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HIV in 2026

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Health information — Educational information, not medical advice. Talk with your healthcare provider about your care and treatment decisions.

Where treatment stands. Where prevention stands. What cure research actually shows. What funding threats are real. And why the work isn't finished — or close to it.

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Last reviewed September 2026

HIV in 2026 is not the same epidemic it was in 2016, or 1996, or 1986. The medical reality has been transformed by science. But the epidemic itself — the people still being diagnosed, the communities still bearing disproportionate burdens, the structural barriers that keep prevention and treatment out of reach — is very much ongoing. This is where things stand.

The U.S. epidemic in numbers

1.2M
People aged 13+ with HIV in the U.S. (2022 estimate)[1]
~31,800
new HIV infections per year in the U.S. (2022 CDC estimate)[2]
13%
of people with HIV unaware of their status (2022 estimate; about 158,000)[3]
69%
of people with diagnosed HIV who reached viral suppression in 2024[4]

CDC estimated about 31,800 new U.S. HIV infections in 2022. An earlier historical analysis estimated a peak of 130,400 in 1984 and 1985; comparing those point estimates gives a decline of about 76 percent. The 2022 estimate is not a count of infections in 2026. Prevention tools have advanced, but reaching people consistently remains a major challenge.[2][5]

CDC reported viral suppression in 69 percent of people with diagnosed HIV in its 2024 care-continuum data. The remainder had no documented suppressed viral load in that measure; surveillance alone cannot tell us whether each person was untreated, out of care, or had an unreported result. Improving access and retention remains essential.[4]

Treatment in 2026

The standard of care

Initial HIV treatment usually uses an oral combination regimen. NIH recommends bictegravir/tenofovir alafenamide/emtricitabine or dolutegravir with two nucleoside/nucleotide drugs for most people. Dolutegravir/lamivudine is a two-drug option for selected patients, with exclusions including hepatitis B and certain viral-load or testing circumstances. Some regimens are one tablet; others are not. Choice depends on resistance, hepatitis B, interactions, other conditions, and patient preference.[6]

Viral suppression often develops over weeks to months after effective ART begins, with monitoring to confirm the response. A 2020 study of insured adults found a 6.8-year life-expectancy gap at age 21 for people who started ART with CD4 counts of at least 500 during 2011–2016. That historical cohort estimate is not a prediction for every person starting treatment in 2026.[7]

Long-acting treatment — a fundamental shift

Long-acting injectable ART has moved from clinical trials to standard practice over the past several years, and it represents a fundamental shift in what HIV treatment can look like.

Cabenuva (cabotegravir plus rilpivirine) is a complete injectable regimen given monthly or every two months. Its label covers eligible adults and adolescents aged 12 or older weighing at least 35 kg who are suppressed on a stable regimen, without a history of treatment failure or known/suspected resistance to its components. A clinical review and reliable injection plan are needed before switching.[8]

Sunlenca (lenacapavir), approved in December 2022, is used with other antiretroviral medicines for heavily treatment-experienced adults with multidrug-resistant HIV whose current regimen is failing. Its injections are six months apart, but it is not a complete twice-yearly treatment by itself. Other components may still be taken daily.[9]

Long-acting regimens can help some people who find daily pills difficult. They also require visits, testing, attention to interactions, and plans for delayed doses. The best option is the one a person and their care team can use safely and consistently.[8]

Approved medicines and research are different: the FDA approved the once-daily doravirine/islatravir tablet Idvynso in April 2026 as a switch option for eligible suppressed adults. That is not an approved weekly or monthly regimen. Lenacapavir–antibody combinations and other longer-acting strategies remain under study; earlier-phase results do not establish routine availability or fewer side effects.[31][32]

Prevention in 2026

The prevention toolkit has never been more powerful

Today, HIV prevention has more tools available than at any point in the epidemic's history — and the gap between what's available and what's being used remains enormous.

