
When an HIV Scientific Breakthrough Isn't Enough
We should be celebrating its arrival.
Instead, aid groups and the countries most affected by HIV are reeling from the Trump administration's relentless attacks on the global health infrastructure. Instead of perfecting plans for a rollout of the medication, they are scrambling to ensure people with HIV have the drugs they need to survive.
Last year, I wrote about the stunning — or as one HIV expert described it, 'spine-chilling'— results from a large study of lenacapavir. None of the women and adolescents who were given the twice-yearly injection in the trial became infected with HIV. In a second study involving men who have sex with men, and transgender individuals who have sex with men, the treatment was 96% effective. Even better, Gilead is working on a newer version that could potentially offer protection for a year or more.
That's about as close to an HIV vaccine we're likely to get — at least for many years. It's also the world's best shot of achieving the goal of ending HIV by 2030.
For low- and middle-income countries that continue to face frustratingly stubborn infection rates, a twice-yearly drug could be a game-changer. Although existing treatments of daily pills do an excellent job at preventing infection, getting people to use them consistently has been difficult.
There is the stigma attached to the pills. Ensuring patients return for frequent testing and refills is also challenging — as is simply remembering to take them daily. Consider the typical day of a mom with a newborn and it's easy to understand how six months of protection could make a real difference in lowering HIV cases in women and infants.
Some experts have even suggested lenacapavir is our best chance of wiping out new infections in children.
That was before the Trump administration abruptly shut down USAID, the lead agency behind Pepfar. The global initiative to combat HIV/AIDS is credited with saving an estimated 26 million lives since its inception in 2003. Although the administration granted a limited waiver to allow some HIV services to continue, funding is significantly restrained.
As health workers grapple with fewer resources, their focus has shifted to people living with HIV. 'When the chips are down, you safeguard treatment because those people will die if they don't get their antiretroviral,' says Linda-Gail Bekker, director of the Desmund Tutu HIV Centre at the University of Cape Town. And yet, she said, 'prevention we know is an absolute cornerstone to bringing this epidemic under control.'
Because the situation is so dynamic, it's been difficult to capture what's happening on the ground. The best current model suggests the administration's actions could result in at least 70,000 additional new infections, and another 5,000 deaths in the next five years.
UCLA infectious disease epidemiologist Dvora Joseph Davey says that in 2024, the eight public health clinics in Cape Town — where she is based — saw three infants who were HIV-positive at birth. In the first five months of this year, they've already seen three babies born with the infection.
She knows there will be more. One pregnant woman with HIV recently came into the clinic and, at 37 weeks, her viral load was dauntingly high. She'd skipped picking up her last three-month supply of pills. The nurse she'd been seeing was let go as part of the funding cuts, and no one was available to do a blood draw at her last visit, Davey says.
If the people who, in theory, should still be benefiting from global aid are falling through the cracks, what hope do we have for prevention?
Prevention efforts have already been severely disrupted in some countries. Supply is responsible for some of the upheaval, but the more complicated problem is getting the drugs to the people who need them most. 'We need low-cost product and also a low-cost delivery mode,' says Carmen Pérez Casas, senior strategy lead at Unitaid, a global health initiative hosted by the World Health Organization. The situation for the latter 'has changed radically,' she says.
HIV prevention is not as simple as just handing out a prescription. It's first identifying those most at risk of infection, getting them tested to confirm they are negative, and offering counseling about their options. It's ensuring they return for more testing and the next dose of their medication. That requires a vast support network ranging from doctors and nurses to counselors, pharmacists, lab technicians, data scientists and more.
Pepfar supported all of that infrastructure. In South Africa, for example, cuts have resulted in lost jobs for some 8,000 health workers focused on HIV.
Aid groups are doing their best to ensure the breakthrough's promise is not entirely lost. Their first hurdle is bridging the gap to the arrival of low-cost generic lenacapavir, which isn't expected until sometime in 2027. (Gilead is allowing a handful of drug companies to make and sell generic forms of lenacapavir in the countries most heavily impacted by HIV.) Global health agencies are anxiously awaiting the company's price tag for those countries to understand how far their funding can be stretched.
