From Ending the HIV Epidemic to Uncertain Ground: PrEP4All's Peter Staley

The mood surrounding US HIV policy in 2026 is markedly different from the cautious optimism that defined much of the past decade. What had once felt like a steady march toward ending the domestic epidemic has, in the view of many advocates, become a period of retrenchment and uncertainty. At the center of that debate is Peter Staley, longtime activist and cofounder and board member of PrEP4All, who is sounding the alarm about what he describes as a coordinated rollback of HIV prevention infrastructure.

Speaking at the 2026 Conference on Retroviruses and Opportunistic Infections (CROI), Staley framed 2025 as an “annus horribilis” for US public health, echoing language used by past researchers to describe the year’s broader health setbacks. In his view, the challenges extend beyond isolated budget cuts. They reflect a deeper political shift—one that has placed scientific institutions, public health agencies, and equity-focused programs under sustained pressure.

Central to his concerns are abrupt federal policy and funding changes that, he argues, have destabilized years of progress in HIV prevention research and implementation. Shortly after returning to office, the Trump administration canceled approximately $80 million in National Institutes of Health grants, many tied—sometimes loosely—to diversity, equity, and inclusion (DEI) priorities.¹ According to Staley, those cuts disproportionately affected HIV prevention efforts, including scale-up studies designed to test real-world strategies for reaching communities at highest risk. Subsequent pullbacks in Medicaid and Affordable Care Act–related programs, he added, have compounded the disruption.

Staley pointed to data presented at CROI as a concrete example of the downstream effects. A poster examining lenacapavir, a long-acting injectable widely viewed as one of the most promising new HIV prevention tools, showed limited real-world uptake in 2025. Despite strong clinical efficacy, sales figures suggested that only a few thousand individuals nationwide accessed the medication. Modeling presented at the meeting estimated that this level of coverage prevented roughly 60 transmission events for the year.

For Staley, the takeaway is structural: without strong public programs to subsidize and actively deploy prevention tools, access remains concentrated among more privileged groups—echoing early adoption patterns seen with oral PrEP such as emtricitabine/tenofovir disoproxil fumarate (Truvada).

From PrEP4All’s vantage point, the earliest and most severe consequences are falling on communities already disproportionately affected by HIV—particularly Black and Latino populations, people in the South, and individuals facing economic instability. Many of the studies designed to identify and overcome barriers to care in these groups, Staley noted, have been halted. At the same time, he raised concerns about reduced federal data reporting, leaving advocates with fewer real-time indicators of whether annual infection rates are shifting.

The interview also underscored a striking political reversal. During his first term, President Donald Trump announced a plan to end the US HIV epidemic by 2030, leading to pilot programs in 5 high-burden jurisdictions that continued under President Joseph Biden and have shown encouraging results. Yet expansion has stalled, and broader HIV initiatives now face contraction.

For Staley, the tools to reduce HIV transmission remain firmly in place. What he sees as missing is sustained federal leadership—and the political will to use it.