Oral PrEP reduces sexual HIV acquisition by about 99 percent when taken as prescribed. Truvada and its generic equivalent use F/TDF; Descovy uses F/TAF. Descovy is not indicated for people whose risk is from receptive vaginal sex. HIV testing and clinical assessment are required before starting and during PrEP. Truvada’s PrEP approval dates to 2012; Descovy’s came later.[33][10][11]

Apretude (cabotegravir) is injectable PrEP approved in December 2021. After the two starting injections one month apart, injections are given every two months. It was superior to daily F/TDF in HPTN 083 and 084; regular HIV testing and timely visits remain essential.[33][12]

Yeztugo (lenacapavir) was approved for PrEP in June 2025 for eligible adults and adolescents weighing at least 35 kg. PURPOSE 1 observed no HIV infections among 2,134 participants assigned lenacapavir; PURPOSE 2 observed two infections among 2,179 participants in the primary analysis, approximately 96 percent fewer than estimated background incidence. These trial results do not guarantee complete protection for every person. The starting regimen includes oral doses, and each six-monthly dose consists of two subcutaneous injections.[28][13][14]

U=U—Undetectable = Untransmittable means a person who maintains a viral load below 200 copies/mL on HIV treatment does not transmit HIV through sex. Monitoring confirms suppression. This evidence is about sexual transmission; it is not a claim about every possible exposure route. Access to treatment and PrEP can prevent many new infections.[15]

Cure research: where it actually stands

HIV cure research has produced several striking results in recent years — while also clarifying the extraordinary scientific difficulty of eliminating a virus that integrates into the genome and establishes latent reservoirs that current drugs suppress but cannot reach.

Documented cures

A small number of people have experienced prolonged HIV remission, considered likely cure in some cases, after stem-cell transplantation needed for serious blood diseases. Many cases involved donors with two CCR5-delta32 copies, but remission has also been reported with a donor carrying one copy and with wild-type CCR5. The heterozygous-donor case first presented in 2024 has since been published. These high-risk transplants are not a routine HIV treatment or a reason to interrupt ART.[16]

Broadly neutralizing antibodies (bNAbs)

Broadly neutralizing antibodies can target multiple HIV strains, but susceptibility varies. The randomized RIO trial enrolled 68 people who had started ART during early HIV infection. At week 20 of a closely monitored treatment interruption, estimated freedom from protocol-defined rebound was 75 percent with two antibodies versus 11 percent with placebo. This is evidence for extended control in selected participants, not a general cure or advice to stop ART.[34]

"Kick and kill" and reservoir strategies

HIV can persist in latent reservoirs, including resting CD4 T cells, despite suppressive ART. “Shock and kill” strategies try to activate latent virus and then clear affected cells. They remain investigational; no general cure has been established. The relative timing of different cure approaches cannot be predicted from early trials.[35]

Gene editing

Gene editing is being investigated to target HIV or make cells less susceptible. Animal experiments and early human studies address different questions, and safety findings are not proof of cure. No gene-editing treatment is approved as a routine HIV cure.[35]

Cure research has made meaningful progress, but there is no broadly available cure. ART remains standard care. Any interruption in a research trial requires close supervision and specific restart criteria; people should not stop treatment to test whether remission has occurred.[34]

Ending the HIV Epidemic

The Ending the HIV Epidemic in the U.S. (EHE) initiative, launched in 2019, set a goal of cutting new HIV infections in the United States by 75% by 2025 and 90% by 2030.[17] The strategy focused federal resources on 57 priority jurisdictions — 48 counties, Washington, D.C., San Juan, Puerto Rico, and 7 states with a high rural HIV burden — that together account for more than half of new U.S. HIV diagnoses.

CDC’s incidence series cited here estimates a 12 percent decline from 2018 to 2022, including a 30 percent decline among ages 13–24. Those data describe progress through 2022, not through 2024, and cannot on their own determine whether the 2025 milestone was met. Incidence estimates and reported diagnoses are different measures.[18]

Funding proposals and enacted budgets must be distinguished. The FY2026 administration budget proposed substantial changes to federal HIV programs. A proposal is not itself an appropriation or evidence that every funded service ended. We track legislation and program implementation in the Policy Hub and ADAP Updates page.[36]

Funding threats and the political environment

HIV programs depend on continuing funding, workforce, and access to care. The following issues deserve attention, with dates and the distinction between policy proposals and implemented changes kept clear.

