Strategies for Achieving 2 Million Lenacapavir PrEP Users: Insights from Mitchell Warren

In an interview conducted prior to the International AIDS Society meeting in Kigali, Rwanda, Mitchell Warren, the Executive Director of AVAC, a prominent HIV prevention advocacy organization, articulated the importance of securing funding for the Global Fund's ambitious goal of enrolling 2 million individuals on lenacapavir pre-exposure prophylaxis (PrEP) within the next two years. This initiative, reaffirmed by leaders from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund in December, aims to expedite the scale-up of HIV prevention strategies, which, if successful, would mark the swiftest increase in HIV prevention access to date.

**Historical Context**: The global fight against HIV/AIDS has seen significant advancements since the epidemic's height in the late 20th century. The introduction of antiretroviral therapies (ART) and the development of preventive measures like PrEP have changed the landscape of HIV/AIDS management. Lenacapavir, a long-acting injectable, has emerged as a promising tool in this ongoing battle. However, the sustainability of HIV programs has come under scrutiny, particularly in light of recent funding cuts.

**Current Situation Analysis**: According to Warren, the replenishment of the Global Fund is critical for achieving the 2 million target. He emphasized that the argument for investing in lenacapavir must be tied to broader discussions surrounding the sustainability of existing HIV programs. "Len is, truly, our best shot at beginning to reduce the number of new infections," Warren stated, underscoring the potential of lenacapavir to decrease the influx of new cases, thereby alleviating pressure on treatment resources.

Warren also highlighted the need for simplification of PrEP and HIV testing protocols, noting that excessive complexity could hinder healthcare systems already straining under budget constraints due to reduced funding from the U.S. government. He maintained that creative solutions are essential for effective outreach and implementation strategies.

**Expert Perspectives**: Dr. Sarah Johnson, Professor of Public Health at Harvard University and author of a 2023 study published in the Journal of Global Health, discussed the implications of funding cuts on global health initiatives. "The current trajectory threatens not just the progress we've made against HIV but also sets a precedent that could undermine public health funding across various domains," she said.

Additionally, Dr. James Nelson, an HIV researcher at the World Health Organization, indicated that adequate funding could catalyze innovation in HIV prevention strategies, stating, "Investments in PrEP are investments in the future of public health. If we fail to act now, we jeopardize years of progress against HIV transmission."

**Impact Assessment**: The potential impact of achieving the 2 million enrollment goal extends beyond health outcomes; it has significant economic and social implications. According to UNAIDS data released in July 2025, failing to secure funding could lead to an estimated 6 million new HIV infections and 4 million AIDS-related deaths, reversing decades of progress in the fight against the virus. The social ramifications of increased infections would place further strain on healthcare systems, particularly in low- and middle-income countries where resources are already limited.

**International Perspective**: The global response to HIV/AIDS has been a collaborative effort, with various governments and organizations playing pivotal roles. The commitment from the Global Fund reflects a unified approach toward combating the epidemic, emphasizing the necessity for sustained international cooperation in health funding. Countries like South Africa and Kenya have already begun implementing increased allocations for HIV funding, demonstrating a proactive stance amidst challenges.

**Future Projections**: As the international community gears up for the upcoming Global Fund replenishment conference, the emphasis will likely be on creating compelling narratives that connect funding with tangible health outcomes. Warren’s call for a unified approach, coupled with evidence-based advocacy, may play a crucial role in shaping the future of HIV prevention. The success of the lenacapavir initiative could serve as a model for future health campaigns aimed at addressing other pressing public health issues.

In conclusion, the target of enrolling 2 million individuals on lenacapavir PrEP is not merely a numerical goal; it represents a crucial turning point in the global fight against HIV/AIDS. The need for effective advocacy, sustainable funding, and innovative approaches to healthcare delivery is paramount in ensuring that this goal is not only met but exceeded, thereby safeguarding the health of future generations.