AIDS 2026 in Rio de Janeiro is over. The sessions have ended, the banners have come down, and the global HIV community is already moving towards its next meeting point — Geneva, where the 14th IAS Conference on HIV Science will take place in 2027.
But the questions raised in Rio did not stay in Rio. They return with us to our regions, organizations, clinics, community centres, mobile teams, peer counselling networks and advocacy spaces. To people who still do not have access to pre-exposure prophylaxis. To people who do not know where to ask for post-exposure prophylaxis. To people living with HIV who still face stigma. To people pushed away from services by criminalization. To people on the move, crossing borders faster than health systems can follow.
During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF followed the conversations shaping the future of HIV prevention: oral pre-exposure prophylaxis, long-acting injectable cabotegravir, twice-yearly injectable lenacapavir, post-exposure prophylaxis, U=U, community-led services, migration, funding, rights and access.
After Rio, one conclusion became impossible to ignore: HIV prevention is not only about what science can make possible. It is about whether people can actually use it.
Science is moving fast. The systems meant to deliver it to people are not.
The UNAIDS Special Report for the 26th International AIDS Conference warns that the world is not moving fast enough to end AIDS as a public health threat by 2030. In 2025, there were 1.2 million new HIV acquisitions and 570,000 AIDS-related deaths globally. In low- and middle-income countries, resources for the HIV response totalled US$17.6 billion — US$4.3 billion less than the amount UNAIDS estimates will be needed annually by 2030.
The same report shows why prevention is now at the centre of the crisis: in 2024, prevention accounted for only 11% of all HIV funding in low- and middle-income countries, while 66% of that prevention funding came from external sources. UNAIDS also notes that between 2010 and 2025, new HIV acquisitions increased in Eastern Europe and Central Asia, Latin America, and the Middle East and North Africa.
For Eastern Europe and Central Asia, these are not background data. This is the reality in which prevention must be rebuilt.
Our region already lives with war, displacement, criminalization, shrinking civic space, stigma, unstable funding and fragmented health systems. If new prevention tools arrive without funding, community leadership, clear information and rights protection, they will not close the gap. They will only make it more visible.
As AIDS 2026 President Beatriz Grinsztejn said at the closing of the conference: “The era of HIV priorities defined by donors is over. Not only because donors are stepping back, but because countries and communities know best what they need.”
This was not a ceremonial line. It was a political challenge. If the era of donor-defined priorities is ending, the next era cannot be built as if communities should receive less money, less protection and more responsibility.
Innovation is necessary. Access is the test
AIDS 2026 showed that HIV prevention is entering a new scientific phase. It is no longer limited to one daily pill or one model of service delivery. Oral pre-exposure prophylaxis, long-acting injectable cabotegravir, the dapivirine vaginal ring and twice-yearly injectable lenacapavir are expanding the very meaning of prevention choice.
In 2022, WHO recommended long-acting injectable cabotegravir as an additional HIV prevention option for people with a substantial likelihood of acquiring HIV.
In 2025, WHO recommended long-acting injectable lenacapavir as an additional HIV prevention choice within combination prevention approaches. WHO also emphasized that additional pre-exposure prophylaxis options can increase uptake because people can choose the method that suits them.
But for Eastern Europe and Central Asia, scientific breakthrough does not automatically mean access. Real access is shaped by small markets, slow registration, patent barriers, limited procurement capacity and shrinking international funding.
A medicine may be approved. A product may exist. A global target may be adopted. But none of this answers the question: will a sex worker in a smaller city, a trans person avoiding humiliation in a clinic, a person who uses drugs and faces police pressure, a migrant without clear documents, or a young person afraid to ask questions actually receive prevention?
Denys Hodlevskyi, Regional Director of ITPCru for Eastern Europe, said during a regional discussion at AIDS 2026: “If training is removed from programmes, we can talk about lenacapavir as much as we want. People will not know why it is needed, how it works or what to do with it. Without this, innovation loses its meaning.”
