In early 2025, 22-year-old Jokpee Emmanuel arrived at Reach Out Mbuya in Kampala, Uganda, expecting to attend the Friends Forum—a safe space for young people to gather, share and support each other. Instead, he was met with a sign on the gate: “Due to the suspension of United States funding, Reach Out Mbuya will be closed for 90 days. We regret the inconvenience caused.” 

The Reach Out Mbuya community health initiative is not just a health facility. It is a lifeline. For years, it served Uganda’s most vulnerable communities, offering care that goes far beyond medicine. For Jokpee, who was born with HIV, Reach Out provided access to antiretroviral therapy, emotional support, school tuition and dignity. “Reach Out was like a second home,” he says. “They did not just give me medicines. They cared for me and reminded me that I am more than my diagnosis. I could live a full life.” 

The closure followed a suspension of United States funding through PEPFAR, which had long supported community-led HIV responses in Uganda. The impact was immediate and severe. Community-led and community-based centres such as Reach Out Mbuya are central to public health in many low-resource settings. They offer holistic, personcentred services catered to local realities. They respond to the social, emotional and economic realities of people’s lives. These systems have been essential to the global HIV response, driving down infections and improving quality of services and life, especially among marginalized groups. 

Jokpee was forced to seek care at an overcrowded Government facility. He waited six hours, only to be told antiretroviral medicines were out of stock and to return the following week. “A week without antiretroviral medicines! That is how resistance develops. That is how people die,” he says. 

He eventually received a one-month supply of medicines, but the fear of another stockout remained. Although the Government of Uganda worked to fill the gap through national health facilities, it could not match the reach or personal connection of community-based programmes. 

In the weeks that followed, Reach Out Mbuya managed to reopen, with support from a PEPFAR-funded programme called Kampala HIV Project. Most staff returned, restoring most of the centre’s core services. The number of clients accessing the centre is slowly increasing but is still below previous levels. 

Jokpee’s story is a warning. When community-led and -based systems lose support, people fall through the cracks. If it were not for places like Reach Out Mbuya, Jokpee and his peers would be at risk of being left behind in the HIV response. 

Sustained investment in community-led responses is the only way forward if we are to end AIDS as a public health threat by 2030.

GENEVA, 15 July 2025–Lenacapavir–a long-acting, six-monthly injectable antiretroviral medicine manufactured by Gilead Sciences–is now recommended by the World Health Organization as an additional HIV prevention choice as part of combination HIV prevention approaches.  

Lenacapavir, a new pre-exposure prophylaxis (PrEP) medicine, has the potential to increase the uptake of PrEP and bolster HIV prevention overall as it allows people to choose a method that they prefer. Lenacapvir, administered twice a year, is highly effective at reducing the risk of HIV acquisition. 

At a time when funding cuts could lead to an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029, long-acting injectable medicines are a fresh option for all people at risk for HIV--especially those who face higher risk and in locations where the virus is highly prevalent: adolescent women and girls, LGBTQI+ people, sex workers and people who use drugs. 

As Gilead has not yet registered Lenacapavir for regulatory approval in all countries, many people, including those facing disproportionate risk for HIV, may have to wait longer than others to access this life-saving tool.  

Transparency in production costs and pricing strategies is fundamental to removing some market barriers to universal access to innovative products. UNAIDS remains committed to ensuring full transparency from originator pharmaceutical companies regarding how much health technologies cost to produce and at what level they are priced. Lenacapavir is no exception. Research shows that Lenacapavir can be produced at a thousand times less than its US price. Dozens of developing countries have been excluded from the licenses for generic Lenacapavir and for cabotegravir (another long-acting injectable antiretroviral for HIV manufactured by ViiV Healthcare).  

The volume of Lenacapavir must be scaled up – but to do so, we need accessibility and affordable prices. Lenacapvir’s limited availability and unaffordable price not only threatens lives, it also undermines the potential positive impact Lenacapavir could have on the AIDS pandemic. Significant funding cuts to foreign assistance for HIV have plunged the global response into crisis. In addition to viral suppression among people living with HIV, ensuring broad, rapid and affordable dissemination of this new health technology would hasten the decline of new HIV infection rates and would help limit the scope of the pandemic; essential, especially in a moment of constrained resources. 

