Rethinking prevention

Rethinking prevention

The funding crisis reshaping global health has hit HIV prevention particularly hard. At the same time, science is handing us some of the most powerful HIV prevention tools we have ever had – long-acting injectables like lenacapavir and cabotegravir, and a monthly oral pill on the horizon. 

But science alone does not deliver prevention. That takes systems, policy, funding and a trained healthcare workforce. It takes communities leading in planning, implementation and holding the HIV response to account. 

This episode of HIV unmuted is a curtain raiser for AIDS 2026, the 26th International AIDS Conference, taking place in Rio de Janeiro, Brazil, and virtually. The theme of the conference, Rethink. Rebuild. Rise., is also the spirit of this episode. We look at what rethinking prevention means in people's lives, what it will take to rebuild the systems and political will to deliver innovation at scale, and how the global HIV response can rise to this moment. 

Meet our guests:

Axel Bautista, Community Mobilization Coordinator at MPACT Global Action for Gay Men’s Health and Rights, shares what rethinking prevention really means on the ground, in communities and in people’s lives. 

Nomathemba Chandiwana, Chief Scientific Officer at the Desmond Tutu Health Foundation in Cape Town and a clinician-scientist at the forefront of HIV prevention, unpacks the systems and science needed to rebuild prevention and make innovation accessible to all. 

Beatriz Grinsztejn, President of the International AIDS Society and infectious disease physician-researcher at Fiocruz in Rio de Janeiro, asks how the global HIV response can rise at AIDS 2026. 

Meet our host:

Ibanomonde Ngema is a South African HIV advocate for young people living with and affected by HIV. She has spoken at major global platforms, including IAS conferences and the United Nations General Assembly. She serves as South Africa’s Her Voice Fund Ambassador and UNFPA’s Regional Youth Advocate for East and Southern Africa and has authored a paper in The Lancet. 

Transcript

Nomonde Ngema 0:01

Welcome to HIV Unmuted, the podcast of the International AIDS Society. I am your host, Nomonde Ngema. We are living through a paradox. Science is handing us some of the most powerful HIV prevention tools we have ever had. We are also going through one of the most turbulent periods global health has ever seen. Funding cuts, geopolitical shifts, services dismantled, communities left without the prevention tools they need. Long-acting injectable Lanacapa via and Kapotagraviya have shown incredible success in preventing HRD. Monthly oral prep is on the horizon. We are closer than ever to giving people options that fit their lives. But science alone does not deliver prevention. That takes systems, policy, funding, and a trained healthcare workforce. It takes communities leading in the planning and implementation and holding the HIV response to account. It takes the kind of determined, collective action this moment calls for. That is the spirit behind the theme of AIDS 2026, the 26th International AIDS Conference. Rethink, rebuild, rise. We need to rethink what prevention means in people's lives. We need to rebuild the systems, funding, and political will to deliver innovation at scale. And we need to rise to this moment together. In this episode, we first look at what rethinking prevention really means with Axel Bautista, a community mobilizer and activist from Mexico City. We turn to the science and systems needed to rebuild prevention with Nomathemba Chandiwana, Chief Scientific Officer at Desmond Tutu Health Foundation in Cape Town, a clinician scientist at the forefront of HIV prevention. We close by looking to AIDS 2026 and asking how the global HIV response can rise with Beatriz Grinsztejn, IAS President, Infectious Disease, Physician, Researcher at Fiocruz in Rio, and an architect of Brazil's remarkable HIV prevention story. Firstly, I want to look at what HIV prevention actually looks like in people's lives right now. Axel Bautista was diagnosed with HIV at the age of 21. More than a decade on, he is one of the most recognized HIV activists in Latin America, working with cure communities across the region. Axel, you work every day with people who want to access HIV prevention and often cannot. In 2026, with funding cuts and services disappearing, what does HIV prevention actually look like for the people that you work with?

