The future of HIV response depends on more than funding medicines and technologies. As governments take greater ownership of HIV programmes, they must also sustain a community centred approaches that have underpinned progress over the last four decades.
As the global HIV community gathers in Rio de Janeiro for the 2026 International AIDS Conference under the theme Rethink. Rebuild. Rise, we find ourselves at a defining moment.
Like never before, science has produced innovative HIV prevention tools with the potential to cut new HIV infections. Emergence of long-acting HIV prevention technologies, including long-acting injectable PrEP, marks another major milestone in the fight against the virus.
Yet new technologies only achieve public health impact when people trust them, can access them and choose to use them.
Kenya’s rollout of oral PrEP in 2017 offers an important example. Awareness and curiosity were initially high, but sustaining uptake proved more challenging. It became clear that making prevention technology available was not enough as people also needed to trust and understand it before feeling more confident using it.
As a technical partner supporting the Ministry of Health and NASCOP in introducing and scaling up oral PrEP, Lvcthealth helped generate evidence that shaped Kenya’s national rollout. During the IPCP oral PrEP demonstration project among adolescent girls and young women and female sex workers, continuation on oral PrEP declined from nearly 100 percent at initiation to about 30 percent within three months.
Working with communities to understand why people were discontinuing oral PrEP, we found that the barriers had little to do with the medicine itself.
We also found that stigma, misconceptions, concerns about confidentiality and low perception of HIV risk often shaped people’s decisions more than the scientific evidence behind the intervention. These findings informed provider training, demand generation and community engagement strategies, ensuring the national rollout better responded to people’s realities.
Working alongside communities, we developed trusted information materials, engaged community gatekeepers, and created spaces for honest dialogue about HIV prevention.
These conversations went beyond encouraging people to use oral PrEP and helped us understand how HIV prevention fit within people’s aspirations, relationships and everyday lives, while building confidence in oral PrEP and informing approaches that continue to shape HIV prevention programmes today.
We have continued applying these lessons through studies supporting introduction of new PrEP technologies under the MOSAIC consortium. Demand-generation tools co-created with young people are now supporting Kenya’s rollout of long-acting injectable PrEP, helping ensure these innovations reach the adolescents and young people who stand to benefit most.
These experiences have also contributed to global evidence on HIV prevention. A recent study published in The Lancet HIV and co-authored by Lvcthealth researchers reinforces what communities have long demonstrated that meaningful community engagement is essential to ensuring HIV prevention programmes are trusted, responsive and effective.
These lessons matter because the next phase of the HIV response will look very different from the last. As countries take greater ownership, there is a real risk that the conversation focuses primarily on sustaining medicines, diagnostics and new prevention technologies. Those investments are essential, but they are only part of what has driven progress.
We must also rebuild trust by ensuring communities are not passive recipients of innovation, but active partners in shaping how new technologies are introduced, delivered and sustained.
Community voices should inform not only what interventions are offered, but how they are implemented, so they respond to people’s realities, priorities, and aspirations.
Putting communities at the centre means much more than consulting them. It means listening before programmes are designed, co-designing solutions alongside communities and continuously adapting services based on their evolving needs and feedback. It is through these partnerships that policies become more responsive, and health systems become more resilient.