By Irénio Gaspar, Director of the National STI, HIV and AIDS Control Programme, Ministry of Health (MISAU), Mozambique
AIDS 2026 made it clear that DSD is entering a defining period. As HIV programmes navigate financing transitions, changes in service delivery structures and persistent inequities, the question is no longer whether services should be differentiated, but how DSD can be used to protect the people and outcomes that matter most.
Across discussions on funding disruptions, prioritization and sustainability, one message came through consistently: DSD should not become shorthand for doing less. Instead, it should help programmes make better and more deliberate choices about how limited resources are used, according to clinical stability, vulnerability and individual needs, while protecting the essential services that sustain treatment continuity, prevention and quality of care. Discussions around TIER-Plus reflected this reality, highlighting the importance of making prioritization decisions deliberately and transparently when resources are constrained.
Integration was another strong theme throughout the conference. Sessions explored opportunities to link HIV services with services for tuberculosis (Monton et al; Moolla et al; Nkomo et al), sexually transmitted infections (Zahabu et al), sexual and reproductive health (Jonas et al; Njambi et al), cervical cancer (Kigen et al; Murwira et al; Uamba Tualufo et al), viral hepatitis (Perazzo et al), hypertension (Kasujja et al; Mosepele et al; Tshimwanga et al; , diabetes (Kasujja et al; Nuwagira et al) and mental health (Manojai et al; Njambi et al). From the client’s perspective, integration should mean fewer fragmented visits and simpler pathways through care. For health systems, it offers an opportunity to strengthen primary healthcare and make better use of existing platforms. But integration should not simply mean adding more services to already stretched providers. It needs to be purposeful, improving convenience and continuity while maintaining the quality of specialized HIV care.
AIDS 2026 also reinforced the importance of choice across the HIV continuum. Discussions on self-testing (Adole et al; Cabuso et al; Damian et al; Thepbinkarn et al), peer-led (Cabuso et al; Manojai et al; Owusu et al) and community-based (Ashivor et al; Ginindza et al; Kasujja et al) approaches, and new long-acting prevention options, including early experiences with lenacapavir for PrEP (Kamau et al; Kerschberger et al; Mulenga et al), showed the potential of differentiated prevention to reach people who may not be well served by conventional facility-based models. Yet, new technologies alone will not transform prevention. Their impact will depend on whether they are delivered through models that are accessible, acceptable and responsive to the realities of young people, mobile populations, key populations and others who continue to face barriers to services.
Importantly, the conference also reminded us that DSD is not only about clinically stable clients receiving multi-month ART refills. Discussions on treatment interruption (Edwards et al; Golbador et al; Lemani et al; Lungu et al; Pienaar et al), re-engagement (Ginindza et al; Manganye et al), point-of-care viral load monitoring (Kikaire et al; Mtenga et al) and advanced HIV disease (Mbeje et al; Molapo; Phiri et al; Shuping et al) pointed towards a broader role for differentiation: providing more support, rather than less, to those most vulnerable. People returning to care, those with viraemia and those with advanced HIV disease require pathways that enable rapid identification, intensified clinical management and strong links between facility and community services.
For me, one of the clearest messages from AIDS 2026 was, therefore, that the next phase of DSD must be about differentiation for protection: protecting continuity, equity, quality and person-centred care while HIV programmes adapt to a changing financing landscape. DSD will remain essential to sustaining progress towards 2030, but its value will increasingly depend on how well it helps programmes protect those most at risk of being left behind precisely when HIV services are under the greatest pressure.