PEPFAR: the programme’s December 2024 results sheet reported support for 20.6 million people receiving treatment in 55 countries as of September 30, 2024, and attributed 26 million lives saved to its work since 2003. These are dated programme results and impact estimates, not a 2026 census. Service interruptions can endanger continuity of care; effects depend on which services are lost and what support replaces them.[19]

CDC prevention funding: CDC supports testing, surveillance, outreach, and linkage to care. Funding proposals that reduce those activities may weaken prevention capacity; the effect depends on which services change and what replaces them.[36]

Ryan White and ADAP: Florida's ADAP program cut eligibility from 400% to 130% of the federal poverty level on March 1, 2026, disenrolling more than 12,000 Floridians (NASTAD initially estimated as many as 16,000 could be affected) before the legislature restored eligibility to 400% FPL later that month through emergency bridge funding.[20] Federal Ryan White funding uncertainty adds further instability. Full context is in the Florida section below and on our ADAP Updates page.

The human rights environment: CHLP’s September 15, 2026 map identifies 40 states with HIV-specific criminal laws and/or sentence enhancements, including 32 with HIV-specific exposure laws. Those are overlapping categories, not two interchangeable totals. Legal and immigration concerns may also affect people’s willingness to seek services.[21]

The science of HIV in 2026 is remarkable. The tools exist to get to near-zero new infections. What stands between where we are and that goal is not biology — it is political will, structural investment, and the removal of the barriers that keep the most affected communities from the tools that could protect them.

Florida in 2026

Florida has a substantial diagnosed HIV population and experienced major ADAP changes in 2026. March restrictions were followed by emergency bridge funding and later appropriations. Those changes restored medication pathways while leaving important limits, including the absence of insurance-premium assistance.[37][22]

Florida ADAP in 2026: what happened, and where things stand

Florida ADAP supports eligible people who need help paying for HIV medicines. Its 2026 rules changed more than once, so enrollment and benefits should be checked with a case manager.

Checked September 20, 2026: Florida DOH lists medication assistance for eligible people at or below 400% FPL. Biktarvy and Descovy returned July 1. Insurance-premium assistance remains unavailable. Eligibility does not guarantee automatic enrollment; contact the ADAP Help Desk at 844-381-2327 or your case manager. See ADAP Updates.[37]

Florida’s HIV criminal laws include provisions that do not make sustained viral suppression a categorical defense. The state has also not expanded Medicaid. People facing coverage gaps should ask about Ryan White and ADAP eligibility rather than assume they cannot obtain treatment.[37][21]

The Florida HIV care infrastructure — Ryan White clinics, AIDS service organizations, FQHC networks, CAN Community Health, AHF — is robust and committed. The gap is between what that infrastructure can do and the structural and political barriers it has to work around.

RiseUpToHIV was built specifically in response to Florida's HIV crisis — to fill information gaps, connect people to care, and refuse to let the epidemic proceed invisibly. That mission is more relevant in 2026 than when we started.

Looking ahead: what to watch in 2027

Most of what will shape 2027 already exists. The tools are approved, the trials are enrolling, and the budgets are written. What is unsettled is whether any of it reaches people. These are the things worth watching — not as predictions, but as the places where the next year actually gets decided.

Whether twice-yearly prevention reaches the people who need it

WHO recommended injectable lenacapavir as an additional PrEP option in July 2025. CDC recommends it for eligible HIV-negative adults and adolescents weighing at least 35 kg. The regimen uses two injections totaling 927 mg every 26 weeks, with a two-week window and required starting oral doses. Trials showed very high efficacy compared with estimated background incidence; they did not prove that all infections are preventable in every setting.2728

Delivery remains essential: coverage, clinical visits, HIV testing, and plans for delayed or stopped doses. Drug remaining in the body is not the same as continued protection. CDC says declining lenacapavir levels after six months do not provide HIV protection. People stopping injections who still need prevention should arrange another PrEP option with their clinician.28

The first efficacy data on once-monthly oral PrEP

Once-monthly oral alimatravir (MK-8527) is investigational. EXPrESSIVE 10 and 11 are Phase 3 prevention trials in different populations. Planned enrollment and completion dates may change, and neither a trial’s size nor its schedule establishes efficacy or approval. Results will show whether this option can add to currently available PrEP.30

