Warren traced HIV epidemic’s history through a series of what he called “critical moments.” In the earliest years, a diagnosis of HIV was effectively a death sentence. The only available interventions were condoms and behaviour-change programmes. The development of antiretroviral therapy in the 1990s transformed the clinical picture, but treatment remained out of reach for the vast majority of people living with the virus in low- and middle-income countries. That inequity helped catalyse the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) in the early 2000s. Those mechanisms now support nearly 30 million people on life-saving treatment.
Still, significant gaps remain: many people are undiagnosed, and many more are not yet on treatment that could both save their lives and prevent further transmission. Mitchell Warren leads AVAC as its Executive Director and is also elected to the Governing Council of International AIDS Society (IAS). He was among the opening keynote speakers at AIDS 2026 Affiliated Independent Event organised by AVAC, CNS and partners worldwide before the largest AIDS conference opens in Brazil (26th International AIDS Conference or AIDS 2026).
Prevention has followed a similar pattern of scientific progress followed by delivery shortfalls. Voluntary medical male circumcision scaled from 2006. Oral pre-exposure prophylaxis (PrEP), approved in 2012, offered a daily pill option for HIV prevention beyond condoms. In the past five years, the dapivirine vaginal ring and long-acting injectable cabotegravir entered the market. Each of these advances, Warren noted, represented a critical moment to deliver with speed, scale, and equity. In each case, the field failed to fully meet that moment.
Now, in July 2026, the latest tool has arrived: injectable lenacapavir, administered only once every six months for almost 100% HIV prevention. Warren described it as a “remarkable product,” while emphasising that earlier options - oral tenofovir/ emtricitabine, the dapivirine ring, and cabotegravir - remain valuable. The question is no longer whether science can produce effective tools. The question is whether political and programmatic systems will finally deliver them to the people who need them most.
The greatest scientific opportunities have emerged precisely as the HIV response confronts its most challenging political and economic conditions. This is what Warren calls it as a "cruel irony."
Still, significant gaps remain: many people are undiagnosed, and many more are not yet on treatment that could both save their lives and prevent further transmission. Mitchell Warren leads AVAC as its Executive Director and is also elected to the Governing Council of International AIDS Society (IAS). He was among the opening keynote speakers at AIDS 2026 Affiliated Independent Event organised by AVAC, CNS and partners worldwide before the largest AIDS conference opens in Brazil (26th International AIDS Conference or AIDS 2026).
Delivery shortfalls
Prevention has followed a similar pattern of scientific progress followed by delivery shortfalls. Voluntary medical male circumcision scaled from 2006. Oral pre-exposure prophylaxis (PrEP), approved in 2012, offered a daily pill option for HIV prevention beyond condoms. In the past five years, the dapivirine vaginal ring and long-acting injectable cabotegravir entered the market. Each of these advances, Warren noted, represented a critical moment to deliver with speed, scale, and equity. In each case, the field failed to fully meet that moment.
Now, in July 2026, the latest tool has arrived: injectable lenacapavir, administered only once every six months for almost 100% HIV prevention. Warren described it as a “remarkable product,” while emphasising that earlier options - oral tenofovir/ emtricitabine, the dapivirine ring, and cabotegravir - remain valuable. The question is no longer whether science can produce effective tools. The question is whether political and programmatic systems will finally deliver them to the people who need them most.
Cruel irony
The greatest scientific opportunities have emerged precisely as the HIV response confronts its most challenging political and economic conditions. This is what Warren calls it as a "cruel irony."
He pointed specifically to the current US political leadership which not only failed to seize the moment but had begun to roll back earlier advances. Those reversals, he argued, now constrain the ability to convert scientific discovery into public-health impact.
That combination of scientific possibility and political retreat, Warren said, makes the present moment more urgent than any in the epidemic’s history. Incremental adjustments will not suffice.
The task is not to restore the architecture that existed before recent policy shifts. It is to build an entirely new one - one capable of delivering results not only on HIV but also on TB, malaria, non-communicable diseases, and a broader range of sexually transmitted infections, said Warren.
Success, he stressed, will require collective action on a scale the field has not previously achieved. The practical goals remain clear and long-standing: ensure every person living with HIV has access to antiretroviral treatment and is virally suppressed; expand HIV combination prevention in all its forms - condoms, circumcision, and the full suite of PrEP options - to everyone who can benefit; and sustain the scientific enterprise so that a vaccine and a cure remain realistic ambitions. “Because we can and we must,” Warren said.
