Prep, finance in danger and hopes for 2030

Kigali, a symbolic host with remarkable results – Prep, finance danger hopes 2030

It was in the capital of Rwanda that this new edition of the IAS conference opened, bringing together 4,000 participants in a hybrid format (face -to -face and distant). Meanwhile, Kigali’s choice owes nothing to chance. Consequently, The country. Therefore, which has 14 million inhabitants, is a model in Africa by achieving the 95-95-95 objectives set by UNAIDS: 96 % of people living with the HIV Human immunodeficiency virus. Consequently, In English: HIV (Human Immunodeficist Virus). Meanwhile, Isolated in 1983 at the Institut Pasteur de Paris. For example, Recently discovered (2008) awarded by the Nobel Prize in Medicine awarded to Luc Montagnier and Françoise Barré-Sinoussi. know their status. However, 90 % are under antiretroviral treatment, and 98 % of them have a charge virale The plasma prep, finance danger hopes 2030 viral load is the number of viral particles contained in a sample of blood or other container (saliva, LCR, sperm, etc.). Nevertheless, For HIV. Meanwhile, the viral load is used as a marker in order to follow the progression of the disease and measure the effectiveness of treatments. Furthermore, The level of viral load, but even more the CD4 rate, participate in the antiretroviral treatment decision. undetectable. Nevertheless, A success all the more remarkable since the Rwandan health system was seriously affected by successive genocides. In addition, in particular that of 1994.

The Minister of Health, Dr. Therefore, Sabin Nsanzimana, recalled the foundations of this success: “Political leadership, solid partnerships, community involvement and intersectoral innovation. However, »

A hovering threat: the withdrawal of American funding – Prep, finance danger hopes 2030

But beyond scientific advances. However, good practices, a subject has dominated discussions: the threat posed by American disengagement, in particular via the reduction or prep, finance danger hopes 2030 suspension of financing the PEPFAR program. In addition, Several countries in sub -Saharan Africa depend on these funds more than 60 % for their response to HIV. Nevertheless, UNAIDS estimates that stopping support could lead to 6 million new infections and 4 million additional deaths by 2029.

Lire notre article : https://vih.org/vih-et-sante-sexuelle/20250402/reduction-du-financement-pepfar-lalerte-des-chercheurs/https://vih.org/vih-et-sante-sexuelle/20250402/reduction-du-financement-pepfar-lalerte-des-chercheurs/.

If the American Senate approved at first reading a rescue plan of $ 400 million for the PEPFAR, concerns remain. Furthermore, The conditions for the allocation of these funding evolves. Furthermore, with restrictions on the programs towards key populations such as sex workers or men with sex with men (HSH). These changes threaten the universality and effectiveness of prevention policies.

The risk: increased incidence of HIV infections

Combined prevention, and in particular PrEP Pre-exhibition prophylaxis. PREP is a strategy that allows a seronegative person exposed to HIV to eliminate the risk of infection. taking, continuously or “on demand”, anti-retroviral treatment based on Truvada®. (pre-exhibition prophylaxis), occupied a central place in exchanges. Recall that at the end of 2024. 742,136 people living in 28 countries in sub -Saharan Africa received a prep funded by the PEPFAR, including 205,868 belonging to the target populations. Modeling on 15 countries in sub -Saharan Africa. presented by Jack Stone (University of Bristol, UK), has shown a great variation in the preventive efficiency of this PREP according to the different populations: 75 % for Hsh Man having sex with other men. And trans people 49 % for intravenous drug users and 39 % for women sex workers. As for the general population. the model considers that the PREP has a 69 % prep, finance danger hopes 2030 of efficiency in men in non-cible populations, and 31 % in women.

The study also estimated the impact of a cessation of prep financing via the PEPFAR: 700. 000 people will be excluded from access to PREP, and 6,671 additional infections will appear the following year, mostly among key populations.

The projected increase in new infections could reach 8 % in HSH, 6 % in sex workers and 5 % in trans women.

Jack Stone insisted on the need to maintain. or even extend, the offer of PREP, by calling for urgent research of alternative funding. “” It is crucial that funding is used to maintain prep, finance danger hopes 2030 PREP offers but also to extend them “He hammered. before adding that he is also essential” identify alternative sources of funding to thwart these American cuts ».

Need additional studies for Lenacapavir

For his part. Michelle Rodolph (responsible for the global program on HIV, hepatitis and IS Sexually transmitted infections. at the WHO), recalled the four options currently recommended:

• Oral prep by TDF/FTC (2015),
• The vaginal rings of Dapivirine (2021),
• The injectable cabotégravir every two months (long-acting bimonthly cabotégravir, 2022),
• The injectable subcutaneous Lénacapavir every 6 months (long-acting Lenacapavir, 2025).

