The HIV/AIDS epidemic is one of the world's longest standing infectious disease threats, infecting more than 88 million people since 1981. We have the tools to curb this disease, but countries worldwide face several barriers that continue to drive inequities.

With 1.3 million new infections recorded in 2023 alone, it’s clear that HIV continues to strain health systems despite the strides made in recent years. However, HIV funding from global donor commitments has decreased by 30% since 2009, with approximately 40 countries reporting financing shortfalls. Most countries with the highest burden of HIV infection rely heavily on donor funding from the Global Fund to Fight AIDS, TB, and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, which are two of the biggest funders of global health initiatives to fight HIV and AIDS.

If we remain on the current trajectory of infection rates, global commitments to end AIDS by 2030 will not be met. Now is the time to reinvigorate global HIV/AIDS initiatives and use the latest science and evidence to work together to end this disease once and for all.

I believe that this is possible.

Every two years, the International AIDS Conference gathers more than 15,000 people from around the world to shift the latest evidence into action and accelerate the fight to end HIV.

Against the backdrop of dwindling global resources dedicated to HIV, this year's conference in Munich, Germany was focused on new ways to integrate HIV services and programs with other health sector initiatives and activities and provide some hope for new approaches and new science.

Palladium staff working on the USAID-funded Data.Fi and PROPEL Health projects, along with our infectious disease and HIV specialists, participated in the conference to showcase advances in HIV digital and information systems, global health security, and health policy and financing.

Several themes emerged throughout the conference—bringing new topics, initiatives, and evidence to the forefront of the global HIV response.

New Preventative HIV Product Success

The headline of the conference was the success of new long-lasting HIV prevention injectable products. The PURPOSE 1 study shared exciting news of zero HIV infections in a large-scale cohort taking the new injectable HIV prevention drug, lenacapavir. This new product offers an efficacious, safe, and discreet choice for pre-exposure prophylaxis, or “PrEP” among women.

The lenacapavir studies also included women who became pregnant through the trial and adolescent girls – which means there will be fewer delays in regulatory approvals for these populations as seen in previous products.

Forthcoming studies with this product and other long acting injectables in cisgender men, men who have sex with men and gender diverse populations are underway around the world.

Children With HIV Have Been Left Behind

Despite substantial progress in the fight against HIV, children remain marginalised. For instance, antiretroviral therapy (ART) coverage is 57% for children compared to 77% for adults. Globally, 1.4 million children live with HIV, predominantly in the global south, with eastern and southern Africa accounting for 59% of the total.

Palladium’s Data.FI project presented a six-year retrospective study (2017-2022) that focused on lessons of progress and challenges in preventing HIV transmission from mothers to their children.
Conference sessions also highlighted efforts in multiple countries that showed the relationship between vertical transmission and intimate partner violence (IPV).

Innovative Approaches

Multiple conference sessions presented on community-led monitoring mechanisms and interventions to improve HIV services and reduce stigma and human rights violations in Thailand, Zambia, Cameroon, Mozambique, and Myanmar, and highlighted the role of local communities to enhance accountability and service quality in HIV care.

Conference attendees also discussed Artificial Intelligence (AI) and its power to inform person-centered HIV care and health programming. Speakers presented projects where AI contributed to improved HIV care and service delivery by reaching underserved populations for HIV through testing or screening of non-communicable diseases, improving referrals, supporting health care providers, and optimising drug combinations.

Palladium’s Benedette Otieno presented a poster about integrating machine learning models in electronic medical record systems to deliver client-centric HIV testing services in Nigeria. Within the context of limited resources for HIV, and maintaining program scale and quality, cutting-edge AI technology has the potential to revolutionise HIV prevention, treatment, and system capacity.

Benedette spoke to the transformative power of AI in enhancing analytics for targeted HIV interventions, advancing differentiated HIV prevention and treatment strategies and bolstering healthcare system capacities in resource-limited settings.

Building on the Momentum from AIDS2024

Throughout the conference, thoughtful and pragmatic strategies were discussed to address inequities in the HIV response at national, regional, and global levels. These inequities are driven by reduced political commitment, low resource allocation, racial discrimination, criminalisation of HIV, lack of community involvement, anti-LGBTQ+ and anti-gender movements, and insecurity.

Palladium’s highest profile contribution to the conference was a joint session organised with our South Africa-based partner organisation, HEERO, titled "HIV and Global Health Security: Policy, Financing, and Data". The session attracted a diverse and global audience, highlighting practical guidance on developing investment case scenarios for countries to improve their HIV strategies and outcomes, and included presentations from Palladium leaders Suneeta Sharma, Ian Sanne, Shreshth Mawandia, and Clint Cavanaugh, as well as presentations from Mike Ruffner, the Deputy Director of the State Department’s Office of Global Health Security and Diplomacy and Mr. Nthabiseng Khoza, Acting Chief Director, HIV/AIDS & STIs, National Department of Health, South Africa.

To address the key drivers of inequity and respond to the complex and ever-changing environments to end HIV, we need bold leadership. We have not come to this point in the global HIV response because of timid leadership.

Initiatives such as the Global Fund and PEPFAR resulted from decisive and daring leadership—paving the way for others to join in the global response. Building from the momentum from AIDS2024, we must continue to bring together our collective expertise, knowledge, and experience to end HIV for good.

Returning home from the conference, I was left with a surprising hopefulness that the global bench of talent, energy and commitment to end HIV and AIDS as a global health threat remains strong. The work ahead remains daunting, but the continued research and the new innovations shared at AIDS2024 should inspire us all.

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