Mitchell Warren says 3M lenacapavir goal falls short | AIDS 2026

In April 2026, the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria upped their goal for lenacapavir pre-exposure prophylaxis (PrEP) from 2 million to 3 million people by 2028.

“They kind of cheaped out,” Mitchell Warren, executive director of AVAC, a U.S.-funded organization that advocates for HIV prevention, said in an interview with Managed Healthcare Executive (MHE) ahead of the 26th International AIDS Conference (AIDS 2026), held this week in Rio de Janeiro that concluded today.

Warren said the existing PrEP market in the highest-burden countries already exceeds 2 million users a year and is growing about 20% annually and that when people are offered a choice, roughly 60% choose injectable PrEP over the daily oral pills for prevention. By his organization’s forecasting, that alone points to demand for about 1.5 million injectable PrEP users in the first year of rollout. He said the 3 million target over three years is also too small to meaningfully change the trajectory of an epidemic that adds roughly 1.3 million new HIV infections a year. “They kind of cheaped out,” Warren said of PEPFAR and the Global Fund’s commitment.

Warren said he still credits PEPFAR and the Global Fund for investing more aggressively in lenacapavir than they did in earlier PrEP options, including oral PrEP and the injectable cabotegravir, which together reached only 3 million users worldwide after 12 years of availability. He argued the funders should be aiming for 5 million people a year within three to five years, in countries such as South Africa, Zambia, Zimbabwe and Mozambique, both to blunt new infections and to drive the price of lenacapavir below that of oral PrEP through volume.

In this interview with MHE, Warren also noted that until the Trump administration, PEPFAR funding had supported programs for “key populations”: gay men, transgender people, sex workers and people who use drugs. Partly in response to the PEFAR cuts, many countries are working toward folding their HIV services into general primary care risks.

“That’s really good for some people. That's not necessarily good for populations who are stigmatized, criminalized, marginalized and that’s a huge worry,” Warren said.

With programs for key populations, “you may still get a bunch of people on len" said Warren, using the shorthand for lenacapavir. "But you may still have a lot of new infections, and that’s a missed opportunity.”