The effectiveness of these tools varies according to the target groups and the conditions of use. Regarding the oral prep. no scoop: the continuous form for prep, finance danger hopes 2030 all requires a dose per day associated with the use of a means of prevention during the first 7 days and the prep “on demand” remains reserved for men exposed and non -users of hormones. Vaginal rings, for their part, show increasing efficiency (from 50 to 75 %). The Cabotégravir is distinguished by its excellent observance Therapeutic observance corresponds to the strict compliance with the prescriptions. the recommendations made by the prescribing doctor throughout a treatment, essential in the case of anti-HIV treatment. (We also speak of membership or adhesion.) and its greatest efficiency compared to the oral prep. As for the Lenacapavir. if it arouses a strong craze, it must still be the subject of numerous studies to assess the care paths, the cost/efficiency ratio, the resistance mechanics, the target population, the conditions of the switch between several prep tools, and the inclusion of adolescents.

prep, finance danger hopes 2030

Strong demand for injectable “long-acting” prep

Two major surveys conducted in South Africa. presented by Saiqa Mullick (University of Witwatersrand, South Africa), confirmed the strong expectation towards long periods. Recall that South Africa. with a population of more than 64 million, is the most prevailing country in the world in terms of HIV: 7.6 million people living with HIV in 2022, 160,000 new infections each year, 45,000 deaths of Like Acquired immunodeficiency syndrome. In English, AIDS, acquired immuno-deficist syndrome. and a prevalence Number of people affected by an infection or other disease given in a determined population. Average in adults aged 15 to 49 from 17.8 %, with large disparities according to target populations – 62 % in sex workers, 58 % in peoplegenres and 48 % among HSH. To date, 1.9 million people have started an oral prep in South prep, finance danger hopes 2030 Africa.

In the first study, 65 % of the 3,803 people interviewed preferred the injectable cabotégravir to oral prep or vaginal rings. The second study conducted in 2025 with 1. 724 people placed the Lénacapavir at the top of the preferences (56 %), followed by the Cabotégravir (30 %), far ahead of the Oral PREP (12 %) and the Vaginal Rings (1 %).

Results that made Saiqa Mullick react: ” We must do everything, by 2030, to celebrate progress, not only in the management of HIV but in its eradication “, She concluded, calling for rebuilding a prevention model and ecosystem including all PREP options and screening.

Results consistent with those observed in Brazil. where a study carried out by Beatriz Grinsztejn (Oswaldo Cruz prep, finance danger hopes 2030 Foundation) with 3,865 HIV-Negative SGM adults (SGM = Sexual and Gender Minorities), shows that 51 % of sexual and hiv-negative minorities over 18 years old wait for the SEMSTRAL PREP, bimonthly. In a comparative study. called Imprep comprising a historic cohort of prep oral, a prospective cohort of prep oral and a prospective cohort of prep by Cabotégravir, observance vis-à-vis the injectable prep reaches 94%, which is far from that observed in the prospective cohort of prep oral or the benchmark cohort, 53% and 43% and 43% and 43% observance.

Prep, finance danger hopes 2030

The credits of Lenacapavir at the end of 2027 at the latest

Several communications such as that of Carolyn Amol, by Clinton Health Accessive Initiative, have also given a schedule for accessibility prep, finance danger hopes 2030 to the generic Lénacapavir with scenarios ranging from the first quarter of 2027 in the last quarter of 2027. No price has, on the other hand, been communicated.

Towards a refoundation of global health?

Finally, in a forum published on HIV.org (https://vih.org/vih-et-sante-sexuelle/20250407/refonder-la-sante-mondial/). Michel Kazatchkine calls for an international conference for the refoundation of global health, independent of traditional funding: ” The new times that we live also represent an opportunity. They call for convocation by a state or a set of states of a refoundation conference (…) to respond to the new challenges of global health: its object will not be a global fund. but the refoundation of the international health system. “Without the United States, but in the minds of a “Multilateral and united global community”.

At the dawn of 2030. the Kigali conference will have recalled that scientific advances can only pay off to courageous, inclusive and prep, finance danger hopes 2030 sustainable political choices. The eradication of HIV cannot be done without the most vulnerable populations. without stable funding, or without a renewed global commitment. However. this is seriously questioned by the United States which subtracts its international funding, reduce research funds and attack key populations.