Is a new HIV prevention plan ambitious enough? And can it survive Trump?

The announcement by several major global health players of plans to deliver a potentially game-changing HIV prevention technology to 2 million people over three years has drawn a range of civil society reactions, from enthusiasm to criticism that the endeavor is not nearly ambitious enough. And now, in the wake of U.S. President Donald Trump’s inauguration Monday, there are questions about whether the effort will even move forward at all.

The proposal, announced by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, and The Global Fund to Fight AIDS, Tuberculosis and Malaria, came late last year. Working with the Gates Foundation and the Children’s Investment Fund Foundation, the donors plan to enable 2 million people to get access to lenacapavir, a twice-yearly injection that showed almost complete efficacy in preventing HIV in two studies released last year.

In the HIV community, there is hope that lenacapavir will transform HIV prevention efforts, which are currently lagging. The Joint United Nations Programme on HIV/AIDS, or UNAIDS, has called for 10 million people to be on some form of preexposure prophylaxis, or PrEP, by the end of this year or 21.2 million to have used PrEP at least once this year. PrEP can dramatically reduce the risk of acquiring HIV. But only 3.5 million people were on PrEP in 2023, according to the World Health Organization, and nearly all of them are using a daily oral version.