Bill Gates has spent over two and a half decades working in global health, and the progress in the fight against HIV/AIDS is one of the most remarkable achievements he has witnessed, second only to the impact of vaccines in saving millions of children's lives.

At the onset of the AIDS epidemic, an HIV diagnosis was often fatal. However, with significant advancements over the years, anti-retroviral medications now allow people with HIV to live full, healthy lives with undetectable viral loads, meaning they cannot transmit the virus. Additionally, PrEP (pre-exposure prophylaxis) medications can reduce the risk of contracting HIV by up to 99% when taken as prescribed.

If these tools could be provided to everyone in need and used correctly, HIV could be stopped in its tracks. Unfortunately, the practicalities of distributing these tools and ensuring their correct use pose significant challenges. Daily adherence to preventative medication is difficult for many due to various barriers, including the need for frequent clinic visits, storage issues, and stigma.

Bill Gates is particularly excited about new innovations in HIV prevention. Scientists are developing longer-lasting PrEP options, such as Lenacapavir, which requires only two doses per year through injection, and Cabotegravir, which works for two months at a time. Additionally, a monthly oral medication called MK-8572 is in trials. The Gates Foundation is exploring ways to extend protection for six months or longer and is working on PrEP options that include contraception.

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To assess these options in real-world settings, the foundation has supported implementation studies in South Africa, Malawi, and other locations. These studies focus on practical challenges like ease of use and cultural acceptance.

Despite the advances in prevention tools, the Gates Foundation remains committed to finding an HIV vaccine. The goal is to create multiple layers of protection, similar to modern cars with seatbelts and airbags.

Partnerships are crucial to ensure these innovations reach those in need. The foundation is working to lower manufacturing costs for HIV drugs, and organizations like the Global Fund and PEPFAR have been instrumental in translating scientific advances into real-world impact. The Global Fund helps more than 24 million people access HIV prevention and treatment, while PEPFAR has saved 25 million lives since 2003.

We are at a critical juncture in the fight against HIV/AIDS. Tremendous progress has been made, but the task now is to ensure that the life-saving innovations available reach the people whose lives they can save.