The First Generation Without AIDS Is Within Reach If We Refuse to Settle
This isn’t about managing the AIDS pandemic. It’s about ending it — and letting a new generation grow and thrive free of its threat.
We stand at the edge of an extraordinary possibility: to end the AIDS pandemic, eliminating HIV as a public health threat. Over the last few decades, more than 40 million people have died of AIDS and there are another 39 million people living with HIV. But now we could see the first generation of children growing up free of the threat of being infected with HIV. This would be a historic achievement.
The science makes this goal achievable. The data makes the case undeniable. What’s uncertain is whether we have the courage to grasp this opportunity.
Today, we are still losing the equivalent of a couple of packed jumbo jets of people to AIDS-related illnesses every day — 630,000 deaths in 2023 alone. In the same year, 1.3 million people were newly infected with HIV. These are not just statistics. These are children, parents, friends and neighbors.
While we have made huge progress against HIV, with deaths down by 73% since 2002 in the countries in which the Global Fund invests, there is a real risk of complacency and incrementalism. We've perhaps grown too comfortable treating HIV and AIDS as chronic conditions to be contained, rather than a crisis to be finished. But epidemics don’t end when we stop paying attention. They end when we confront hard realities, back what works and refuse to settle for anything less than success.
The most glaring failure is in prevention. Despite huge progress in treatment access — now reaching nearly 30 million people — HIV prevention has flatlined. This is not good enough, particularly for the adolescent girls and young women in sub-Saharan Africa who account for three-quarters of new infections in their age group. No epidemic has ever been ended without stopping transmission.
That’s what makes the arrival of long-acting PrEP so significant. Lenacapavir, a twice-yearly injectable for HIV prevention, has the potential to change the game — not just for individuals, but for public health. For young women who face stigma taking daily pills, or for key populations living under the threat of criminalization, lenacapavir offers discretion, durability and dignity.
On 9 July 2025, the Global Fund announced an agreement with Gilead, the manufacturer of Lenacapavir, to ensure affordable access to this ground breaking innovation in low- and middle-income countries. Together with partners, we aim to make Lenacapavir available to 2 million people in the next three years. The Global Fund is already working with countries, communities and partners to prepare for rapid, equitable rollout — supporting regulatory readiness, delivery infrastructure and community engagement.
Yet biomedical innovations like Lenacapavir only make a difference if they reach the people who can benefit the most. Since 70% of new HIV infections occur among key populations and their sexual partners, that means tackling the barriers to access these communities often face. Without action on stigma, discrimination and criminalization, we will not realize the full potential of Lenacapavir.
Empowering communities to take the lead on HIV prevention is vital: where communities lead, outcomes improve; where they’re sidelined, infections grow. That’s why the Global Fund channels much of our investment in HIV prevention — about a third of our total spend on HIV — through civil society networks that can reach the people most at risk.
Cutting the number of new infections is also critical to ensuring the longer-term sustainability of the fight against HIV. Countries must accelerate their journey toward nationally owned and nationally financed HIV responses, no longer dependent on external support. Yet this transition is a pathway, not a switch. Too abrupt a transition would derail progress, leave people behind and cost millions of lives. The lower the rate of new infections, the faster and more feasible the path to countries’ self-reliance. Taking on responsibility for a long duration but declining health issue is a much more manageable challenge than taking on a still rapidly growing problem.
That’s why we see Lenacapavir as an integral part of our sustainability and transition strategy. It’s also why the Global Fund supports countries in building systems that will outlast us — including integrated service delivery, robust supply chains, health workforce capacity and digital data systems.
Reducing funding for prevention would defer the end of the AIDS pandemic and cost many more lives. It would also delay the transition away from external funding. Ending AIDS is one of the most achievable and cost-effective goals in global health. For every US$1 invested in HIV prevention, US$7 are saved in treatment and care costs later. We either pay to end the epidemic now, or we pay the human and economic price for decades to come.
This isn’t just a technical challenge — it’s a test of values. Do we believe that a girl born in rural Malawi deserves the same chance to live HIV-free as a girl born in Manchester or Minneapolis? Do we believe that access to lifesaving services should not depend on who you are, whom you love or where you live?
The first generation without AIDS is not a dream. It is a choice. But it’s a choice that requires urgency, clarity and courage — not next year, but now. History won’t remember how well we managed AIDS, but will record whether we ended it.
This op-ed was originally published on Forbes.