During AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF is launching Rio Briefs — a series of reports from Rio exploring how HIV prevention is changing and what these changes mean for people in Central and Eastern Europe and Central Asia.
The final day of AIDS 2026 in Rio de Janeiro raised a question that will shape the future of the global HIV response: what happens after a scientific breakthrough?
Today, pre-exposure prophylaxis is available as a daily pill, an injection every two months and a long-acting option administered twice a year. Other approaches that could further expand prevention choice are also under development.
Science is moving forward at extraordinary speed. But a new medicine does not change lives simply by appearing in a scientific paper, clinical guidelines or a medicines registry.
It begins to make a difference only when people can access it.
Choice is not a contest between a pill and an injection
Long-acting pre-exposure prophylaxis was one of the central topics of the day.
Studies of long-acting cabotegravir have demonstrated its high efficacy. At the same time, researchers highlighted an important point: the advantage of an injectable option is often linked not to any lack of efficacy of oral PrEP, but to the challenges people may face in taking a pill every day.
Findings on lenacapavir, administered once every six months, have strengthened expectations that HIV prevention could become considerably more convenient for many people.
Yet no single option will be best for everyone.
In a study presented at the conference, 83% of participants chose injectable PrEP. Their reasons included a lower likelihood of missing a dose, convenience, privacy and a greater sense of protection.
At the same time, some people preferred pills. For them, avoiding injections, using a familiar prevention method, being able to stop taking it themselves and having less reliance on a healthcare facility while travelling or relocating were important considerations.
The key conclusion is not that one option should replace another. Different prevention options suit different lives and circumstances.
True innovation means having a choice.
That choice is not permanent. A person may start with pills, move to an injectable option and later return to oral PrEP. Their needs may change with their place of residence, relationships, health, work, safety or ability to visit a healthcare facility regularly.
Choice, therefore, cannot be offered only once. It must be revisited during every conversation about prevention.
Long-acting does not mean support-free
An injection every two or six months can reduce reliance on taking a pill every day. But it does not remove the need for accessible, welcoming and people-centred services.
People still need clear information, HIV testing, reminders about their next injection, a way to contact a healthcare provider quickly and support if they are unable to receive an injection on time.
Long-acting prevention is therefore not prevention that “works by itself”.
Its success depends on the flexibility of the entire system surrounding the medicine.
People do not choose only a prevention product. They also make choices about where they receive services, how often they attend, who they speak to about their health and how much time each visit requires.
Even a highly effective option may fail to achieve its potential at the population level if it is offered only at a distant clinic, during inconvenient hours, following a complicated registration process or in an environment where people experience stigma.
The future of prevention is therefore not only about new medicines. It is also about primary healthcare, community-based organizations, mobile teams, pharmacies, remote services and other safe access points integrated into people’s everyday lives.
Regulatory approval does not automatically mean access
According to data presented at AIDS 2026, approximately 140,000 people acquired HIV in Latin America in 2025. This represents an increase of about 30% compared with 2010.
PrEP coverage remains far below the level of need, while most PrEP provision in the region is concentrated in Brazil.
Latin American countries and members of local communities participated in studies of new medicines. Yet in many of these countries, long-acting options have still not become part of routine prevention programmes.
One conference session expressed it plainly: innovation without access is injustice.
Between a scientific discovery and an actual service stand affordability, patents, procurement, reliable supply, national guidelines, a trained workforce and governments willing to invest in implementation.
If a medicine exists but a country cannot afford to procure it, that is not meaningful access.
If a medicine is available in a country but cannot be obtained within communities, that is not access.
If a person is eligible for prevention but is afraid to seek it because of stigma, criminalization or the risk of having their personal information disclosed, that is not access either.
This is especially important for Central and Eastern Europe and Central Asia. Our region has repeatedly seen effective health tools remain unavailable for years because of high prices, slow regulatory processes, small markets, political indifference and insufficient funding for community-led programmes.
We cannot allow the next generation of prevention options to follow the same path.
“No patent can be above life”
The affordability of new prevention options featured prominently during the closing ceremony.
Brazilian parliamentarian and trans* activist Duda Salabert, who received the Barbara Lee Political Leadership Award, called for universal access to lenacapavir and urged decision-makers not to allow patent restrictions to put the medicine beyond the reach of public health systems.