Axel Bautista 3:07

The gap between what exists on paper and what exists in practice for full communities and other key populations in Latin America and in Mexico has always been white. And now it's getting wider. And of course, funding has always been a concern, but barriers have been around for like 40 years or longer. And like homophobia, transphobia, xenophobia against migrants, racism, and stigma related to people living with HIV is still persistent in all over the world. It doesn't matter if you live in Latin America or in Europe, in Central Asia or in Africa, it doesn't matter. Structural barriers and stigma having always been the problem. And what happens is that these structural barriers have a negative impact in prevention. For many people, HIV prevention is not something abstract. It's a very practical question. Can I access to PrEP? Can I access other prevention options? Can I have access to this without being judged for my sexuality or my sexual identity? Do you know what I mean? For queer people who already face barriers, these questions are not just about what does prevention look like. It's more about does prevention exist for me at all? So funding cuts just make it harder. Especially for the grassroots organizations that work directly with the community and that work as counterweight for stigma, inequality, and discrimination. The war, of course, becomes more difficult if you have like funding cuts because public services disappear, clinics close, and prevention programs get defunded. Building a strong community among poor people living with HIV can definitely benefit people who are not living with HIV because when they witness that there is like a supportive and a vibrant community, that people living with HIV can still be um strong, can be happy, can have a life, probably they will be less afraid of getting tested or potentially get an HIV diagnosis.

Nomonde Ngema 5:25

So community-led prevention is talked about constantly, but in Mexico and Latin America broadly, what does it take to build something that works and what gets in the way?

Axel Bautista 5:38

It means meaningful investing in queer communities and in key populations, empowering people, you know, mobilizing and activism. We need to address political and structural barriers. In Mexico and Latin America, we have a long history of community mobilization, not only in HIV, but also in women's rights, in queer rights, in uh workers' rights. We need to foster a community and a leadership that is political enough to see themselves with the capacity and the agency to challenge and change the power relationships that reproduce stigma and inequality. And that we need to empower that community so they can feel with the power to transform narratives about what it means to be queer and what it means to be living with HIV.

Nomonde Ngema 6:31

Axel, for my final question, I want you to picture this with me. You are sitting with someone holding their hand, they've lost access to HIV prevention, they've watched services and funding disappear, and they are exhausted. What do you say to them?

Axel Bautista 6:48

I actually say this to every person that gets an HIV diagnosis. I would say, we're not alone, you are not alone. You know, there is a queer community of people living with HIV that is gonna back you up. We're in this together, and that community will continue working to make HIV prevention services and other services better for everyone. Because sometimes what you know, like when we feel in that situation of isolation, we tend to think that there's nobody like going through the same situation, but like there is, and there is a community, and that's why people like you and Amanda and like me and other activists are working to make this community visible and make this community stronger so people can feel that they have somebody next to them and say, Okay, I'm strong and I can continue living. Also, I would say that your sexuality, your sex, and your sexual identity are not the problem. Estigma, discrimination, and structural barriers are. It's very easy that people feel that the problem is on them, you know, that the problem is them. And we need to continue saying that no, that's not a problem. This problem is something else, it's structural, it's political. You are not the problem. And actually, we as a community, we deserve to be invested in. There is like a bunch of activists that are still working and pushing the boundaries to put our needs at the top of the agenda. In moments of crisis, you know, having a strong community backing you up can save your life.

Nomonde Ngema 8:29

The scientific progress in HIV prevention right now is genuinely extraordinary. But extraordinary science and real-world access are different things. What does it take to rebuild a prevention system capable of delivering on the promise of these new schools? Dr. Nomathemba Chandiwana is Chief Scientific Officer at the Desmond Tutu Health Foundation in Cape Town, South Africa. A clinician scientist who has run large-scale HIV clinical trials across Africa and co-authored South Africa's national HIV strategy. She has dedicated her career to the question of how we get the best science to the people who need it the most. Noma Temba, welcome. So we have injectable Lenacapavir and Cabotegravir. Lenacapavir rollout started in South Africa in early June this year. We have monthly oral prep on the horizon. What does this scientific moment actually mean? And how close are we to making it real for the people who need it the most?

