PrEP for All – Scaling Innovation

PrEP for All:

Scaling Long-Acting Innovation to Bend the Curve

By Dr. José M. Zuniga

The Kaplan-Reiter Memorial Lecture at Continuum 2026 in San Juan, PR, was masterfully delivered by Dr. Linda-Gail Bekker, Chief Executive Officer of the Desmond Tutu Health Foundation and one of the world’s leading voices in HIV prevention. Her lecture offered both a celebration of how far the HIV response has come and a call to action regarding the work that remains.

The memorial lecture paid tribute to the memory of Drs. Andy Kaplan and Gary Reiter, whose lives and legacies continue to inspire compassion, care, and advocacy within the HIV community. Dr. Bekker framed their contributions within the broader history of the epidemic – a history marked by extraordinary loss, remarkable scientific achievement, and relentless activism that shaped the HIV response.

Reflecting on the epidemic’s early years, she reminded conference attendees that more than 86 million people have acquired HIV since the beginning of the pandemic. The trajectory of HIV has been shaped not only by biomedical advances but also by the determination of communities that demanded action when governments, institutions, and healthcare systems often failed to respond.

Dr. Bekker highlighted the pivotal role of activists, advocates, and treatment access movements around the world. Their efforts helped transform HIV from a death sentence into a manageable chronic condition for millions of people. The development and global scale-up of antiretroviral therapy (ART) stands as one of the greatest public health achievements of modern times. Today, more than 31 million people are on ART, millions of lives have been saved, and AIDS-related deaths have declined dramatically.

Despite ART advances and the success of U=U, the world remains off track in preventing new HIV infections. Approximately 1.3 million people acquired HIV in 2024, which is the equivalent to more than 3,500 new infections every day. Young women in sub-Saharan Africa continue to face disproportionate risk, while key populations remain heavily affected across every region of the world. For Dr. Bekker, these statistics point to an unavoidable conclusion: the next phase of the HIV response must be driven by a primary prevention revolution.

While daily oral pre-exposure prophylaxis (PrEP) has transformed HIV prevention, it has not yet been sufficient to achieve the scale or persistence required to end the epidemic as an adjunct to treatment as prevention (TasP). Many individuals face challenges related to adherence, stigma, privacy concerns, and access to services. Prevention options that work well for one person may not work for another. The future therefore lies not in a single intervention, but in expanding prevention choice.

A central focus of the memorial lecture was the emergence of long-acting HIV prevention technologies. Dr. Bekker reviewed the growing evidence supporting long-acting PrEP. She noted that clinical trial results have demonstrated unprecedented levels of efficacy. These findings have generated considerable excitement within the global HIV community and offer the possibility of dramatically expanding prevention coverage among populations for whom daily medication presents barriers.

Importantly, Dr. Bekker stressed that scientific innovation alone will not end the epidemic. She repeatedly returned to the concepts of access, equity, and choice. Prevention technologies must be delivered through community-centered systems that recognize the diverse realities of people’s lives. Services should be integrated, tailored, and responsive to individual needs rather than expecting individuals to adapt to rigid healthcare structures.

Drawing on implementation science from South Africa and other settings, she highlighted the effectiveness of models that bundle HIV prevention with sexual and reproductive healthcare, mental health services, peer navigation, gender-affirming care, social support, and other essential services. Such approaches not only improve uptake of prevention tools but also help sustain engagement over time.

Community leadership emerged as another central theme. Dr. Bekker emphasized that communities are not merely recipients of HIV services; they are architects of successful responses. From the earliest days of the epidemic to today’s efforts to expand PrEP access, community organizations have played an indispensable role in building trust, reaching marginalized populations, reducing stigma, and advocating for equitable policies.

At the same time, she warned that recent funding disruptions, growing political hostility towards vulnerable populations, and reductions in international development assistance threaten decades of progress. She rightly indicated that scientific breakthroughs cannot achieve their full impact if access remains constrained by cost, policy barriers, discrimination, or insufficient investment.

Dr. Bekker’s memorial lecture concluded with a powerful challenge: advocate, agitate, act, and accelerate. There is no time to lose if the global community hopes to achieve HIV control by 2030. The tools exist. The science is stronger than ever. The question is whether the world will mobilize the political will and resources necessary to ensure that innovation reaches everyone who needs it everywhere. Time will tell…

Editorial Note from Dr. José M. Zuniga

Throughout the history of the HIV response, scientific breakthroughs have achieved their greatest impact only when accompanied by strong advocacy, community mobilization, and a commitment to equity. Long-acting HIV prevention technologies have the potential to transform the epidemic’s trajectory, but only if they are accessible to all who could benefit from them.

As funding uncertainties grow and health inequities widen, advocacy around access becomes more important – not less. We must work collectively to ensure affordable pricing, accelerate regulatory approvals, strengthen procurement mechanisms, support community-led delivery models, and protect the investments necessary to scale prevention.

The promise of long-acting PrEP is extraordinary. Realizing that promise will require the same courage, persistence, and activism that helped secure access to HIV treatment for millions of people around the world. The future of HIV prevention will not be determined solely by what science makes possible, but by whether we are willing to ensure that those possibilities are available to everyone.

Dr. José M. Zuniga is President/CEO of IAPAC, Fast-Track Health, and the Fast-Track Cities Institute.