Five Things I'll Be Watching at AIDS 2026

The biggest debates at this year's International AIDS Conference aren't just about science—they're about money, medicines, delivery, technology, and power.

We are now two weeks out from AIDS 2026 in Rio, which means the excitement is building, the group chats are multiplying, and the conference schedule is an impossible puzzle. At home, the packing has its own complexity: my husband and I will be traveling with our five-month-old, who may well be the conference’s youngest registered participant and is already bringing a more demanding logistics plan than either of us.

AIDS 2026, the 26th International AIDS Conference, taking place in Rio de Janeiro, Brazil, and virtually on 26-31 July 2026, comes at a crucial time for the HIV response.

Between plenaries, panels, side events, receptions, bilateral meetings, and the inevitable last-minute additions, the challenge is no longer finding something worth attending. It is deciding what matters most.

So, rather than trying to map every session, I have been looking across the public agenda for the bigger signals. What are the debates that will shape the week? Where are the real tensions? And what should those of us working in HIV policy, financing, science, advocacy, and implementation be listening for?

And next week, I’ll publish my list of the 10 People to Watch at AIDS 2026. If you haven’t already, subscribe and stay tuned. I think you’ll discover a few names you weren’t expecting.

Five big themes I will be watching in Rio.

1. Can the global HIV response survive the funding reset?

Why this matters

This conference comes at the most consequential moment for the global HIV response in two decades. PEPFAR has entered a period of profound structural transition, NIH and CDC are under pressure, and many countries are being asked to assume greater responsibility of their HIV and health programs while simultaneously facing dramatic fiscal constraints. At the same time, UNAIDS is undergoing a major contraction with an uncertain future, while both WHO and the Global Fund are preparing for leadership changes that will shape the next chapter of the response. Rio will reveal whether the institutions at the center of the global HIV response have a credible plan for sustaining epidemic control—or whether “country ownership” is becoming shorthand for managing decline.

What I’m listening for

• Is anyone presenting a realistic roadmap to replace shrinking external financing, or are we simply hearing calls for “more domestic resources” without specifics?

• How are countries prioritizing what to protect first—treatment, prevention, surveillance, workforce, or community systems?

• What role do the private sector, philanthropy, and innovative financing realistically play, beyond conference rhetoric?

AIDS 2018: President Clinton addresses the conference as activists make their voices heard.

2. The prevention revolution meets the delivery bottleneck

Why this matters

Long-acting PrEP may become one of the most important biomedical advances since oral PrEP. But history shows that scientific breakthroughs do not automatically translate into population-level impact. PEPFAR, the Global Fund, the Gates Foundation, national governments, manufacturers, and delivery partners will all need to solve questions of affordability, regulation, procurement, and service delivery if these innovations are to reach the people who need them most. CHAI and Unitaid will be especially important in shaping the market, lowering prices, accelerating generic access, and helping countries translate promising products into workable delivery models. That challenge is becoming even more urgent as the world’s largest HIV donor pulls back from prevention and reduces support for populations at greatest risk of acquiring HIV.

What I’m listening for

• Are discussions focused on equitable access, or primarily on exciting new products?

• Which delivery models—pharmacies, telehealth, community-based care, self-care—are emerging as the most scalable?

• Who is paying for long-acting prevention at real scale, and what targets are achievable?

AIDS 2018: Elton John takes the stage in Amsterdam to call for stronger global action on HIV.

3. HIV care is leaving the clinic

Why this matters

The future of HIV services may depend less on the next new medicine than on whether we finally start designing around what people actually want. Consumers have already shown that they value convenience, privacy, speed, choice, and care that fits into their lives. The rapid uptake of GLP-1 medicines and online PrEP in the US offers lessons in how clear marketing, telemedicine, direct-to-consumer platforms, and flexible delivery can turn complex medical products into services people actively seek out. As funding tightens and health workforces shrink, PEPFAR, the Global Fund, and national governments should invest not only in clinics and commodities, but also in pharmacies, digital platforms, community-led models, home delivery, and other approaches that treat people as consumers with preferences, not simply patients expected to navigate rigid systems.

What I’m listening for

• Who is designing HIV services around what people actually want, and what implementation experience exists for pharmacy-based and community-led models?

• Which companies, governments, and community organizations are using pharmacies, telemedicine, digital platforms, or home delivery in genuinely innovative ways?

• What can the HIV response learn from the consumer experience, marketing, and rapid delivery models that have helped scale GLP-1 medicines and online PrEP?

4. AI moves from the margins to the mainstream

Why this matters

Artificial intelligence is moving rapidly into HIV prevention, care, and public health decision-making. As one of the conference track leads, I am especially excited that AIDS 2026 will feature more AI content than any previous International AIDS Conference, including, for the first time, a plenary address on AI on Friday, July 31, delivered by Dr. Izukanji Sikazwe. Rio offers a chance to move the conversation beyond novelty and ask which applications are actually improving outcomes, strengthening health systems, and reaching people more effectively. The Audere Africa–AVAC guide is a useful roadmap to the AI conversations taking place across the conference.

What I’m listening for

• Are AI discussions grounded in implementation and measurable impact, or primarily in technological optimism?

• Who owns, governs, and benefits from the data powering these tools?

• How are countries and donors identifying the most effective AI use cases and moving them from pilot projects to scale?

AIDS 2022: Global health leaders launch the UNAIDS Global AIDS Update during a critical moment for the response.

5. The last mile is political

Why this matters

Ending HIV has never been solely a scientific challenge. Progress depends on sustained political leadership, community trust, human rights, and long-term investment. As the world becomes more multipolar, the future of the HIV response will depend increasingly on how governments redefine international cooperation, regional leadership, and shared responsibility. At the same time, civil society organizations are facing growing financial pressure and shrinking civic space. Rio will be the first major global gathering after the 2026 UN High-Level Meeting on HIV, where countries reached a historic agreement on the next phase of the response. The question now is whether those commitments will translate into political action.

What I’m listening for

• How are community organizations adapting to funding reductions, and what support do they need most?

• Are governments strengthening partnerships with affected communities, or centralizing decisions as financing and political conditions tighten?

• What concrete commitments will protect human rights, scientific collaboration, civic space, and international cooperation over the next five years?

How I’ll be following Rio

Rather than trying to attend everything, I’ll use these five themes to guide my week in Rio. By the end of the conference, we should have a clearer sense of whether the HIV response is entering a period of reinvention—or retrenchment.

And this is just the beginning.

Next Sunday, I’ll publish my first “10 People to Watch at AIDS 2026”—a list of researchers, policymakers, advocates, innovators, and emerging leaders who I think will shape the conversations in Rio and the future of the HIV response.

If there’s someone you think belongs on the list, send me your nomination. And if you haven’t already, subscribe so you don’t miss it.

P.S. This year’s gathering carries a different weight. Funding shifts and organizational cuts have made it impossible for many colleagues, advocates, and community leaders to travel to Rio. That makes the time we do have together in person more important, more intentional, and more precious.

AIDS 2024: With Former Congresswoman Barbara Lee, a longtime champion of the global HIV response.