“No patent can be above life,” she said.
This is not an argument against science or pharmaceutical innovation. It is a demand that we remain clear about the purpose for which new medicines are developed.
A scientific breakthrough cannot be considered complete if its benefits are available only to people born in the right country or able to pay the required price.
Science has done its part. Politics must now ensure that its results reach people.
The conference is ending. The gaps remain
At the closing ceremony, AIDS 2026 International Co-Chair Dário Varela reminded participants that the conversations held in Rio would not, by themselves, close the gaps in access.
“The gaps we have discussed here did not close this week. They will close only when ministries, parliaments and donors decide to close them,” he said.
The most important part of the work, he argued, begins after the conference: translating knowledge into public policy, budgets, services and tangible changes within communities.
The closing speeches were united by a shared call to stop devastating funding cuts, protect the progress already made, strengthen community leadership and remove structural barriers, including racism, stigma, discrimination and criminalization.
Speakers also warned about the shrinking space for civil society and attempts to make decisions without the meaningful participation of the people whose lives those decisions directly affect.
The HIV response was not built by scientists and healthcare workers alone. It was also built by people living with HIV, members of key populations, activists, community-based organizations, journalists, policymakers and those who spent years defending the right to health where systems refused to recognize it.
Brazilian researcher and activist Jean Vinicius Oliveira reminded the audience that HIV cannot be addressed without confronting inequality, racism, sexism, homophobia, transphobia and economic exclusion.
He used a powerful metaphor: “The cure already exists, and it is called solidarity.”
There is currently no medicine that can cure HIV. But without solidarity, even the most effective medicines will remain out of reach for the people who need them most.
“The era of donor-driven HIV priorities is over”
As she handed the IAS presidency to Kenneth Ngure, AIDS 2026 President Beatriz Grinsztejn spoke about more than the scientific advances presented at the conference.
She reflected on the human cost of geopolitical decisions and funding cuts: clinics closing, services being interrupted, children losing access to treatment and members of key populations being denied prevention.
“The era of donor-driven HIV priorities is over. Not only because donors are retreating, but because countries and communities know best what they need,” she said.
This is an especially important message for regions where reductions in international support could leave thousands of people without essential services.
Sustainability does not mean simply transferring responsibility to communities. It means that governments must fund services, recognize community expertise and include communities as equal partners in decision-making.
“I will not rest, and we will not rest, until all people affected by HIV can access the science they need and the rights to which they are entitled,” Beatriz Grinsztejn said.
Science changes lives only when it reaches people
The new IAS President, Kenneth Ngure, began his address with the principle of ubuntu: “I am because we are.”
He called for collaboration over division, evidence over ideology and hope over despair.
Addressing young people, Ngure said:
“You are not here by accident. You belong.”
Young people, community representatives and professionals from countries most affected by inequality must not be symbolic participants in the next phase of the HIV response. They must be among its full and equal authors.
“Science changes lives only when it reaches people,” Kenneth Ngure emphasized.
He proposed three guiding principles for the work ahead: science as the foundation, equity as the measure and impact on people’s lives as the purpose.
What Rio leaves with our region
Over six days at AIDS 2026, we saw the future of HIV prevention.
It is a future in which people can choose between different prevention options. A future in which prevention is not tied to a single healthcare facility. A future in which communities participate in designing services. A future in which an injection administered once every few months can offer privacy, freedom and protection.
But we also saw how easily this future could become a privilege.
For people in Central and Eastern Europe and Central Asia, access will depend on more than the efficacy of medicines. It will depend on affordability, political will, decriminalization, sustainable funding, community participation and the capacity of health systems to continue functioning amid war, displacement, repression and increasing stigma.
The next generation of HIV prevention must not be left waiting for years at the borders of our region.
We must demand timely registration, fair pricing, transparent procurement and service-delivery models that follow people wherever they are. We must protect everyone’s right to make an informed choice and support community-led organizations, without which that choice too often remains only on paper.
A scientific breakthrough is not measured by the number of presentations, publications or approved medicines.
It is measured by the number of lives it changes.
AIDS 2026 has ended.
The work has not.
