The HIV pandemic has changed the face of global health, posing serious challenges to development and political, economic, and cultural stability in many countries and communities. Since the beginning of the pandemic in the early-1980s, an estimated 75 million people have contracted HIV, and 32 million have died of AIDS-related illnesses. Fueled by scientific advances and global political and financial will, more than 23 million people were on lifesaving anti-retroviral treatment (ART) at the end of 2018. In stark contrast, prevention programs have struggled, and despite early declines, the annual number of new infections has hovered at or just below 2 million per year for the last decade. Dramatically reducing infections is essential to bringing the HIV pandemic under control, but it will require both ensuring innovative prevention technology reaches those who need it and the political and financial will to make prevention a global priority.
Over the last almost four decades, many prevention strategies and tools have been utilized to try to stymie the spread of HIV, with moderate success. The arsenal of prevention tools and approaches used over that period has enabled many gains, including the provision of treatment to mothers during pregnancy, childbirth, and breastfeeding. However, prevention programs have faced a variety of structural barriers even as new tools have come to market, including inadequate financing, regulatory and guideline obstacles, and inefficient delivery of health services. There is an opportunity now to address critical implementation challenges for prevention tools with several novel HIV prevention tools at different stages of development. Elevating prevention now will have to be a political, policy, and financial choice that puts more resources toward accelerating access to important new HIV technology with the goal of driving down the infection rate. As the U.S. government remains the leading funder of global HIV efforts, a systematic reassessment of U.S. prioritization of and commitment to prevention should be conducted before development of a new strategy for 2021 and beyond starts over the next year.