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Confronting Advanced HIV Disease: Why It Still Matters

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When we talk about HIV in 2025, the story we often hear is about progress: more people than ever are on treatment, new prevention methods are available, and the science of HIV cure is advancing. Yet, behind this progress lies a quieter crisis, Advanced HIV Disease (AHD) . What Is Advanced HIV Disease? The World Health Organisation (WHO) defines Advanced HIV Disease as when a person has a CD4 count below 200 cells/mm³ or is in WHO clinical stage 3 or 4. For children younger than five years, any HIV infection is considered advanced because of their high vulnerability. People with AHD are extremely vulnerable to severe opportunistic infections such as cryptococcal meningitis, tuberculosis, histoplasmosis, and Pneumocystis pneumonia, alongside weight loss, persistent fevers, and other life-threatening complications. Why Does AHD Still Happen? One might ask: If treatment is widely available, why are people still reaching this stage? The reasons are complex: Late diagnosis ...
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Understanding the EFFECT and sub-EFFECT Studies: What Do They Mean for People Living with HIV?

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In many parts of Africa, including South Africa and Tanzania, some people living with HIV still get very sick because their immune system is weak. One serious illness they can get is   cryptococcal meningitis , a deadly infection that affects the brain. It is caused by a fungus called   Cryptococcus . Luckily, there's a test that can find the infection early, before it spreads to the brain. This test looks for a warning sign in the blood called  CrAg  (cryptococcal antigen). If the test is positive, it means the person might be at risk of developing meningitis. Two important studies, called  EFFECT  and  sub-EFFECT , are helping us learn the best way to protect people who test CrAg-positive. What is the EFFECT Study? The EFFECT study is testing a new way to treat people who are CrAg-positive but do not yet have meningitis. These people feel fine, but their blood test shows they could get sick soon if not treated . Right now, many are given a medicine c...
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Once a Year, Peace of Mind: How Lenacapavir Could Change HIV Prevention Forever

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It’s not every year that a single study ignites excitement across the global HIV prevention movement. But this March, at the Conference on Retroviruses and Opportunistic Infections (CROI) 2025 , held in San Francisco from 9 to 12 March , we witnessed something truly promising. A new approach to HIV prevention moved closer to reality: a once-yearly injectable medicine called Lenacapavir could soon transform how we protect people from HIV. For those of us who have spent years advocating for better, simpler and more respectful prevention options, this is more than just a scientific milestone. It represents hope, delivered in a single injection. A Single Shot, a Year of Protection The data came from a Phase 1 study involving 40 HIV-negative adults , aged 18 to 55, all considered at low risk for HIV. Each participant received one injection of Lenacapavir into the buttock muscle, using either a 5% or 10% ethanol-based formulation. They were then followed for 56 weeks . The results ...
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IMPRINT: A Bold Step in the Fight Against HIV-Associated Mycoses

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The International (HIV) Mycoses Prevention, Research, Implementation, Networks & Training consortium, better known as IMPRINT , is a ground-breaking global health research initiative that is reshaping how we address life-threatening fungal infections among people living with HIV (PLHIV). These infections, particularly cryptococcal meningitis (CM) , continue to cause thousands of deaths every year, especially in sub-Saharan Africa where access to timely diagnostics and antifungal treatments is limited. What Is IMPRINT? Cryptococcal meningitis (CM) alone accounts for approximately 15% of all HIV-related deaths globally , translating to over 112,000 deaths each year , with the vast majority occurring in sub-Saharan Africa. Despite the availability of antiretroviral therapy (ART), CM remains a leading killer of people living with HIV due to late diagnosis, inadequate access to diagnostics and life-saving treatment, and gaps in health system capacity. However, hope lies in the dev...
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Reimagining HIV Prevention Trials in the Era of 95-95-95

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Globally, the HIV response has seen significant progress. In Botswana, for instance, over 95 per cent of people living with HIV (PLHIV) are aware of their status, receive treatment, and achieve viral suppression. These results reflect sustained investment in public health and strong community engagement. As a result, the country has seen a notable decline in HIV incidence. While this is an encouraging development, it introduces new complexity for HIV prevention researchers. With fewer new infections, widespread access to antiretroviral therapy (ART), and the availability of proven prevention tools like pre-exposure prophylaxis (PrEP), we are faced with a pressing question: How do we design HIV prevention trials in settings where the number of new infections is becoming increasingly low? The Paradox of Success Traditionally, HIV prevention trials have measured the rate of new HIV infections between those who receive an intervention and those who do not. In high-coverage setting...
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Aging with HIV in Botswana: Time to Update Our Treatment Guidelines

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A New Face of Botswana’s HIV Epidemic As an HIV activist, I have witnessed a profound shift in our epidemic’s demographics. Two decades ago, the focus was on keeping people alive. Today, thanks to widespread antiretroviral therapy (ART), many of those same people are alive into their 50s, 60s, and beyond. In fact, Botswana’s HIV population is graying rapidly. By some estimates, over 50% of people living with HIV in Botswana are now over 40 years old, making older adults the new face of our country’s HIV community. This is a testament to our success in expanding treatment, but it also presents urgent new challenges. While ART has extended life expectancy, additional years of life are not necessarily spent in good health. Many older PLHIV are surviving, but not thriving. They struggle with chronic pain, fatigue, heart disease, or depression. Such stories underscore a hard truth: we have won on longevity, but we are lagging on quality of life. Medical complications, multimorbidities, ...
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HIV Prevention Research in a Time of Scarcity: Why Health Economics Must Lead the Way

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What is Health Economics? Health economics is a field of study that examines how health resources are allocated, used, and financed. It helps decision-makers understand the trade-offs involved in investing in different health interventions by analysing their costs, benefits, and overall impact on population health. Through tools such as cost-effectiveness analysis and budget impact modelling, health economics supports evidence-based decisions that aim to maximise health outcomes with limited resources. In HIV prevention, this means ensuring that every intervention, from new biomedical tools to health service delivery, delivers real value for money and is accessible to the people who need it most. Why Health Economics Literacy Matters for HIV Advocates As an AVAC Clinical Trials Design Academy member and advocate for HIV prevention, developing health economics literacy is vital. It empowers advocates to engage meaningfully in decision-making spaces, to interrogate the value and feasi...
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