In the last quarter of 2024, the breakthrough year of new long-acting technologies for HIV prevention concluded with the release of findings from key studies. The Global HIV Prevention Coalition welcomed results of PURPOSE 2 for Lenacapavir and the announcement of three-month vaginal pre-exposure prophylaxis (PrEP) rings presented at the Research for Prevention conference; AVAC launched a Gears for Lenacapavir for PrEP suggesting a pathway for roll-out; UNAIDS launched the World AIDS Day report calling on key stakeholders in the response to thread human rights across programmes and policies to ensure all people have access to HIV services and The Global Fund, PEPFAR garnered support with CIFF and BMGF to reach over 2 million people with Lenacapavir pending regulatory approval. This newsletter will dive into these developments whilst providing a snapshot into what’s next in 2025.
New long-acting technologies for HIV Prevention in 2025
Innovations in long-acting HIV prevention generated excitement around the globe in 2024, particularly the prospect of a three-month dapivarine vaginal rings and injectable Lenacapavir for HIV prevention which may become available in 2025.
Lenacapavir for HIV prevention
With the results from PURPOSE 1 and 2 trials, Gilead Science’s 6-monthly injectable Lenacapavir (LEN) has been hailed as the breakthrough of the year in science - a promising prevention option widening the array of choices. The results from PURPOSE 1 showed 100% efficacy in preventing HIV in 5,300 cisgender women in Uganda and South Africa, and the PURPOSE 2 trial showed a 96% reduction in HIV incidence among cisgender men, trans, and non-binary individuals across multiple countries in the America, Africa and Asia. During the last quarter of 2024, AVAC launched the Gears for Lenacapavir for PrEP roll out report outlining the need for a multisectoral approach to ensure equitable access to this innovative tool. This was also highlighted in a webinar titled “Update on Injectable Lenacapavir for PrEP”. You can read more on lenacapavir here.
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In 2025, Gilead sciences will be working with countries to obtain regulatory approvals. In January, the World Health Organization is convening a Guideline Development Group to develop the guidelines for injectable lenacapavir as HIV PrEP and the optimization of HIV testing services for long-acting prevention products. With regulatory approval from the United States Food and Drug Authority, the Global Fund, PEPFAR, CIFF and BMGF through a coordinated effort plan to work with partners to ensure that two million people have equitable access to affordable lenacapavir in Global Fund and PEPFAR supported countries for three years. Gilead sciences is also working on a 12-month injectable lenacapavir for PrEP.
The dapivarine vaginal ring
During the second half of 2024, a partnership announcement was made by the Global Fund and the Children’s Investment Fund Foundation (CIFF) of an USD 2 million initiative for 2024-2025 to purchase an estimated 150 000 dapivirine vaginal rings for use as PrEP in the Global Fund grant implementing countries. In October 2024, at the Research for Prevention (R4P) conference in Peru, the Population Council announced phase 1 trial results from IPM 054, showing that the three-month dapivirine ring is as safe as the currently available one-month ring with similar levels of drug release. This would increase accessibility to one of the most discreet HIV prevention options for Women and Girls.
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Real-world studies for long-acting injectable cabotegravir (CAB-LA) for PrEP show more high effectiveness and adherence in preventing new HIV infections.
ViiV Health care real-world studies presented at IDWeek2024 showed high effectiveness and adherence in three implementation studies with a total of nearly 1,300 individuals in the United States of America. These include: the Trio Health cohort conducted among 474 cis-and transgender male and female individuals showed CAB-LA for PrEP’s effectiveness in the real-world with zero cases of HIV acquisition during follow-up and adherence to CAB-LA for PrEP was high, Of the 396 participants with continuation injections, only 3% of participants experienced a missed injection.
The OPERA study conducted among 764 individuals (29% of whom are Black and 29% Hispanic) highlighted high adherence and effectiveness of CAB-LA for PrEP. CAB-LA for PrEP with only 2 of 764 (0.3%) participants acquiring HIV. 85%of individuals taking CAB-LA for PrEP had complete initiation of the regimen – 69% of these complete initiators received all their continuation injections on time.