The same applies to every pre-exposure prophylaxis option. Oral prevention, long-acting injectable cabotegravir or lenacapavir will work as public health tools only when people know they exist, understand how they work, can access them without judgement and can continue using them safely.
Medicines do not explain themselves. Medicines do not fight stigma. Medicines do not call a person who has disappeared from support. Medicines do not translate guidance into the language of trust.
People do that. Communities do that. Services do that.
Prevention is a system of trust
In Eastern Europe and Central Asia, many people most affected by HIV do not begin their journey with a public clinic. They begin with a peer counsellor, a community organization, a trusted activist, a harm reduction site, a migration navigator, a women’s support group or a person who can explain the system without judgement.
Globally in 2024, people from key populations and their sexual partners accounted for 49% of all new HIV acquisitions. The likelihood of acquiring HIV was 34 times higher among people who inject drugs, 18 times higher among gay men and other men who have sex with men, 17 times higher among sex workers, and 17 times higher among trans women compared with the adult population overall.
These figures are not only epidemiological. They are political. They show where prevention must go if it truly wants to work.
Anton Basenko, Executive Director of the International Network of People who Use Drugs (INPUD), gave one of the clearest warnings during the regional discussion: “What began as a financial crisis has now become a crisis of public health, human rights and human dignity.”
For people who use drugs, harm reduction services are often places of safety, recognition and survival. That is why service integration cannot mean the disappearance of community-led organizations. If people do not trust the system, the formal existence of a service does not create access.
A service can exist on paper and still remain unreachable.
U=U shows why communication is prevention
One of the strongest lessons of the campaign is that evidence does not speak for itself.
Mengfei Li, global health communication specialist, youth advocate, PhD candidate at the University of Hong Kong and lead of the #UequalsUDanceChallenge campaign, put it simply: “Strong evidence does not automatically lead to strong communication.”
Speaking about U=U, she explained that the challenge is not only whether people have heard the message. The question is whether they can connect it to their lives: dating, sex, marriage, pregnancy, trust, partnership, family and fear of judgement.
Zila Virginia Esther Guevara Vicencio, a representative of Asociación Ciclo Positivo in Argentina and one of the advocates advancing U=U, described U=U not only as a scientific fact but as a rights-based shift. In her words, U=U changed the narrative — from fear, guilt and disease to power, bodily autonomy, pleasure and dignity.
U=U tells people living with HIV that they are not a danger. It tells partners that intimacy does not have to be built around fear. It tells health systems that their task is not only to achieve viral suppression, but also to protect dignity.
For our region, this is especially important: prevention messages cannot depend on one donor, one ministry, one campaign or one political moment. They must live in communities.
Our region cannot remain off the map
AIDS 2026 made visible a frustration that has followed Eastern Europe and Central Asia for too long: our region is often described as exceptional, complicated or transitional — but not always treated as central to the global prevention agenda.
Tetiana Deshko, Director of International Programmes at Alliance for Public Health, said it directly: “Our region is special. Unfortunately, we fall out of the bigger picture — in terms of the epidemic situation, the loss of funding, and the availability of new medicines and services.”
This is not a request for symbolic inclusion. It is an epidemiological and political necessity.
War and displacement have added another layer. Ukraine has shown that HIV services can continue even under extraordinary pressure when systems are flexible and when communities, civil society and state institutions work together. But Ukraine has also shown what happens when people cannot physically reach support: support must move.
From self-testing kit delivery and electronic referrals to mobile teams and support for people crossing borders, the Ukrainian experience has shaped a very clear principle: innovation is not only a medicine. Innovation is also a service model that follows people when life becomes unstable.
A clinic in one country cannot protect a person who is already in another. A prevention strategy that does not account for migration is incomplete.
The funding crisis is a crisis of accountability
UNAIDS reports that HIV funding disruptions have seriously affected prevention, testing and community-led services. For Eastern Europe and Central Asia, the danger is that transition to domestic financing may happen faster than countries build systems capable of protecting access, rights and community-led services.
