During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF is launching Rio Briefs — a series of stories from Rio exploring how HIV prevention is changing today and what these changes mean for people in Central and Eastern Europe and Central Asia.
On 30 July, the fifth day of AIDS 2026, the discussion about the future of the HIV response became particularly urgent.
Part of the day was devoted to a closed expert discussion on the future of global HIV advocacy. The details remain within that conversation. However, the question put to the participants matters to everyone: what must change when established advocacy approaches no longer correspond to the new political and financial reality?
The open regional discussion offered a very concrete answer.
For Central and Eastern Europe and Central Asia, the crisis of the future has already arrived. And it is no longer only a funding crisis.
It is a crisis of access to prevention and treatment. A crisis for civil society organizations losing funding and staff. A crisis of trust, human rights and safety. A crisis within a system in which governments are often not yet ready to take responsibility for services that have been developed over many years with support from international partners and under community leadership.
The regional discussion brought together Denis Godlevskiy of ITPC, Tetiana Deshko of the Alliance for Public Health, Denys Denysenko of the Elton John AIDS Foundation and Anton Basenko of INPUD.
They spoke about different parts of the same problem: what will happen to people if the transition from international to domestic financing takes place faster than countries can build sustainable and accessible systems of care?
Denis Godlevskiy began with the simplest and most dangerous answer: the first thing to decline is the number of people reached by services.
In some countries, the number of civil society organizations included in new funding applications is already being reduced by half. Along with them, outreach, education, navigation and contact with people whom formal health systems often fail to reach are disappearing.
Targets are being reduced. Fewer people are receiving prevention services. Community preparedness and service quality monitoring are being removed from programmes.
“The first thing that begins to suffer is coverage. If the number of civil society organizations involved in a programme is cut in half, that means half as many people will be able to receive services,” Denis Godlevskiy emphasized.
This is particularly dangerous ahead of the introduction of new long-acting HIV prevention options.
A country can register a medicine, procure its first doses and announce the launch of a programme. But who will explain to sex workers in remote areas, people who use drugs, migrants, trans* people and other people from key populations how the new option works, who it may be suitable for and where it can be accessed?
“If we remove education from our programmes, we can talk about lenacapavir as much as we like. People will not know why they need it, how it works or what to do with it. Without this, innovation loses its meaning,” Godlevskiy said.
A medicine alone does not create access. Access emerges when the medicine is accompanied by clear information, trained professionals, trust, choice and the ability to ask questions without judgement.
For several countries in the region, current grants may be the last before responsibility for procuring HIV tests, antiretroviral medicines, tuberculosis medicines and other health products is transferred entirely to domestic financing.
Such a transition is necessary. Governments must take responsibility for people’s health.
But a transition without adequate preparation could lead to stock-outs, fewer treatment choices, the loss of community-based services and the replacement of experienced organizations with providers that do not have the trust of communities.
The region must therefore prepare not for an optimistic scenario, but for a situation in which international support declines substantially.
According to Denis Godlevskiy, countries need to ensure that several quality medicines are registered in each category, promote competition among manufacturers, remove intellectual property barriers and closely monitor registration costs.
Individual countries in the region represent small markets. If each acts alone, manufacturers may not see sufficient demand. Pooled procurement and regional cooperation could generate greater volumes, lower prices and wider choice.
Community-led monitoring is equally important. It can demonstrate that what appears to be an isolated case in which a person was denied a medicine is, in fact, a systemic problem affecting multiple cities or an entire country.
“When an individual case in which a service was not provided is transformed into data showing a systemic problem at the national level, it begins to produce results,” Godlevskiy emphasized.
Yet community-led monitoring is among the first areas currently losing funding.
Without it, stock-outs remain invisible. Rights violations do not appear in reports. A successful “transition” may exist only on paper.
Denys Denysenko explained how the Elton John AIDS Foundation is changing its approach to supporting the region.
The Foundation is focusing on three areas: testing new solutions, replicating successful models in other countries, and addressing the social and structural barriers that prevent people from accessing services that already exist.
“We can no longer speak about innovation as an opportunity. We must speak about innovation as a necessity,” Denys Denysenko emphasized.
In a context of shrinking resources, however, innovation does not necessarily mean a new application, platform or medicine.
Innovation can be a model that enables a civil society organization to receive public funding. A mechanism that removes a legal barrier. A way to maintain continuity of treatment during war or displacement. A solution that has demonstrated its effectiveness in one country and can be adapted in another.
Among the models whose experience could be replicated, Denysenko mentioned HelpNowHUB — a system created to preserve access to treatment and support for people forced to leave Ukraine.
The new approach also means that every investment should do more than meet a short-term need: it should help change the system.
“Funding is becoming more limited. We must therefore think not only about how to attract more resources, but about how to ensure that every dollar works as effectively as possible,” Denysenko said.
Community-led organizations remain a priority for the Elton John AIDS Foundation. However, projects will increasingly be expected not only to provide services directly, but also to remove barriers, change policies, advance decriminalization and mobilize public financing.
“We remain committed to community-led organizations. But today, it is not enough simply to cover services. We need to change systems and remove the barriers preventing people from accessing support that already exists,” Denysenko explained.