The PILLAR implementation study conducted in more than 200 men who have sex with men (MSM) and transgender men (TGM) who initiated CAB-LA for PrEP after previous experience with daily oral PrEP. showed that CAB-LA for PrEP may help address key PrEP challenges of stigma and anxiety. The six-month findings from the PILLAR trial showed that individuals taking CAB-LA for PrEP reported lower rates of PrEP stigma and anxiety compared to their prior oral PrEP experience, and that the long-acting injectable was feasible, acceptable, and convenient for their life. Further research will continue to explore the long-term benefits of CAB-LA for PrEP and optimize its’ use.
Countries that have commenced with the programmatic roll out of CAB-LA include Zambia, Zimbabwe, Malawi, Eswatini, Ukraine, Ethiopia with additional countries joining in 2025.
HIV Prevention at the UNAIDS Programme Coordinating Board
In December 2024, the 55th UNAIDS Programme Coordinating Board (PCB) hosted in Nairobi, Kenya. Global Leaders during this meeting, called for access to long-acting medicines as well as highlighting opportunities to reduce prices of Lenacapavir for HIV prevention through generics, expanded local and regional production, and the use of TRIPS flexibilities by member states.
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The 2021-2026 Global AIDS Strategy (GAS) mid-term review findings were presented showing that progress towards reaching the 2025 targets for combination HIV prevention as off track. Modelled projections showed that over 2.5 million additional HIV infections will occur between 2020 and 2030; significant reduction of new HIV infections towards the 2030 targets will require strengthened efforts towards societal enablers alongside other prevention interventions. The annotated outline for the GAS 2026-2031 will be developed through a transparent multistakeholder process and presented at the PCB in June 2025 for consideration.
An Update on HIV in prisons and other closed settings underscored the lack of progress on HIV prevention, treatment and care related to persistent challenges of stigma and discrimination. Member states were urged to: collect disaggregated data on epidemiological trends and related service provision; create legal and policy framework that contributes to improving prison conditions; integrate HIV services across prisons and public health departments, community-led services and other relevant stakeholders to strengthen comprehensive access to services and prioritize resource allocation for comprehensive combination HIV prevention in prisons and other closed settings as part of national Sustainability Roadmaps.
Country progress in HIV Prevention – national road maps and scorecards
By December 2024, over 25 countries within the coalition had developed HIV prevention national roadmaps and/or strategies – an achievement attributable to all the coalition partners notably BMGF and the UNAIDS Technical support mechanism through which eligible countries are funded to develop these strategic documents that serve as programmatic and policy instruments to accelerate HIV prevention efforts.
Following the implementation of the 2025 Global HIV prevention Road map survey, results showed that majority of the countries were adopting and implementing the 10 essential actions particularly on milestones and commitments to allocating public funds to community-led services, policies on legal and structural barriers as well as new prevention strategies.
The 2024 national scorecards show variations in progress across the different countries within the coalition; countries with steeper declines like Botswana, Eswatini, Kenya, Lesotho, Malawi, Rwanda, Zimbabwe among others showed progress in primary prevention and treatment.
The Global HIV Prevention Scorecards serve as a key tool in monitoring and assessing national progress in implementing HIV prevention programs. They offer a clear, data-driven overview of countries' achievements and challenges across key areas of HIV prevention; supporting stakeholders perform HIV prevention programmes reviews to showcase areas of progress and identify gaps where resources and efforts should be concentrated. The 2024 scorecards were disseminated through a webinar: Download scorecard resources.