Denys Denysenko, Portfolio Lead for Eastern Europe and Central Asia at the Elton John AIDS Foundation, framed innovation as a necessity, not an optional extra: “We can no longer speak about innovation as a possibility. We must speak about innovation as a necessity.”
But in a funding crisis, innovation does not always mean a new medicine. Innovation can be a model that allows a community organization to receive public funding. A legal mechanism that removes a barrier to care. A system that keeps a person on treatment during war or displacement.
“We remain committed to community-led organizations. But today, it is not enough to cover services. We need to change the system and remove what prevents people from receiving the care that already exists,” Denysenko explained.
Not every project is sustainable simply because it has a final report. It is sustainable only when we can answer what happens after it ends: whether the state will fund it, whether it can be integrated without losing trust, whether community-led monitoring will continue, and whether a person will still be able to ask for help without fear.
Community leadership must be funded, not romanticized
The 2026 Political Declaration targets cited by UNAIDS are clear: by 2030, 30% of HIV testing and support services related to care and treatment should be delivered by community-led organizations; 80% of person-centred HIV prevention programmes for people from key populations should be delivered by community-led organizations; and 60% of programmes supporting societal enablers should be delivered by community-led organizations.
But targets do not deliver services. Funding, laws, contracts, protection and civic space do.
Community-led organizations cannot be praised on international stages while being left outside national financing. They cannot be called indispensable while being forced to survive on short-term grants.
As UNAIDS Executive Director Winnie Byanyima said during the launch of the UNAIDS special report in Rio: “The era of relying on international aid is over.” But she also drew a clear human rights line: “You cannot end AIDS while criminalizing people living with and most at risk of HIV.”
Greater state responsibility is necessary. But state responsibility without human rights, community leadership and sustainable funding will not end AIDS. It will only shift the burden from donors to people.
From Rio to Geneva: what must change before IAS 2027
At the closing of AIDS 2026, International AIDS Society President Kenneth Ngure reminded the conference: “Science changes lives only when it reaches people.”
By the time the global HIV community meets again in Geneva for the 14th IAS Conference on HIV Science in 2027, our region should no longer be asking whether oral pre-exposure prophylaxis, long-acting injectable cabotegravir or lenacapavir are theoretically possible. It should be talking about how many people have real access to prevention choice; how governments have budgeted for it; how peer counsellors explain new options; how migrants continue prevention across borders; and how people from key communities receive prevention without fear.
Tetiana Deshko formulated one of the clearest regional demands heard in Rio: “I would very much like us, at the next conference, to speak not only about opportunities or individual projects, but about hundreds of thousands of people receiving long-acting HIV prevention and modern treatment.”
That is the measure.
Not a pilot. Not an abstract commitment to “leave no one behind.”
After Rio, prevention must become science translated into access; access protected by rights; rights defended by communities; and communities supported by sustainable systems.
From the author
As an IAS HIV Prevention Ambassador, I returned from Rio with one clear conviction: HIV prevention cannot remain a promise made on global stages. It has to become a real option in people’s lives.
For our region, this means building systems capable of delivering prevention choice — oral pre-exposure prophylaxis, long-acting injectable cabotegravir, lenacapavir, post-exposure prophylaxis, testing, U=U information and community-led support — to people who are too often reached last, or not reached at all.
Prevention is not only about reducing the likelihood of acquiring HIV. It is about expanding freedom: the freedom to choose, to ask questions, to protect one’s health, to cross borders without losing care, and to live with dignity and without fear.
I am deeply grateful to the IAS team, fellow Prevention Ambassadors, speakers, researchers, journalists, community leaders and activists who made these conversations possible. I am also grateful to everyone from Eastern Europe and Central Asia who continues to insist that our region must not remain off the map.
Rio 2026 showed what is possible.
Geneva 2027 must show what we have done with that possibility.
Julia Golub