A private foundation can support a demonstration project, help prove that a model works or prepare it for expansion. But it cannot permanently replace the state or compensate for the full scale of declining international financing.
“No private foundation can replace the resources that governments can and should provide,” Denysenko emphasized.
Every demonstration project must therefore answer the next question: what happens when it ends? Will the government take responsibility for it? Will the Global Fund support it? Can the solution be expanded nationally?
Otherwise, even a successful model will remain a temporary exception rather than becoming a new standard.
Anton Basenko presented INPUD data on the effects of funding cuts on community-led organizations and harm reduction programmes.
According to the data he presented, 59 organizations reported losing between 26% and 100% of their budgets. Almost 40% were forced to reduce staff. Sixty-four per cent reported shortages of harm reduction supplies, 77% reported increased discrimination, and 64% reported growing police pressure and criminalization.
“What began as a financial crisis has now become a crisis of public health, human rights and human dignity,” Anton Basenko emphasized.
For Central and Eastern Europe and Central Asia, this is no longer a temporary funding shortfall. It is the risk of a systematic dismantling of harm reduction services delivered by or under the leadership of communities.
These organizations are often the first — and sometimes the only — places where a person who uses drugs feels accepted, heard and safe.
“Civil society organizations are sometimes the only places where people who use drugs feel accepted and supported. Governments must recognize these organizations as an integral part of the health system,” Basenko said.
Service integration must not mean mechanically moving harm reduction into an ordinary primary healthcare facility.
If people do not trust a public institution or fear registration, judgement or police harassment, the service may formally exist but remain inaccessible.
Community-led organizations must retain their role, trust and autonomy while gaining opportunities to work in partnership with governments and receive national or municipal funding.
“Integration is not simply about moving harm reduction services into primary healthcare. Community-led organizations must continue to be an essential part of the system,” Basenko emphasized.
Anton Basenko also highlighted the importance of community-led monitoring.
Its data often emerge long before official statistics. They are the first to reveal shortages of medicines, disappearing harm reduction supplies, denial of services, discrimination and police pressure.
Cutting such monitoring during a crisis means depriving the system of its ability to identify its own problems in time.
Broader partnerships are also essential. Organizations can no longer afford to reject cooperation because they compete for grants or belong to different networks.
“We must stop working in isolation. The funding landscape will never be what it was before. This is a time for broad partnerships and coalitions,” Basenko said.
The example of Kazakhstan showed that a united community position can influence even decisions that previously appeared final.
When a funding application effectively failed to provide an appropriate role for organizations representing people living with HIV, several communities spoke out together. As a result, the application was returned for revision and their comments were incorporated.
“When we unite, we can change decisions. For our country, this was a unique case,” Basenko emphasized.
Opioid agonist therapy was another focus of the discussion.
The term “substitution therapy” still allows opponents to misrepresent treatment as merely “replacing one drug with another”. Such language reinforces stigma and political resistance to evidence-based treatment.
Moving towards the person-centred and scientifically accurate term “opioid agonist therapy” is part of changing attitudes towards the programme itself.
But changing language is not enough without addressing criminalization.
Even the best prevention or treatment programme will fail if a person risks being detained, harassed or humiliated on the way to a service site.
Advocacy for decriminalization, the reform of punitive laws and the reduction of police pressure are therefore not separate human rights issues. They are essential conditions for an effective HIV response.
The discussion concluded with access to new long-acting HIV prevention options.
Several countries are already preparing to register lenacapavir. Registration alone, however, does not mean that people will receive the medicine.
If a national budget does not include a single dose, if there are no resources to prepare communities and if no budget advocacy is taking place, the innovation will remain no more than an entry in a national register.
An international donor or private foundation can support initial projects and help demonstrate how a new prevention option works. But hundreds of thousands of people will gain access to long-acting prevention only when it becomes part of national programmes and budgets.
Countries must therefore begin planning procurement, preparing guidance, training professionals, engaging communities and explaining the available prevention choices now.
Otherwise, the region will once again see a scientific breakthrough only from the stage of an international conference.
Summing up the discussion, Tetiana Deshko emphasized that Central and Eastern Europe and Central Asia are too often left outside global plans — because of the distinct nature of the epidemic, declining financing and unequal access to new medicines.
“Our region is unique. Unfortunately, we are being left out of the broader picture — in terms of the epidemiological situation, the loss of funding, and access to new medicines and services,” Tetiana Deshko said.
The next conference, however, must not once again end with discussions limited to possibilities, registration or small demonstration projects.
“I would very much like the next conference to be a place where we are no longer talking only about opportunities or individual projects, but about hundreds of thousands of people receiving long-acting HIV prevention and modern treatment,” Deshko concluded.
The region does not need another declaration or another promise that “no one will be left behind”.
It needs registered and affordable medicines. Competition among manufacturers. Public funding for community-led organizations. Service quality monitoring. Decriminalization. Flexible transition funding. Regional procurement. And collective advocacy capable of transforming one person’s experience into systemic change.
Cuts in funding must not mean cuts in rights.
Integration must not mean the disappearance of communities.
The transition to domestic financing must not mean treatment interruptions.
And the registration of a new medicine must not remain a victory only on paper.
Central and Eastern Europe and Central Asia are not asking for a separate future.
The region is demanding not to be erased from the future of HIV prevention and treatment.