Then they need to get the drug to patients. Experts tell me they've scaled back their expectations given the upheaval with Pepfar. The Trump administration's termination of National Institutes of Health grants to foreign countries has created additional hurdles. It's been particularly devastating in South Africa, where the NIH supported a significant chunk of research related to HIV. That means less money to conduct so-called implementation studies for lenacapavir, which are crucial for understanding how to improve the drug's use in the real world. One simple thing the Trump administration could do is free up funding for prevention. Pepfar continues to operate under a waiver that only allows PrEP money to be spent for those who are pregnant or breastfeeding.
Groundbreaking science alone won't end HIV. It must be paired with affordability and access. The Trump administration's callous cuts to global health efforts put all of those things at risk — including the promising future where HIV is brought to heel.
More From Bloomberg Opinion:
This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
More stories like this are available on bloomberg.com/opinion
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles


The Print
4 hours ago
- The Print
UNAIDS 2025 report warns of funding gaps in fight against HIV as India battles stigma, discrimination
Also, in India, more than 80 percent of surveyed women aged between 15 and 49 years were reported between 2020 and 2024 to lack autonomy over their sexual choices and reproductive healthcare. Additionally, over 90 percent of them lacked information about contraceptive use. The report titled 'AIDS, Crisis And The Power To Transform', released on 10 July, also highlights that the prevalence of intimate partner violence among partnered or married women living with HIV in the same age group in India stood at 24 percent—just 10 percent less than Liberia, where the prevalence was found to be highest globally. The figures are based on data from 2020-2024. New Delhi: The 2025 Global AIDS Update by UNAIDS (Joint United Nations Programme on HIV/AIDS) shows that 30 percent of people surveyed in the 15-49 age group in India reported facing HIV-related stigma and discrimination. The 2025 update notes the impact that massive funding cuts by international donors are having on countries most affected by HIV, and how the threat of a funding crisis may hurt global progress in the fight against HIV/AIDS unless countries alter their programming. According to the UNAIDS Executive Director Winnie Byanyima, the Global HIV response shows a decline of newly HIV infected persons by 40 percent, and of 56 percent deaths since 2010. However, the withdrawal of the US President's Emergency Plan for AIDS Relief (PEPFAR), the biggest contributor to global response, may lead to 6 million additional people being infected, and an additional 4 million deaths by 2029. The funding crisis has disrupted treatment and prevention programmes around the world, the report says. But it also points to the emergence of new prevention tools, like Lenacapavir, a long-acting injectable pre-exposure prophylaxis (PrEP), 'which has shown near-complete efficacy in clinical trials'. It can prevent HIV with injection doses twice a year. The manufacturer of Lenacapavir, Gilead Sciences, has licenced six generic manufacturers, of which Dr Reddy's Laboratories, Emcure, Hetero, and Mylan—subsidiary of Viatris—operate in India. However, affordability and access are still big challenges. According to the report, in terms of region-wise distribution, Eastern and Southern Africa saw the highest new HIV infections in 2024 at 37 percent, the lowest being in the Caribbean at one percent. In Asia and the Asia Pacific, of which India is a part, the figure stands at 23 percent. With respect to people living with HIV in 2024, the highest was reported in Eastern and Southern Africa at 52 percent, or 21.1 million. The lowest number of people was in the Caribbean—one percent, or 3,40,000. In Asia and Asia Pacific, the number was 17 percent, or 6.9 million. India is among the 13 of the 35 reporting countries that have reached safe injecting targets—90 percent using sterile equipment at last injection. It is clubbed with South Africa, Thailand and Brazil under Low-Dependency Countries in the matrix of dependency on PEPFAR funding. The report also mentions that social enterprises help diversify revenue resources. In India, the Mist LGBTQ Foundation runs an online platform to market merchandise, and offer HIV self-testing and PrEP consultations, either free or at a low rate. Another organisation, the Network of Maharashtra People Living with HIV TAAL+ Pharmacy sells antiretroviral and other medicines at discounted prices via corporate social responsibility partnerships. (Edited by Mannat Chugh) Also Read: Bringing dramatic drop in TB deaths, how TN set an example for rest of India with one-of-a-kind model


