Takeaways from the 2026 International AIDS Conference

1. Morrison: The Shadow of US Policy Shifts

Timestamp: 00:10:25 to 00:17:17 - watch this moment on skim

The 26th International AIDS Conference occurred amidst significant global health policy uncertainty, largely stemming from shifts in US government strategy and funding. The US, historically a major funder and leader, has seen its role challenged, creating dissonance and requiring careful engagement from the US delegation at the conference.

Significance (High): Sets the stage for the conference by highlighting the geopolitical and financial context, emphasizing the critical role of US policy in global HIV/AIDS efforts.

Sources in support: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center)

2. Morrison: Community Resilience and Activism

Timestamp: 00:15:47 to 00:17:40 - watch this moment on skim

The conference underscored the critical role of community resilience and the emergence of a new generation of leaders. The question remains whether protest culture will re-emerge in new forms to push governments for greater action, especially in light of funding uncertainties.

Significance (Medium): Highlights the vital role of community engagement and activism in driving progress, while posing a forward-looking question about future advocacy.

Sources in support: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center)

3. Mulenga: Resilience and Future Focus

Timestamp: 00:18:02 to 00:21:34 - watch this moment on skim

Despite the challenges and funding gaps left by US withdrawal, programs have shown resilience. The conference offered a forward-looking perspective, emphasizing scientific innovations like long-acting prevention methods, signaling a need to 'rise' beyond past difficulties.

Significance (High): Provides a crucial perspective on program sustainability and the importance of innovation in overcoming funding setbacks, offering a message of hope.

Sources in support: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia)

4. Macharia: Triple Elimination and Persistent Gaps

Timestamp: 00:23:56 to 00:29:08 - watch this moment on skim

Momentum is building for triple elimination (HIV, syphilis, hepatitis B) in mothers and babies, with cost-effective testing strategies. However, persistent gaps in the PMTCT cascade, especially late testing and issues during breastfeeding, require urgent attention, alongside support for HIV-exposed but uninfected children.

Significance (High): Underscores progress in pediatric HIV prevention while critically identifying ongoing challenges and new cohorts needing specialized care.

Sources in support: Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation)

5. Ratevosian: Governments Adapting to New Realities

Timestamp: 00:29:28 to 00:33:34 - watch this moment on skim

Governments are demonstrating refreshing pragmatism in adapting to reduced donor funding by prioritizing prevention and modernizing treatment regimens. Integrating HIV services into primary healthcare and leveraging AI for service delivery and supply chain management are key strategies emerging from this period of change.

Significance (High): Illustrates how national health systems are proactively responding to funding shifts and technological advancements, signaling a more integrated and data-driven approach to HIV.

Sources in support: Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

6. AI's Role in Health Systems

Timestamp: 00:32:46 to 00:36:21 - watch this moment on skim

Artificial Intelligence (AI) is poised to revolutionize health outcomes by improving applications and utility. In Zambia, discussions at the conference explored embedding AI into electronic health systems for predictive modeling, identifying individuals at risk of falling out of care, and optimizing resource allocation. AI can also enhance the capacity and skills of community health workers, making service delivery cheaper and more effective, a concept resonating with resource-limited settings.

Significance (High): AI integration promises to make healthcare delivery more efficient and cost-effective, particularly in resource-constrained environments. Its predictive capabilities can proactively address patient retention and resource management, while its role in upskilling health workers could significantly boost service quality.

Sources in support: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia)

7. US Policy Shifts and PEPFAR's Future

Timestamp: 00:34:51 to 00:36:31 - watch this moment on skim

The US relationship with South Africa has undergone a dramatic transformation, leading to the potential dissolution of the PEPFAR relationship and disruption of NIH grant-making. This shift, driven by an 'America First' global health strategy, complicates decades-long partnerships with South African scientific talent. The implications of this new hole in US engagement on science and programs in Africa are significant, raising questions about continued support and collaboration.

Significance (High): The potential withdrawal or significant alteration of PEPFAR funding and partnerships poses a substantial risk to established HIV/AIDS programs and scientific collaborations in Africa. This policy shift could undermine decades of progress and create a void in critical health initiatives, demanding a re-evaluation of global health engagement strategies.