Advanced VMMC modelling results show its’ impact on epidemic control
Advanced voluntary medical male circumcision (VMMC) modeling results are based on applying the GOALS HIV model in 13 countries (Botswana, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe). About a million new HIV infections have been averted by the 37 million VMMCs – representing one infection averted for every 42 VMMCs conducted since programme inception in 2008 to 2023. In the first scenario, the projection for each country used circumcisions through 2023 and assumed no more VMMC after 2023 while the counterfactual scenario assumed that no VMMC program ever existed. Infections averted are the difference in new infections between the two scenarios.
The number of PLHIV in the counterfactual was relatively higher due to absence of VMMC. Through to 2030, new infections averted by VMMCs already will rise to 1.4 million and by 2050, the cumulative impact will be 3.2 million new HIV infections averted. Scaling up VMMC efforts will therefore have a relatively significant impact in reaching epidemic control within 15 priority countries, which still matter for the response globally. Access VMMC more modelling resources here.
Addressing risks of stimulant drug use in the context of HIV prevention among people who inject drugs
Gaps persist between stimulant drug use and appropriate interventions such as harm reduction among people who use and inject with drugs. The world drug report underscored a 6-fold higher mortality rate among stimulant drug users. The South-to-South Learning Network hosted the GPC key population community of practice webinar that was focused on addressing risks that could be fatal as well mental health issues across all populations particularly among people who use and inject with drugs. UNODC has conducted a series of trainings and workshops across various countries globally including Brazil, Malawi, Zambia, South Africa, Pakistan among others. A detailed update can be accessed here.
Take the Rights path to end AIDS
The 2024, World AIDS Day theme, “Take the rights path to end AIDS” was a call to all global and national stakeholders to streamline human rights-based approaches across programmes and policies to reach the goal of ending AIDS as public health threat by 2030. With the era of new prevention long-acting technologies, an era of HIV prevention method mix and choice is in sight, however this would require all stakeholders to address HIV prevention as a human right and ensure that all people have equitable access to HIV prevention services.
Steering country stewardship for HIV Prevention
According to the 2024 Global AIDS Update, an estimated 1.3 million new HIV infections were acquired in 2023 – three times more than the global target of fewer than 370 000 annual HIV infections by 2025. For prevention – much more so than for life-saving treatment or nutrition – demand and action are not a given. Strengthened prevention stewardship remains central to ensuring Primary HIV prevention remains high on the agenda across countries by bridging the persistent gaps in prevention financing including social contracting, creating an enabling legal and policy environment for implementation of programmes and strengthening political leadership to advance HIV prevention. To which end, the HIV multisector leadership forum with support from the GPC secretariat hosted the third quarterly meeting aimed at steering stewardship discussions across the GPC focus countries. Read full report.
A preview into 2025 – a snapshot into what the Global HIV Prevention Coalition will advance collectively:
1. A major global push for prevention access including both new and existing prevention options.
2. A new 2030 global prevention plan and subsequently country plans with revised targets reflecting the new era of HIV prevention method mix.
3. Expanded support to country-led and community-led prevention ensuring trusted access platforms for services, scaled programmes and united action to address barriers to prevention access.
GPC Upcoming Events
Global HIV Prevention community of practice webinar, 27 February 2025
HIV Multisector leadership Forum quarterly meeting, 27 March 2025
International Condom Day, 13 February 2025
Zero Discrimination Day, 1 March 2025
International Women’s Day, 8 March 2025
Publications in the last quarter of 2024
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For any comments or questions on the above, please contact us at hivpc@unaids.org.
Kind regards,
Global HIV Prevention Coalition Secretariat | UNAIDS Joint United Nations Programme on HIV/AIDS | 20, Avenue Appia CH-1211 Geneva 27. Switzerland.
About the GPC
In 2017, a global coalition of United Nations Member States, donors, civil society organizations, and implementers was established to support global efforts to accelerate HIV prevention. Membership includes 38 of the highest HIV-burden countries, UNAIDS Cosponsors, donors, civil society, and private sector organizations. The overarching goal of the Global HIV Prevention Coalition is to strengthen and sustain a political commitment to primary prevention by setting a common agenda among key policy-makers, funders, and programme implementers.