Time of India
10 hours ago
- Time of India
US aid cuts halt HIV vaccine research in South Africa, with global impact
Johannesburg: Just a week had remained before scientists in South Africa were to begin clinical trials of an HIV vaccine , and hopes were high for another step toward limiting one of history's deadliest pandemics. Then the email arrived. Stop all work, it said. The United States under the Trump administration was withdrawing all its funding. The news devastated the researchers, who live and work in a region where more people live with HIV than anywhere else in the world. Their research project, called BRILLIANT , was meant to be the latest to draw on the region's genetic diversity and deep expertise in the hope of benefiting people everywhere. But the $46 million from the U.S. for the project was disappearing, part of the dismantling of foreign aid by the world's biggest donor earlier this year as President Donald Trump announced a focus on priorities at home. South Africa hit hard by aid cuts South Africa has been hit especially hard because of Trump's baseless claims about the targeting of the country's white Afrikaner minority. The country had been receiving about $400 million a year via USAID and the HIV-focused PEPFAR. Now that's gone. Glenda Grey, who heads the Brilliant program, said the African continent has been vital to the development of HIV medication, and the U.S. cuts threaten its capability to do such work in the future. Significant advances have included clinical trials for lenacapavir, the world's only twice-a-year shot to prevent HIV, recently approved for use by the U.S. Food and Drug Administration. One study to show its efficacy involved young South Africans. "We do the trials better, faster and cheaper than anywhere else in the world, and so without South Africa as part of these programs, the world, in my opinion, is much poorer," Gray said. She noted that during the urgency of the COVID-19 pandemic , South Africa played a crucial role by testing the Johnson & Johnson and Novavax vaccines, and South African scientists' genomic surveillance led to the identification of an important variant. Labs empty and thousands are laid off A team of researchers at the University of the Witwatersrand has been part of the unit developing the HIV vaccines for the trials. Inside the Wits laboratory, technician Nozipho Mlotshwa was among the young people in white gowns working on samples, but she may soon be out of a job. Her position is grant-funded. She uses her salary to support her family and fund her studies in a country where youth unemployment hovers around 46%. "It's very sad and devastating, honestly," she said of the U.S. cuts and overall uncertainty. "We'll also miss out collaborating with other scientists across the continent." Professor Abdullah Ely leads the team of researchers. He said the work had promising results indicating that the vaccines were producing an immune response. But now that momentum, he said, has "all kind of had to come to a halt." The BRILLIANT program is scrambling to find money to save the project. The purchase of key equipment has stopped. South Africa's health department says about 100 researchers for that program and others related to HIV have been laid off. Funding for postdoctoral students involved in experiments for the projects is at risk. South Africa's government has estimated that universities and science councils could lose about $107 million in U.S. research funding over the next five years due to the aid cuts, which affect not only work on HIV but also tuberculosis - another disease with a high number of cases in the country. Less money, and less data on what's affected South Africa's government has said it will be very difficult to find funding to replace the U.S. support. And now the number of HIV infections will grow. Medication is more difficult to obtain. At least 8,000 health workers in South Africa's HIV program have already been laid off, the government has said. Also gone are the data collectors who tracked patients and their care, as well as HIV counselors who could reach vulnerable patients in rural communities. For researchers, Universities South Africa, an umbrella body, has applied to the national treasury for over $110 million for projects at some of the largest schools. During a visit to South Africa in June, UNAIDS executive director Winnie Byanyima was well aware of the stakes, and the lives at risk, as research and health care struggle in South Africa and across Africa at large. Other countries that were highly dependent on U.S. funding including Zambia, Nigeria, Burundi and Ivory Coast are already increasing their own resources, she said. "But let's be clear, what they are putting down will not be funding in the same way that the American resources were funding," Byanyima said.


