'Best of Times, Worst of Times for HIV Prevention,' Says Mitchell Warren of AVAC | IAS 2025

In this excerpt of an interview with Managed Healthcare Executive conducted before the International AIDS Society meeting in Kigali, Rwanda, Mitchell Warren, executive director of AVAC, describes the current state of HIV prevention.

"I would argue that this is the proverbial best of times and worst of times in HIV prevention," said Warren. He labeled the FDA's approval of a twice-a-year formulation of lenacapavir as "the greatest opportunity in 44 years for HIV prevention" and noted that the World Health Organization is scheduled to issue recommendations for lenacapavir for HIV preexposure prophylaxis (PrEP) today after he speaks at the International AIDS Society meeting.

Warren said, though, it is the worst of times for delivery of HIV prevention services with the dissolution of the United States Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief, better known by its acronym, PEPFAR, being told to restrict its prevention efforts ot pregnant and breastfeeding women.

Warren said it is also a time of "erasure" by the Trump administration of gay and transgender people and people who use drugs. As a result, he said that people in greatest need of lenacapavir are not being tracked, counted or engaged by PEPFAR or, domestically, by the Centers for Disease Control and Prevention.

"We should be at the moment of saying, 'How do we scale lenacapavir with speed, with scale and equity to truly bend the curve of the epidemic?' Yet the rug was pulled out from under us." HIV PrEP was never going to be without its challenges, said Warren, but it got much more difficult with the Trump administration. "We are not out, but it is going to be a helluva lot harder."

Mitchell is one of the speakers scheduled to speak at a satellite symposium today at the IAS meeting. The symposium is titled "Re-imagining Prevention: Ensuring Sustainable PrEP Access in an Evolving Funding Context." AVAC and the Zambian Ministry of Health sponsored the symposium.