Sources in support: Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

8. South Africa's HIV Response Innovations

Timestamp: 00:36:53 to 00:39:12 - watch this moment on skim

South Africa demonstrated significant progress at the conference, showcasing its leadership in licensing Lenacapir and enrolling the largest global cohort of pregnant and breastfeeding women on this treatment. This initiative offers valuable insights for maternal and child health (MNCH) work and sets a precedent for Len roll-out. Furthermore, South Africa's commitment to domestic resource mobilization, particularly through national health insurance, highlights their efforts to bridge funding gaps and sustain HIV support.

Significance (High): South Africa's advancements in Lenacapir roll-out, especially among vulnerable populations, provide critical data and a model for other nations. Their proactive approach to domestic financing underscores the importance of sustainable funding mechanisms for long-term HIV management.

Sources in support: Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation)

Neutral sources: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

9. Value of US Engagement in Global Health

Timestamp: 00:39:40 to 00:41:49 - watch this moment on skim

The presence and engagement of US government representatives at the conference were crucial for demonstrating continued American involvement in global health. This engagement provides hope and clarity for governments and implementers, signaling a willingness to invest in prevention, particularly for pregnant and breastfeeding populations. The US participation also facilitates technical exchange and reinforces the importance of partnerships in addressing the HIV/AIDS epidemic.

Significance (Medium): Visible US engagement reassures global partners and reinforces the commitment to combating HIV/AIDS. It signals potential for continued investment and technical collaboration, which is vital for sustaining and expanding critical health programs worldwide.

Sources in support: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Jirair Ratevosian (Research Scholar, Duke Global Health Institute), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization)

10. Priorities for the Next Few Years

Timestamp: 00:46:39 to 00:50:37 - watch this moment on skim

Key priorities for the coming years include strengthening domestic financing for HIV response, ensuring governments demonstrate their commitment to their populations, and focusing on prevention. The 'prevention revolution' is underway, driven by innovations like long-acting PrEP and investigational products. Making prevention easier, demedicalizing it, and utilizing AI are crucial for putting choices in people's hands and overcoming health system limitations. Additionally, addressing the needs of adolescents and ensuring youth-friendly services remain a critical focus.

Significance (High): A multi-pronged approach focusing on sustainable domestic funding, robust prevention strategies, and tailored adolescent services is essential for advancing the global HIV/AIDS response. Embracing innovation and simplifying access to prevention tools will be key to overcoming current challenges.

Sources in support: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

11. Latin America's HIV Response and PAHO's Role

Timestamp: 00:51:02 to 00:53:26 - watch this moment on skim

For Latin America, maintaining current HIV treatment gains and ensuring access to innovations are paramount. PAHO emphasizes integrating HIV services into primary care, addressing co-infections like tuberculosis, and managing comorbidities. PAHO's revolving strategic fund offers a cost-effective procurement mechanism for medicines and supplies, aiming to reduce the time between technological availability and public access, fostering collaboration with the industry from an early stage.

Significance (High): PAHO's strategic approach to HIV response in Latin America focuses on sustainability, integration, and equitable access to innovations. The revolving fund mechanism is a key tool for optimizing resource utilization and ensuring that life-saving treatments reach those in need efficiently.

Sources in support: Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation)

12. Adolescent Health and DREAMS Program

Timestamp: 00:55:44 to 00:56:33 - watch this moment on skim

The disappearance of programs like DREAMS, which specifically targeted adolescent girls and women for HIV prevention, is a concern. While there's focus on mothers and pregnant women, the protection and services for non-pregnant adolescents and young women need renewed attention. The question remains whether new large-scale initiatives will emerge or if this responsibility will fall solely on individual countries, highlighting a gap in tailored adolescent HIV prevention strategies.

Significance (High): The lack of dedicated, large-scale programs for adolescent HIV prevention risks leaving a vulnerable population underserved. Ensuring that services are youth-friendly and tailored to their specific needs is critical to maintaining progress and preventing new infections.

