On the Cusp of a New Future: How Science is Accelerating Progress against HIV

We are at a turning point. 40 years into the HIV epidemic, science is delivering its most promising breakthroughs yet. And just as budgets are being retracted, the HIV innovation pipeline is stronger than ever. Long-acting prevention tools are poised to transform the response and vaccine science is advancing with decades of hard-won knowledge behind it.

This momentum reflects sustained community leadership, technical ingenuity, and global partnership. Treatment has already transformed what was once a death sentence into a chronic, manageable condition for millions. Over the past 15 years, new HIV infections have fallen by 40%. And the next 15 years could see new innovations help to virtually eliminate deaths from the disease.

A New Era of HIV Prevention Has Arrived
Breakthroughs like lenacapavir–a twice-yearly injectable prevention option offering near-complete protection—are ushering in a new chapter in the HIV response. And just this year, critical agreements were put in place to expand access in low- and middle-income countries (LMICs), with the first doses delivered to Zambia and Eswatini last month. At the same time, new manufacturing partnerships aim to scale delivery of a generic version of the injectable at a lowered price of roughly $40 a year for individuals in LMICs as early as 2027.

The prevention toolkit is also becoming more diverse. A once-monthly HIV prevention pill entered Phase 3 trials this year, offering the potential for even more choice and less daily burden. Evidence from Kenya and Uganda shows that when people can choose between oral and injectable pre-exposure prophylaxis (PrEP), uptake increases—especially among populations previously disengaged from the health system.

But innovation isn’t limited to PrEP. Countries are reimagining how treatment and testing are delivered. In Vietnam, online platforms are making HIV self-testing kits easier to order discreetly, helping people test earlier and on their own terms. In Uganda and Malawi, community-led outreach is expanding access for people who rarely interact with formal health services. Injectable long-acting treatment is emerging as a near-term opportunity to help ensure more babies are born HIV-free, while new regimens continue to advance for other impacted communities. And, increasingly, AI-powered chatbots are providing private, round-the-clock guidance on HIV risk, testing and treatment—meeting people where they are, in ways that feel safe and judgment-free. This is exactly the future we imagine and are investing in at the Gates Foundation, together with our partners.

Breakthrough Science on the Horizon
The future of HIV science remains deeply promising. Gene-based cure strategies, once only hypothetical, are now in early clinical trials. Researchers are exploring approaches that could eliminate HIV reservoirs and better harness immune responses. Advances in mRNA platforms are refining next-generation vaccine concepts, even as recent trials underscore how challenging HIV remains. Each study brings critical insight, sharpening the hypotheses that guide the field forward.

This is what a scientific turning point looks like: not one breakthrough, but many advances moving forward together. As someone who spent the early part of my career as an HIV researcher, this convergence of promising scientific advancements that were once a distant dream is astounding.

Yet scientific progress alone won’t end the epidemic. The Global Fund to Fight AIDS, Malaria and Tuberculosis remains one of the largest and most effective mechanisms for translating HIV innovation into equitable access.

This year’s replenishment brought in over $11 billion in pledges—an important sign of global support at a moment of declining global health budgets. As pledges continue to come in, fully funding the Global Fund remains essential to bridge the gap between discovery and delivery and to ensure that next-generation tools reach people quickly and fairly. That’s exactly why the Gates Foundation pledged our contribution of $912 million earlier this year. With millions of lives on the line, continued leadership from governments and the private sector is critical.

The Path Ahead
Ending AIDS requires a three-part approach: scale the tools we already have, accelerate access to new innovations, and sustain long-term research investment. The tools to end AIDS either exist or are within reach. The question now is whether we choose to develop and deliver them—urgently, equitably, and at scale.

This World AIDS Day, the opportunity is historic. So is the responsibility. Together, we can usher in an AIDS-free future.

Author: Nina Russell, Director of TB & HIV Research and Development, Gates Foundation