By Elina Mwasinga, Advocate with the Coalition of Women Living with HIV and AVAC Fellow
In the early 1980s and ’90s, the idea of an HIV cure felt like science fiction. Even prevention tools like PrEP were unthinkable. Today, we’ve made progress in HIV prevention, treatment, and care with Malawi successfully achieving the 95-95-95 targets a year ahead of the 2025 global deadline.
HIV prevalence among adults (15+ years) declined significantly from over 14 percent in the late 1990s to 7 percent in 2024 and the scale-up of the long-acting injectable form of pre-exposure prophylaxis (PrEP) administered every two months is ongoing in over 50 sites nationally.
However, we have not invested enough in the next frontier: cure research. As science moves closer to making the seemingly impossible possible, Malawi cannot afford to be left behind.
As we stride on from tales of no hope to testimonials of the impacts of treatment and prevention, let us also engage in the key discussions around cure, which is defined as the lasting control of HIV with no need for life-time treatment with antiretrovirals.
In May of this year, Malawi marked another historic milestone: a first national-level conversation, headed by the National AIDS Commission (NAC), on HIV cure and vaccine research. Government, researchers and community actors came together to collectively shape our stake in the future of the HIV response.
Despite my prior activities on cure as an AVAC Fellow, this was the first time Malawi united to drive scientific dialogue, a visionary step towards setting the National HIV cure agenda.
So, what exactly is an HIV cure? In simple terms, it means the complete eradication of the virus from the body or its permanent suppression without the need for daily antiretroviral medication, known as ART.
Currently, at least eight people globally have achieved complete HIV remission having been cured through highly intensive procedures like stem cell transplants, often performed for co-occurring conditions like cancer.
While these procedures are not scalable for the millions living with HIV, they offer crucial insights into how a cure might work in the future. Scientists are exploring various avenues, including gene therapy, analytic treatment interruptions and therapeutic vaccines among other strategies, all with the goal of achieving lasting control of the virus.
But then, this year abruptly saw the cruel and unforeseen USAID stop-work order. While efforts were made to maintain treatment for those living with HIV, this halt in funding has significantly impacted various HIV prevention programs in Malawi, such as PrEP.
Additionally, projects exploring new vaccines and cure research were either terminated or suspended globally, some of which feed into Malawi’s cure research and advocacy. Malawi’s understandable prioritisation of essential services unfortunately undermines the opportunity to effectively explore cure research.
However, this would be a critical time to intensify the search for a cure, given the threat to sustained donor funding for HIV programs.
Lifelong HIV treatment is costly for both individuals and health systems. A cure would significantly reduce healthcare costs, freeing up resources for HIV prevention and other pressing health needs. Investing in an HIV cure, could eventually bring epidemic control and sustainability.
The funding freeze didn’t just stall programs; it cracked hope and need for cure discussions and advocacy that Malawi has been building over the last year. As the funding freezes, the virus thaws, and recent data show a spike in new infections.
As an advocate who has walked this journey with communities across the country, I can say with certainty: the cost of silence is too high. Behind the halted programs are young women expecting one day to shift from daily oral PrEP to a two- or six-month injectable PrEP or a vaginal ring and young people living with HIV tired of the pill burden.
The recent HIV Cure Agenda-Setting Meeting in Malawi exposed glaring gaps in community knowledge and policy readiness. Participants questioned whether Malawi benefits from the research happening within its borders, such as the HVTN 805/HPTN 093, the AMP an analytical treatment interruption (ATI) study.
This clinical research, by the University of North Carolina, assessed whether the immune system can control HIV without treatment after an intentional interruption of antiretroviral therapy with results showing that ATIs can be conducted safely and well in Africa.
Other questions persist, like whether our data governance policies are protective enough, and if our communities are being meaningfully prepared for breakthroughs that are already underway? Participants called for national frameworks, not just pilot projects, and for real investments in public education, inclusion, and policy flexibility for innovations.
This is not just about being part of the science, it is about the right to improved medical technologies for all. We must ensure that when cure or vaccine solutions are developed with our input they are also equitably available and understood by the people they are meant to serve. But that won’t happen by accident.
It requires deliberate action now: building literacy, countering misinformation, engaging media, and putting young people, mothers, and community leaders at the heart of advocacy. It also calls for strong linkages and collaboration between the researchers and community. The US stop-work order might have frozen funds, but it must not freeze our fight to continue the response.
