Lloyd Mulenga, M.B.Ch.B., Ph.D., on HIV prevention funding cuts | IAS 2026

U.S. government funding cuts have sharply curtailed Zambia's HIV prevention programs even as treatment and laboratory support have continued largely intact, according to Lloyd Mulenga, M.B.Ch.B., Ph.D., director of infectious diseases at the Zambia Ministry of Health. Mulenga spoke to Managed Healthcare Executive before AIDS 2026, the 26th International AIDS Conference, taking place this week in Rio de Janeiro, Brazil. He is listed as a featured speaker at the meeting.

Mulenga said commitments the U.S. government made for 2026 for treatment-related commodities still stand, and Zambia has continued receiving antiretrovirals for treatment as well as laboratory supplies. Prevention is a different story: funding for oral pre-exposure prophylaxis (PrEP) pills and for the long-acting injectable cabotegravir has disappeared. Zambia is nonetheless expecting a shipment of the long-acting injectable lenacapavir from the U.S. government shortly, part of a broader procurement Mulenga said is in the tens of thousands of doses, though he did not give a precise figure.

“For you to deliver prevention…you need to have the community systems supported,” Mulenga said, describing what has been lost even when “commodities” for treatment are still arriving.

Prevention efforts in Zambia had largely been run through community providers supported by the U.S. government, Mulenga said. Staffing has also been affected: Mulenga said Zambia's program is funded with confidence only through September, with no clarity yet on what human resource support will look like from October onward.

Disruption and cuts in funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) are expected to be a major topic of the Rio meeting, which is sponsored by the International AIDS Society. According to a search of the meeting’s program, three sessions where abstracts are being presented orally, two e-posters and 14 posters have PEPFAR in the title. PEPFAR cuts have been one of the topics discussed at the premeeting press conferences. Results from a survey conducted by amfAR, The Foundation for AIDS Research. found that disruption of funding has led to the closure of 1,700 service delivery sites.