Whether prevention funding holds

UNAIDS’ 2026 prevention report models possible increases in infections if prevention funding falls, even when treatment coverage is held steady. Those are conditional projections, not observed future outcomes. Effects depend on what services are lost, local transmission patterns, and replacement funding. PEPFAR and domestic appropriations remain important to follow.2919

A midpoint reckoning on Ending the HIV Epidemic

EHE set reductions in new HIV infections of 75 percent by 2025 and at least 90 percent by 2030. Its commonly cited long-term benchmark is fewer than 3,000 annual infections. The 2022 incidence estimates linked here are insufficient to evaluate the final 2025 outcome; future assessment needs comparable, current data.17

Florida: a funding cliff with a date on it

Florida’s budget includes nonrecurring funding and a 21,000-person direct-medication cap. Future appropriations and implementation will matter for access. An annual funding cycle does not by itself prove that every enrollee’s prescription will stop on a particular date. People should verify their own enrollment and benefits with ADAP.26

References & Sources

  1. HIV.gov. U.S. Statistics. At year-end 2022, an estimated 1.2 million people ages 13 and older in the U.S. had HIV (diagnosed and undiagnosed). hiv.gov. ↩
  2. CDC. Estimated HIV Incidence and Prevalence, 2018–2022. Historical estimate of 31,800 infections in 2022. Source. ↩
  3. HIV.gov. U.S. Statistics. About 13% (roughly 158,249) of people living with HIV in the U.S. don't know they have it. hiv.gov. ↩
  4. CDC. National HIV Prevention and Care Objectives, released May 2026; 2024 care measures. Missing documented suppression is not proof of treatment failure. Source. ↩↩
  5. CDC MMWR. Estimated Annual Number of HIV Infections — United States, 1981–2019. MMWR 2021;70(22):801–806. Estimated annual HIV incidence rose from 20,000 in 1981 to a peak of 130,400 in 1984 and 1985, then declined to 34,800 in 2019. cdc.gov. ↩
  6. National Institutes of Health, ClinicalInfo.HIV.gov. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV: What to Start. Recommended initial regimens for most people with HIV include bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy) and dolutegravir-based combinations. clinicalinfo.hiv.gov. ↩
  7. Marcus JL, Leyden WA, Alexeeff SE, et al. Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000–2016. JAMA Network Open. 2020;3:e207954. The 6.8-year gap refers to the early-ART subgroup during 2011–2016, not every person with HIV. Source. ↩
  8. FDA. Cabenuva (cabotegravir and rilpivirine) prescribing information. Current indication and monthly or every-two-month dosing: FDA label (PDF). The original January 21, 2021 approval is documented in the FDA announcement reproduced by HIV.gov. ↩
  9. NIH Clinicalinfo. Lenacapavir patient drug record: Sunlenca for treatment with other ARVs; Yeztugo for prevention. Source. ↩
  10. CDC. PrEP Effectiveness. When taken as prescribed, PrEP reduces the risk of getting HIV from sex by about 99%. cdc.gov. ↩
  11. HIV.gov. Timeline of the HIV and AIDS Epidemic. July 16, 2012 entry: the FDA approves the use of Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP), the first medication approved to reduce the risk of sexually acquired HIV. hiv.gov. ↩
  12. FDA. Approval letter, NDA 215499: Apretude (cabotegravir extended-release injectable suspension) (December 20, 2021). Approved as the first long-acting injectable PrEP option, given once every two months. accessdata.fda.gov. ↩
  13. Gilead Sciences. Yeztugo (Lenacapavir) Is Now the First and Only FDA Approved HIV Prevention Option Offering 6 Months of Protection (press release, June 18, 2025). gilead.com. ↩
  14. Bekker LG, Das M, Abdool Karim Q, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. N Engl J Med. 2024;391(13):1179–1192 (PURPOSE 1); and Kelley CF, Acevedo-Quiñones M, Agwu AL, et al. Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons. N Engl J Med. 2024 (PURPOSE 2). PURPOSE 2; PURPOSE 1. ↩