Hindustan Times
10 hours ago
- Hindustan Times
Trump's budget cuts for US aid halt HIV vaccine research in South Africa
Just a week had remained before scientists in South Africa were to begin clinical trials of an HIV vaccine, and hopes were high for another step toward limiting one of history's deadliest pandemics. Then the email arrived. The research project, called BRILLIANT, was meant to be the latest to draw on the region's genetic diversity and deep expertise in the hope of benefiting people everywhere.(AP/Representational) Stop all work, it said. The United States under the Trump administration was withdrawing all its funding. The news devastated the researchers, who live and work in a region where more people live with HIV than anywhere else in the world. Their research project, called BRILLIANT, was meant to be the latest to draw on the region's genetic diversity and deep expertise in the hope of benefiting people everywhere. But the $46 million from the U.S. for the project was disappearing, part of the dismantling of foreign aid by the world's biggest donor earlier this year as President Donald Trump announced a focus on priorities at home. South Africa hit hard by aid cuts South Africa has been hit especially hard because of Trump's baseless claims about the targeting of the country's white Afrikaner minority. The country had been receiving about $400 million a year via USAID and the HIV-focused PEPFAR. Now that's gone. Glenda Grey, who heads the Brilliant program, said the African continent has been vital to the development of HIV medication, and the U.S. cuts threaten its capability to do such work in the future. Significant advances have included clinical trials for lenacapavir, the world's only twice-a-year shot to prevent HIV, recently approved for use by the U.S. Food and Drug Administration. One study to show its efficacy involved young South Africans. 'We do the trials better, faster and cheaper than anywhere else in the world, and so without South Africa as part of these programs, the world, in my opinion, is much poorer,' Gray said. She noted that during the urgency of the COVID-19 pandemic, South Africa played a crucial role by testing the Johnson & Johnson and Novavax vaccines, and South African scientists' genomic surveillance led to the identification of an important variant. Labs empty and thousands are laid off A team of researchers at the University of the Witwatersrand has been part of the unit developing the HIV vaccines for the trials. Inside the Wits laboratory, technician Nozipho Mlotshwa was among the young people in white gowns working on samples, but she may soon be out of a job. Her position is grant-funded. She uses her salary to support her family and fund her studies in a country where youth unemployment hovers around 46%. 'It's very sad and devastating, honestly," she said of the U.S. cuts and overall uncertainty. 'We'll also miss out collaborating with other scientists across the continent.' Professor Abdullah Ely leads the team of researchers. He said the work had promising results indicating that the vaccines were producing an immune response. But now that momentum, he said, has 'all kind of had to come to a halt.' The BRILLIANT program is scrambling to find money to save the project. The purchase of key equipment has stopped. South Africa's health department says about 100 researchers for that program and others related to HIV have been laid off. Funding for postdoctoral students involved in experiments for the projects is at risk. South Africa's government has estimated that universities and science councils could lose about $107 million in U.S. research funding over the next five years due to the aid cuts, which affect not only work on HIV but also tuberculosis — another disease with a high number of cases in the country. Less money, and less data on what's affected South Africa's government has said it will be very difficult to find funding to replace the U.S. support. And now the number of HIV infections will grow. Medication is more difficult to obtain. At least 8,000 health workers in South Africa's HIV program have already been laid off, the government has said. Also gone are the data collectors who tracked patients and their care, as well as HIV counselors who could reach vulnerable patients in rural communities. For researchers, Universities South Africa, an umbrella body, has applied to the national treasury for over $110 million for projects at some of the largest schools. During a visit to South Africa in June, UNAIDS executive director Winnie Byanyima was well aware of the stakes, and the lives at risk, as research and health care struggle in South Africa and across Africa at large. Other countries that were highly dependent on U.S. funding including Zambia, Nigeria, Burundi and Ivory Coast are already increasing their own resources, she said. 'But let's be clear, what they are putting down will not be funding in the same way that the American resources were funding," Byanyima said.