a path between a product and a person. That path can be short, clear and safe. Or it can be so complicated that the person simply never gets there.
Community-led demand generation is not a “communications add-on” to a medical programme. It is what creates trust, explains meaning, reduces fear, translates scientific language into human language, answers real questions and helps people make choices without pressure.
It is peer counsellors. It is people from communities. It is activists who know which questions people are ashamed to ask a doctor. It is organizations people come to not because there is a “service”, but because they are not humiliated there.
In this sense, communities are not a delivery channel.
Communities are part of the prevention infrastructure itself.
For Eastern Europe and Central Asia, this discussion is especially urgent.
In our region, HIV prevention has long existed in far from ideal conditions. It exists in the reality of stigma, criminalization, unequal access, political pressure, unstable funding and donor fatigue. For Ukraine and Ukrainians forced to move because of the war, this is compounded by migration, disruptions in care pathways, new health systems, language barriers, documents, and fear of losing treatment or support.
In this reality, prevention is not only a question of whether PrEP exists.
It is a question of whether a person knows where to get it. Whether they can seek it without fear. Whether the service will be friendly. Whether someone nearby can explain the pathway. Whether the programme will disappear because of funding cuts. Whether prevention will become the first casualty of political economy.
That is why, for Eastern Europe and Central Asia, the conversation about innovation must be a conversation about access.
We cannot simply wait for new global products to change the region on their own. They will change nothing unless they are embedded in real systems of support, navigation, trust and rights protection led by communities.
The first day in Rio left a very clear feeling: the world is on the brink of a major technological shift in HIV prevention. At the same time, it is facing an old, painful and deeply political question: who will get access first, who will get it last, and who will once again be left outside?
This is where it will be decided whether new tools become a real breakthrough.
Because the prevention of the future is not only molecules, dosing schedules and research programmes.
It is also price. Procurement. Generic medicines. Training. Guidelines. Trust. Language. Decriminalization. Community-led monitoring. Rights protection. Services that do not punish people for their lives. Communication that does not shame. Systems that do not wait for a person to become “convenient” before they receive help.
It starts where a person first hears: you have a choice. You have the right to protection. And you do not have to walk this path alone.