  15. CDC. HIV Risk and Prevention Estimates. Sustained viral suppression prevents sexual transmission. Source. ↩
  16. Sustained HIV-1 remission after heterozygous CCR5Δ32 stem cell transplantation. Nature. Published online 2025, volume 650 (2026). Source. ↩
  17. HIV.gov. Ending the HIV Epidemic in the U.S.: Overview. EHE aims to reduce new HIV infections in the U.S. by 75% by 2025 and 90% by 2030, focused on 57 priority jurisdictions. hiv.gov. ↩
  18. HIV.gov. U.S. Statistics. New HIV infections decreased 12% from 36,200 in 2018 to 31,800 in 2022, driven by a 30% decrease among people aged 13–24. hiv.gov. ↩
  19. U.S. Department of State. PEPFAR latest global programme results, December 2024. Dated service counts and attributed impact estimates. Source. ↩
  20. Florida Senate. HB 697 (2026) history and enacted text; governor approved March 24, 2026. Source. ↩
  21. Center for HIV Law and Policy. Mapping HIV Criminalization Laws in the U.S., September 15, 2026: 40 states overall, including 32 exposure-law states. Source. ↩↩
  22. CDC. Diagnoses, Deaths, and Prevalence of HIV in the United States and 6 Territories and Freely Associated States, 2023. Florida remains among the highest-burden states for HIV; the South accounted for roughly half of new HIV infections in 2022. stacks.cdc.gov. ↩
  23. International Association of Providers of AIDS Care (IAPAC). News Alert — Florida ADAP Changes (January 12, 2026). Florida DOH announcement of the March 1 ADAP eligibility change from 400% to 130% FPL. iapac.org. ↩
  24. WLRN Public Media. State sued over access to HIV/AIDS medication for low-income Floridians (January 28, 2026). AHF lawsuit and NASTAD estimate that up to 16,000 Floridians would lose ADAP coverage. wlrn.org. ↩
  25. Florida Senate. HB 697 (2026) history: approved March 24; chapter number March 25. $30.9 million bridge legislation. Source. ↩
  26. Florida Legislature. Enrolled HB 5001E (2026E), section 101, printed page 518: $75 million nonrecurring ADAP funding, carry-forward, and 21,000 direct-medication cap. Source. ↩
  27. World Health Organization. WHO recommends injectable lenacapavir for HIV prevention (July 14, 2025). WHO recommended twice-yearly injectable lenacapavir as an additional PrEP option and urged governments, donors, and partners to begin rolling it out immediately within national combination prevention programmes. who.int. ↩
  28. Patel RR, Hoover KW, Lale A, et al. CDC MMWR clinical recommendation for injectable lenacapavir PrEP, 2025. Discontinuation section: residual tail does not provide protection after six months. Source. ↩
  29. UNAIDS. HIV Prevention 2030 (March 2026). “Even if HIV treatment coverage is sustained at current levels (and only primary prevention is affected by funding cuts), new HIV infections are projected to rise from 2026.” unaids.org. ↩
  30. Merck. July 14, 2025 announcement of EXPrESSIVE Phase 3 trials for once-monthly investigational MK-8527. Trial plans are not an approval or efficacy result. Source. ↩
  31. FDA. Idvynso prescribing information, April 2026: once-daily switch regimen and eligibility. Source. Checked September 20, 2026. ↩
  32. Lenacapavir, teropavimab, and zinlirvimab. Phase 2 week-26 primary outcomes, 2026. Source. Checked September 20, 2026. ↩
  33. CDC HIV Nexus. Clinical Guidance for PrEP: eligibility, formulations, schedules, testing, and follow-up. Source. Checked September 20, 2026. ↩
  34. Lee MJ et al. RIO randomized trial. Lancet HIV. 2026. 68 participants, early-treated population, supervised treatment interruption. Source. Checked September 20, 2026. ↩
  35. NIH Office of AIDS Research. FY2026 Professional Judgment Budget: investigational HIV cure research strategies. Source. Checked September 20, 2026. ↩
  36. HHS. FY2026 Budget in Brief. Administration proposal, not enacted appropriations. Source. Checked September 20, 2026. ↩
  37. Florida DOH. ADAP current rules and FAQs: medication assistance up to 400% FPL, July 1 formulary restoration, no premium assistance. Source. Checked September 20, 2026. ↩
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