Nomathemba Chandiwana 9:40

It's a really exciting time for HIV prevention in Africa and the rest of the world. This is because we've got so many things in our toolbox, a few that you've mentioned. The injectable are the Lenacapavir and Cabotegravir. And also in the pipeline, we have other longer acting, easier-to-take things, such as the oral prep, as you had mentioned. It's quite an exciting time for me as a research scientist, but also primarily for our communities, because it's not offering one prep option versus another. It's like fruit, you know, instead of offering everyone bananas, we're offering people bananas, apples, pineapples because people have got different things that work for them and work for their lifestyle. So this is an exciting time not only for researchers, but for communities and for the HIV prevention program.

Nomonde Ngema 10:36

Over the past year, funding cuts have reshaped the research and HIV delivery landscape. What have you seen on the ground at the Desmond Tutu Health Foundation? Um, and what disappears when the money goes?

Nomathemba Chandiwana 10:49

The funding cuts that have affected South Africa have been really quite devastating for the program. And it's taken us quite a few steps back in terms of having access, having services available for people, particularly people that are harder to reach. This has also affected our communities and having our trust with the program that you don't have services that are available today and potentially disappear tomorrow. But South Africa program is one of the largest programs in the world. So the funding cuts not only affect what happens in South Africa, but also in the region, and also affecting not just service delivery, but research gains as well. At the Desmond Tutu Foundation, we've been affected much like a lot of governmental organizations and NPOs that are working in this space. We've lost colleagues and we've had to close some of the research programs that we're doing. South Africa's HIV program has had quite a difficult moment, especially in the past. And these gains that we've been able to make in the last 20 years have been largely in part through to all these investments that have been made by USAID, the PEPFAR program, and Global Fund. So these cuts have affected our program. With that said, I think though the funding cuts have also allowed us to prioritize, to make sure what is important in our program and why at this pivotal time in HIV prevention, why it's important for us to make sure that we do not go back and maintain the gains that we've made when it comes to HIV treatment and care.

Nomonde Ngema 12:41

With our previous guest, we were rethinking prevention. With you, we are rebuilding it. And that word matters because rebuilding implies that something was broken. It implies we know what we lost, but it implies also that we are going to be building again. What would a rebuild HIV prevention system, one that is genuined, look like to you?

Nomathemba Chandiwana 13:08

I love that framing around rebuilding. Not only about just the funding cuts, but HIV prevention, we've had to look at rebuilding it, making sure that it's stigma-free, that it's sustainable, and it's also involving our communities and accessible for people. For the average person living their life, going to work, going to school, HIV prevention needs to be slotted into their lives, not asking them to do extraordinary things to protect themselves and their loved ones. We need to make HIV prevention easy. So rebuilding it means we need to make access easier, meet people where they are. So giving them choice, and choice makes it more accessible. The third thing is around sustainability. We need to rebuild our program so that it's robust because we've had epidemics before, we had COVID-19 that shook our system, and we'll have other things that will come up in the future as threats to global health. So, how do you rebuild a system that can last and also last through whatever comes? As we're rebuilding, we can't rebuild it the same way. We have to rebuild it in a way that works. I think the emphasis in prevention before has been around biomedical things. We know the drugs work. It's really around how do we make sure that that package of services works for people and meet them where they are.

Nomonde Ngema 14:54

We have rethought what prevention means. We have looked at what rebuilding requires. Now we come to rise to what the global HIV response must do to deliver on the promise of this prevention moment in Rio de Janeiro. Dr. Beatriz Grinsztejn is the president of the International Aid Society and an infectious disease physician researcher who has spent her career in Rio. She co-founded the FIOCruz HIV and AIDS service. Beatrice is the first Latin American woman to lead the IAS and will host the world's largest conference on HIV and AIDS in her own city. Beatriz, Brazil has often been held up as proof that political will can change the cause of an epidemic, that a country can outperform far wealthier nations on HIV. You have lived inside that story. Tell us why Brazil has been so successful in the HIV response.

