At The Brink Of Eradicating HIV, America Retreats From Heroism To Hesitation

Correction, April 10: This article has been updated to clarify differences between the once-yearly and twice-yearly formulations of lenacapavir. Lenacapavir for HIV prevention remains investigational and is not approved anywhere globally. Phase 1 studies indicate promising results for once-yearly use. However, further research, including Phase 3 trials, is necessary to confirm its efficacy and safety. Meanwhile, the twice-yearly formulation is currently under priority review by regulatory bodies. Additional information has been included to clarify these distinctions.

What an extraordinary moment in medical history: Science has handed us a potential superpower to eradicate HIV/AIDS. Lenacapavir is being investigated as a once-yearly injection for HIV prevention, as shown in Phase 1 study results published in The Lancet. This breakthrough opens the door to eliminating HIV from humanity entirely though the drug remains investigational and has not yet been approved globally. Meanwhile, the United States is retreating from its global leadership role in infectious disease control.

We have the tools to become heroes, but instead of rallying behind this breakthrough, the U.S. is pulling back infectious disease programming at a critical juncture. Health and Human Services Secretary Robert F. Kennedy Jr. has dismantled key programs like the Office of Infectious Diseases and HIV Policy.

Lenacapavir is no ordinary drug. It represents a leap in HIV prevention and treatment. Recent clinical trials on the twice-yearly formulation of the drug have demonstrated near-perfect efficacy: zero infections among certain populations of participants who received the injection compared to expected rates without intervention. It slashed the risk of HIV acquisition by 96%.

Lenacapavir has demonstrated sustained plasma concentrations above efficacy thresholds for HIV prevention for over 56 weeks in Phase 1 trials on its once-yearly formulation, showing promise as a long-acting PrEP option. In the future, this could make the drug more accessible in regions with limited health infrastructure and as easy as getting a flu shot.

A Model for Eradication

This isn’t science fiction or wishful thinking. We’ve seen similar feats achieved before. Egypt recently eradicated hepatitis C in under a year by combining bold public health strategies with cutting-edge medicine. Egypt diagnosed 87% of people living with hepatitis C and provided curative treatment to 93% of those diagnosed, far exceeding WHO targets.

It didn’t have limitless resources; it relied on loans from the World Bank and decisive action. In less than three years, Egypt implemented a comprehensive testing program and tested 60 million people for the hepatitis C virus. If Egypt can do it with hepatitis C, why can’t we do it with HIV?

The answer lies not in science but in politics. The Trump administration’s cuts threaten to reverse decades of progress and disproportionately harm marginalized communities already at higher risk for HIV infection.

The administration has made significant reductions to key initiatives like the U.S. Centers for Disease Control and Prevention’s HIV Prevention Funding and the President’s Emergency Plan for AIDS Relief, jeopardizing access to life-saving services such as testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapy.

These cuts disproportionately affect marginalized communities, including LGBTQ+ individuals, Black and Latino populations and people experiencing homelessness. Globally, PEPFAR reductions threaten millions of lives in low- and middle-income countries, with South Africa alone projected to see hundreds of thousands of additional infections by 2028.

Science Alone Is Not Enough

The timing couldn’t be worse. Science magazine recently named lenacapavir its “Breakthrough of the Year,” highlighting its potential to transform global health outcomes. Yet, while researchers are delivering miracles that could end HIV, policymakers are choosing not to act.

Imagine what could be achieved if we embraced this opportunity instead of retreating. In the future, with lenacapavir as our cornerstone, we could launch a global campaign to eliminate HIV entirely:

• Treat and Prevent: Lenacapavir represents significant progress in HIV prevention but requires further research and complementary interventions to address global challenges in achieving eradication.
• Universal Testing: Population-wide testing campaigns could identify at-risk individuals and connect them with care.
• Strengthened Infrastructure: Building robust healthcare systems would ensure the effective delivery of treatments worldwide.

These steps aren’t hypothetical but achievable with political will and coordinated action. The World Health Organization is already preparing guidelines for global implementation, but success depends on nations stepping up to prioritize eradication.

Critics may point to challenges like manufacturing costs or cold-chain storage requirements for lenacapavir. Still, these hurdles pale in comparison to the stakes: ending an epidemic that has devastated lives for over four decades.

The choice is clear: embrace this historic moment or squander it through inaction. Lenacapavir offers hope for ending HIV/AIDS worldwide — a chance to rewrite history and save millions of lives. But hope alone isn’t enough; it requires leadership, investment and commitment.

America must decide whether it wants to be remembered as the nation that eradicated one of history’s deadliest epidemics or as the one that let it persist despite having the power to stop it. Science has delivered; now, it’s up to us to act decisively or face the consequences of our failure.