The future of the global HIV response risks being undermined by shrinking funding and wavering political will, health leaders have warned as the International AIDS Society (IAS) Conference on HIV Science opened on July 14 in Kigali.

Addressing the conference virtually, World Health Organization (WHO) Director General Dr. Tedros Adhanom Ghebreyesus said abrupt funding cuts were already disrupting access to life-saving HIV services in many countries. He urged governments and donors to protect decades of hard-won progress in treatment, prevention, and care.

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"These investments have led to advances in treatment, prevention, and care for millions of people.”

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He commended African scientists, clinicians, and communities for their role in advancing HIV knowledge and care, adding that they are advancing knowledge and transforming what’s possible.

During the conference, the WHO released new guidelines for lenacapavir, the first injectable option for HIV pre-exposure prophylaxis, along with updated recommendations for injectable antiviral treatments. Dr. Ghebreyesus stressed that these treatments will only have an impact if health systems can deliver them to those who need them.

He described the current funding crisis as a moment of potential change, noting that many health leaders are looking to shift from dependence on external aid to more sustainable self-governance.

"They see this crisis as an opportunity to leave behind the era of dependence and move towards sustainable self-governance by mobilizing resources that truly support human freedom,” he said.

Dr. Ghebreyesus urged leaders to fulfill their commitments under the Key Goal to Action initiative, noting the importance of partnerships with people living with HIV and protecting human rights. "We have the tools to turn the corner on HIV,” he said.

Minister of Health, Dr. Sabin Nsanzimana, spoke about Rwanda’s recovery since the 1994 Genocide against the Tutsi, which destroyed much of the country’s health system. "We are rebuilding from scratch,” he said.

In the years following the genocide, Rwanda faced some of the highest rates of HIV transmission and AIDS-related deaths, a journey that took three decades, Dr. Nsanzimana said.

He credited Rwanda’s progress to leadership, partnerships, community involvement, innovation, and a willingness to take risks. He recalled a moment in 2003, when the government hosted its first main conference on HIV counseling and testing.

Dr. Nsanzimana reflected on his own experience 20 years ago, working at the University Teaching Hospital of Kigali (CHUK), where he helped start one of Rwanda’s largest HIV clinics, and had 5,000 patients.

Looking at national data, he showed how HIV infections and AIDS-related deaths have dropped steadily over time. Rwanda is on track to meet the UNAIDS 95-95-95 targets, which aim for 95% of people with HIV to know their status, 95% of those diagnosed to receive treatment, and 95% of those on treatment to achieve viral suppression.

Despite progress, Dr. Nsanzimana acknowledged ongoing challenges, including the threat of other diseases and the need for continued investment in affordable and efficient health services.

"We have to use science to make treatments and prevention available to everyone. It is an investment. It is not a cost,” he stated.

Beatriz Grinsztejn, a Brazilian infectious disease physician and HIV researcher, noted that the HIV response faces conflicting forces, explaining that science has never been stronger due to advances such as long-acting prevention methods, improved antiretroviral therapy regimens, and emerging mRNA strategies.

However, she said that budget cuts, declining political support, and increasing inequality threaten progress. She pointed to the closure of USAID’s PEPFAR office and the loss of thousands of health experts.

Grinsztejn appreciated the recent efforts by the Global Fund to increase access to new prevention tools but criticized the lack of transparency in drug pricing, which she said must change.

She called upon the global HIV community to unite and remain focused on science as the foundation of the response, free from political influence, urging everyone to make the most of their time together to reaffirm, refocus, and rebuild.

Prof. Jeanine Condo, a Rwandan physician and public health expert who is the Local Co-Chair of IAS 2025, described the conference as essential for Africa, a continent heavily impacted by HIV.

Prof. Condo noted the increasing leadership of African researchers and the continent’s growing role in shaping the global HIV research agenda.

"The conference programme will address what funding cuts mean for progress and future efforts in Africa. We cannot and will not allow the current crisis to erase over 40 years of hard-won progress,” she said.

She called for national, regional, and global ownership of the HIV response, urging the United Nations and other institutions to explore new approaches.

"Together, we are stronger, and together, we will rise to meet the challenges,” she said.