Beatriz Grinsztejn 15:56

So in Brazil, we have access to universal healthcare and communities also taking the lead in the response. We also had the luck to have political will at the highest level and capacity in place to produce generic drugs. So all of that grounded in a commitment to human rights and to health as a universal right in our society. So what people often miss when they talk about the Brazilian model is that it did not happen by accident. Brazil made sometimes difficult and costly political choices and helped them across decades and across different governments. So after decades of a harsh civil-military dictatorship during which Brazilian citizens experienced all sorts of crimes against human rights, the social response to this has been the creation of our universal multilevel health system called SUS, which ensures that all Brazilians have access free of charge to prevention and health care. But let us also be honest, the work is not at all finished. Inequalities in access remain along racial, social, class, and geographical lines. And for people who are still not fully accessing the services, mostly due to the social determinants of health. Brazil had made huge contributions to the science of prevention. I have been working in HIV prevention and treatment for about 35 years, and I can tell you the science we have now is absolutely extraordinary. We have tools that can change everything. The question is whether we will make the political and financial choices to deliver them to everyone who needs them. So for Brazil, rising means going further than protecting what has been won. It means providing access to the people the system has not yet reached and defending the foundations that made it possible.

Nomonde Ngema 18:11

Speaking of rising to the moment, let's turn to AIDS 2026. In July 2026, the world comes to your city for AIDS 2026 to rethink, rebuild, and rise. Beatriz, this is personal for you in a way that it cannot be for anyone else. What does it mean to bring the world to Rio? And what do you want people to take home with them?

Beatriz Grinsztejn 18:36

Yes, it's really significant for me personally. I was born in Rio and I have built my entire career in Rio working at Fio Cruz, the biggest and the most important research institution in the region. I have been working closely with communities most affected by this epidemic, including on prevention trials that are reshaping what we believe is possible. So Latin America brings something to this conversation, the experience of building a community-centered HIV response under enormous pressure, with limited resources in the face of stigma, inequality, and political resistance. What I want every delegate to carry home is renewed political commitment and a genuine commitment to putting communities in the center. Our slogan, rethink, rebuild, rise, is a call to action.

Nomonde Ngema 19:35

Thank you so much. So for my final question, I want to tie it in with hope. What do you say to a scientist, an activist, a policymaker, and someone who is losing faith that we can actually end this pandemic?

Beatriz Grinsztejn 19:50

I would say your work is changing lives in ways that would have seemed impossible just a decade ago. So keep going despite all the issues that you can face. Please pursue your career. To the activists, every major advance in the HIV response happened because communities demanded change and refused to accept no for an answer. To the policymakers, I would say that we have given you the science. We already know what works. What we need from you now is the courage to turn scientific progress into policies, programs, and investments that can reach people. And to an in-person losing faith, I would say that look at how far this response has come. The HIV response has always moved forward, built by people who had reasons to give up and kept showing up anyway. We are living through an extraordinary moment of scientific progress, but science alone is not enough. We need communities, political commitment, and collective action. So my message is simple. We all need to keep going. What is not simple at all? So we need to go forward together. Scientists, stakeholders, policymakers, activists, and the entire community. Bring your science, determination, experience, and ideas to AIDS 2026. There we will rethink, rebuild, and rise together.

Nomonde Ngema 21:43

What this episode has made clear is that we are living in a time of profound contradiction. We are at the same moment closer to ending HIV as a public health threat than we have ever seen before, and more at risk of losing ground than we've ever been in Euros. The science is extraordinary. The tools exist. What the world needs now is the political will, the funding, the health systems, and for the community to lead, to put those tools in people's hands. This is what Rethink, Rebuild, Rise means. It is not just a conference slogan, it is a program for action. Rethink outdated models that leave people behind. Rebuild systems that put people first rise together through inclusive policies, sustained funding, and the kind of community leadership that has always been at the heart of the HIV response. In July 2026, thousands of people from across the world will meet for AIDS 2026 in Rio de Janeiro and Virtue. We hope you will join us. This has been HIV Unmuted, the podcast of the International AIDS Society. To find out more about AIDS 2026, visit AIDS2026.org. If this episode moved you, share it. And if you're working in HIV prevention at any level in any community, thank you. Until next time.