In 2025, while the world celebrated a scientific leap in HIV prevention with the approval of lenacapavir, a powerful biannual injection, the progress was simultaneously threatened by major funding cuts — both at home and abroad — by the United States government. Once the largest funder of global HIV efforts, the U.S. has pulled back under the Trump administration's renewed term, raising alarms among health experts worldwide.

The Promise of Lenacapavir

Lenacapavir, a drug hailed as a “miracle product” by UNAIDS Executive Director Winnie Byanyima, offers protection against HIV for up to six months. In clinical trials, it showed an almost perfect rate of suppressing HIV infection. Unlike traditional PrEP pills, which require daily intake and target one stage of the HIV lifecycle, lenacapavir attacks the virus at multiple stages, making it a game-changing solution in prevention.

Its approval by the U.S. Food and Drug Administration (FDA) as a pre-exposure prophylaxis (PrEP) drug marked a scientific milestone. For the 400,000 Americans currently using daily PrEP pills, the option of a twice-yearly injection offered unprecedented convenience and protection.

Funding Cuts Threaten Rollout and Access

Despite this breakthrough, experts worry that the defunding of essential U.S. public health agencies may cripple the country’s ability to distribute the drug effectively. Key institutions like the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and health programs including Medicare and Medicaid have faced budget reductions.

Mitchell Warren, executive director of AVAC, cautioned against losing what he described as the greatest opportunity in four decades of HIV prevention. "Are we going to squander this?" he asked, highlighting how public infrastructure is essential to getting the drug into the hands of those most at risk.

Vulnerable Groups Left Behind

The cuts could disproportionately affect vulnerable populations — including low-income individuals, gay and bisexual men, sex workers, and people who inject drugs. Medicaid expansion in certain U.S. states has led to a rise in PrEP usage, showing that access matters. Without such support, these groups may lose access to the very protection that lenacapavir promises.

Jeffrey Crowley, head of the Center for HIV and Infectious Disease Policy at Georgetown’s O’Neill Institute, stressed that Medicaid and similar services have played a vital role in reducing HIV transmission. The rollback, he warned, could undo years of progress.

A Global Setback with Deadly Consequences

Beyond U.S. borders, the situation is equally dire. Programs like PEPFAR and USAID, once lifelines for HIV-impacted nations, especially in Africa, have seen drastic funding reductions. UNAIDS estimates that 2,300 additional HIV infections may occur annually due to PEPFAR cuts alone.

Byanyima noted a visible drop in clinic visits across several countries, and Warren likened the scale of regression to “throwing out a whole generation” of effort. While pregnant women and new mothers still receive support under PEPFAR, access for key risk groups has been curtailed.

After decades of progress, the global fight against HIV stands at a dangerous crossroads. The development of lenacapavir could have been the turning point — a near “silver bullet.” But without the public health infrastructure and funding to deliver it equitably, this scientific victory risks becoming a missed opportunity.