AVAC leader Mitchell Warren said that historical record shows "product availability alone has never been enough." Delivery systems, community leadership, sustained financing, and political commitment have repeatedly determined whether scientific advances reach those who need them.
In this current moment, we have a rare, high-stakes opportunity to correct past delivery failures while science continues to advance. Warren sought to inject urgency at AIDS 2026 to match scientific possibility with political and programmatic will.
Dr Lucica Ditiu, Executive Director of the Stop TB Partnership said that the time for siloed approaches, exceptionalism and donor-dependent projects is over. What is required now, she said, is smarter collaboration that places communities at the centre while building interventions capable of surviving beyond external funding cycles.
Dr Ditiu was also among the keynote speakers of the above-mentioned event affiliated to AIDS 2026.
Networks of TB survivors and civil society organisations were built with far fewer resources compared to the HIV response. The challenge now, she said, is to ensure these networks are meaningfully engaged in every country - not merely as advocates, but as partners in health service delivery.
There should be "zero doubts" that ending TB, HIV, malaria, hepatitis and other sexually transmitted infections is impossible without communities and grassroots organisations. Their role extends far beyond advocacy. Communities accompany people through diagnosis, demystify complex health needs, support individuals facing isolation, stigma and fear, and help ensure services are accessible to all. "That's established. That should be a no-brainer and that should be never questioned,” Dr Ditiu said.
Scientific possibility versus political retreat
That combination of scientific possibility and political retreat, Warren said, makes the present moment more urgent than any in the epidemic’s history. Incremental adjustments will not suffice.
The task is not to restore the architecture that existed before recent policy shifts. It is to build an entirely new one - one capable of delivering results not only on HIV but also on TB, malaria, non-communicable diseases, and a broader range of sexually transmitted infections, said Warren.
Success, he stressed, will require collective action on a scale the field has not previously achieved. The practical goals remain clear and long-standing: ensure every person living with HIV has access to antiretroviral treatment and is virally suppressed; expand HIV combination prevention in all its forms - condoms, circumcision, and the full suite of PrEP options - to everyone who can benefit; and sustain the scientific enterprise so that a vaccine and a cure remain realistic ambitions. “Because we can and we must,” Warren said.
Product availability has never been enough
AVAC leader Mitchell Warren said that historical record shows "product availability alone has never been enough." Delivery systems, community leadership, sustained financing, and political commitment have repeatedly determined whether scientific advances reach those who need them.
In this current moment, we have a rare, high-stakes opportunity to correct past delivery failures while science continues to advance. Warren sought to inject urgency at AIDS 2026 to match scientific possibility with political and programmatic will.
Communities are essential, silos are obsolete
Dr Ditiu was also among the keynote speakers of the above-mentioned event affiliated to AIDS 2026.
Networks of TB survivors and civil society organisations were built with far fewer resources compared to the HIV response. The challenge now, she said, is to ensure these networks are meaningfully engaged in every country - not merely as advocates, but as partners in health service delivery.
There should be "zero doubts" that ending TB, HIV, malaria, hepatitis and other sexually transmitted infections is impossible without communities and grassroots organisations. Their role extends far beyond advocacy. Communities accompany people through diagnosis, demystify complex health needs, support individuals facing isolation, stigma and fear, and help ensure services are accessible to all. "That's established. That should be a no-brainer and that should be never questioned,” Dr Ditiu said.
Dr Ditiu said that billions of dollars invested in fighting these diseases have saved countless lives and built important systems. Yet too many community interventions and projects remain heavily dependent on external financing. "The interventions, the projects and the work that is done by and with external funding… [are] at risk of being closed and disappearing the moment the funding stops." Every organisation, she said, must ask itself a hard question: will the work being done today continue if a particular donor or funding stream ends? Temporary projects that save lives in the short term have value, but architectures that collapse when money disappears create lasting problems. Investment must therefore prioritise interventions that are resilient and capable of being sustained.
Dr Ditiu also addressed a recurring source of tension: the relationship between governments and civil society. External funding has sometimes worsened this friction by supporting community tracks without sufficient government involvement. Governments, focused on universal access, rights and equity, have often felt disconnected from community activities. At the same time, communities have not always engaged effectively with government priorities.
Without communities at the centre of health responses, and without systems capable of enduring beyond any single funding cycle, the targets for ending AIDS and TB will remain out of reach, said Dr Ditiu in an unambiguous term. The science and the tools exist. The question now is whether the architecture of the response can finally match the reality of the people it is meant to serve, she said.
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