Sources in support: Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

13. Lloyd Mulenga: Data Gaps and Prevention Woes

Timestamp: 00:58:41 to 01:00:51 - watch this moment on skim

The reliance on USG funding for data systems has created fragility, making it difficult to track individuals lost to follow-up. This disruption, particularly in prevention programs like safe spaces for key populations, is a major concern, potentially leading to an increase in new infections. While mortality data lags, the immediate worry is the erosion of prevention infrastructure.

Significance (High): The erosion of data systems and prevention programs directly threatens progress in combating HIV/AIDS, risking a resurgence of new infections.

Sources in support: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia)

Neutral sources: Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

14. Doris Macharia: The Unaccounted Children and Adolescent Services

Timestamp: 01:01:14 to 01:04:27 - watch this moment on skim

The fragmentation of support has severely impacted data systems, making it hard to track individuals, especially the 77,000 unaccounted-for children on antiretroviral treatment. Current aggregated data systems are insufficient. Furthermore, adolescent and youth-friendly services, crucial for HIV prevention and treatment, lack adequate government investment and support, necessitating innovative integration with existing services like HPV vaccination programs.

Significance (High): The lack of granular data and investment in youth-focused services creates significant blind spots and service gaps, jeopardizing efforts to achieve viral suppression and prep access for vulnerable young populations.

Sources in support: Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

15. Omar Sued: Multilateralism's Resilience Amidst Reform

Timestamp: 01:05:31 to 01:08:42 - watch this moment on skim

Despite criticisms and the need for reform, multilateral mechanisms like WHO and PAHO are indispensable for public health, as demonstrated during COVID-19 and other outbreaks. While facing potential funding reductions, these bodies are crucial for sharing experiences and supporting countries, as seen in the elimination of mother-to-child transmission initiatives in the Americas. The upcoming WHO leadership elections present an opportunity for debate on the future global health agenda.

Significance (Medium): The continued existence and effectiveness of multilateral health organizations are vital for coordinated global health responses, even as they navigate internal reforms and leadership transitions.

Sources in support: Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization), Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation)

16. Mark (implied speaker, referenced by Morrison): Key Populations and Funding Gaps

Timestamp: 01:08:45 to 01:10:31 - watch this moment on skim

The critical issue of key populations, which was under-discussed, is central to all challenges in adapting HIV/AIDS programs. The US, a major funder of key population programming through PEPFAR, has issued waivers that prevent many programs from continuing, forcing countries to struggle and find new ways to operate. Without focusing on these populations and robust data, ending HIV is unlikely.

Significance (High): The disruption of funding for key population programs and the lack of focus on these high-risk groups represent a significant impediment to achieving HIV/AIDS eradication goals.

Sources in support: Jirair Ratevosian (Research Scholar, Duke Global Health Institute)

Neutral sources: J. Stephen Morrison (Senior Vice President and Director, CSIS Global Health Policy Center), Lloyd Mulenga (Professor of Infectious Diseases, University Teaching Hospital, Zambia), Doris Macharia (President, Elizabeth Glaser Pediatric AIDS Foundation), Omar Sued (HIV Treatment and Care Regional Adviser, Pan American Health Organization)

Gates Foundation Funding (Low severity)

Type: Financial

The event is made possible by generous support from the Gates Foundation, which has significant interests in global health initiatives.

Significance: While the Gates Foundation is a major funder of global health, their financial support for this discussion could subtly influence the framing of priorities or the emphasis on certain solutions. However, the panel's diverse expertise likely mitigates any significant bias.

Foundation Funding (Low severity)

Type: Financial

The event and related work are supported by the Gates Foundation, a major funder in global health initiatives, including HIV/AIDS.

Significance: While the Gates Foundation is a critical partner, their significant financial role could subtly influence the framing of discussions around funding priorities and solutions, potentially favoring approaches aligned with their strategic interests.

PAHO Advisor's Advocacy (Medium severity)

Type: Professional

Omar Sued, as an HIV Treatment and Care Regional Advisor for PAHO, expresses strong support for multilateral mechanisms and the work of PAHO/WHO. This professional role inherently aligns him with advocating for these organizations and their continued funding and effectiveness.

Significance: Sued's position within PAHO means his advocacy for multilateral health bodies, while potentially valid, is also a professional imperative. This raises questions about whether his critique of global fund elections and praise for WHO's work are purely objective assessments or influenced by his organizational affiliation and career interests.