UNAIDS urges Gilead to swiftly register Lenacapavir for regulatory approval in all low- and middle-income countries - starting with those with the highest HIV incidence - and to ensure affordable access for everyone who could benefit, wherever they live. UNAIDS also encourages countries to prioritize prevention options that deliver impact and use simplified and differentiated delivery of prevention services to reach those in need. 

There is no more time to waste. Governments, civil society, and the private sector need to take all steps necessary to enable equitable, global access to new health technologies for HIV such as Lenacapavir and Cabotegravir - and UNAIDS is here to support them.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

“There is no such thing as peer support here,” says Mark Shaheel Lal, founder of Living Positive Fiji. “We are starting from zero.”

When other parts of the world were wrestling with soaring HIV rates during the 1990s and early 2000s, Fiji was hardly affected. With a population of under one million, HIV remained under the radar in the South Pacific island chain. 

But there has been an exponential increase in recent years. Since 2014, the number of new HIV infections in Fiji has risen ten-fold. Last year the number of newly diagnosed people tripled from 2023 levels

In January the Government of Fiji declared an HIV outbreak in response to the sharp increase in new diagnoses. Although its HIV Surge Strategy seeks to rapidly expand HIV testing and treatment, most people still aren’t accessing the services they need. 

Last year just a quarter of people living with HIV in Fiji were receiving antiretroviral therapy. Concerningly, a third of those who have been diagnosed are not on treatment.

Mr Lal is among a group of stakeholders that is working not only to spread the word that HIV medicines work, but to support people to access care. He is also among the few people living openly with HIV in Fiji.

“There is this idea that you come from a small island and everyone knows each other, so the stigma here is high. I want to help reduce that,” he explains. 

Dean Cassano is a Senior International Health Project Officer at Burnet Institute, an Australian public health research organization with a focus on underserved communities. 

“The intervention we are proposing is a community-led response and what that looks like is peers counselling other peers. Somebody living with HIV is enabled, trained and mentored with the skills and methodology to counsel other people living with HIV. The core objective is to improve treatment adherence,” Mr Cassano explains. “We know that when someone talks to a peer they can ask about misconceptions, fears, advice on how to have a baby or how to tell a partner. They would be getting holistic support, so they know there is a way through.”

At present, people who learn they are HIV-positive in Fiji are referred to one of three sexual health clinics. Many simply never show up. 

“They are too embarrassed… too scared,” Mr Lal says.

The new approach would immediately introduce newly diagnosed people to a peer counsellor. Peer counsellors would also play a key role in supporting clients as they access treatment, contact tracing, and reaching out to those who have stopped coming to the clinic. 

The Institute had worked on an HIV Peer Counselling Toolkit for neighboring Papua New Guinea (PNG) where new infections are also rising dramatically. Together with Igat Hope, PNG’s main people living with HIV organization, they developed culturally specific modules. The Australian Government funded this initiative as part of the Sexual Reproductive Health Integration Project.

“There are ten topics that someone newly diagnosed with HIV needs to know about how to live well,” Mr Cassano explains. 

Burnet has collaborated with partners in Fiji to adapt the toolkit, for example including local specifics in sections on food and alcohol. Fiji requires an additional module on harm reduction. Among newly diagnosed people who are currently receiving antiretroviral therapy, half contracted HIV through injecting drug use.

Now comes the next step—mobilizing and training these peer counselors. With no resources immediately available, the partners raised more than AUD$146000 through a crowdfunding campaign which ended in June. Now the training begins.

“This began as a result of us seeing a need and hearing from local partners that they want this but realizing that there is no money. The long-term plan is that this peer support is embedded into the national HIV response and is a core tenet for post-diagnosis support. Our hope is that it is sustained but first it must start,” Mr Cassano said.