First, the good news: the science of has advanced remarkably. Although we still lack a vaccine or cure, a new long-acting injection can offer protection against HIV for six months with a single dose. This breakthrough could revolutionize efforts to still claim a life every minute. However, the rise of populism and regressive governance threatens to undo many of the gains in public health and the fight against HIV.
In the United States, the successful and bipartisan (PEPFAR) is under attack, and its possible dismantling could . It is estimated that this program has saved about 25 million lives in the last two decades. It was conceived out of concerns that the AIDS pandemic could devastate generations in low- and middle-income countries and fuel political instability.
The National Institutes of Health (NIH) is facing scrutiny over its funding of HIV research, with some lawmakers questioning the validity of decades of peer-reviewed science. Robert F. Kennedy Jr., appointed by the Trump administration as the next US health secretary, is a vaccine skeptic who for many years has falsely linked vaccines to autism. Kennedy has also publicly denied the causal relationship between HIV and AIDS. Treating evidence-based research as an opinion interchangeable with another without scientific validity is a serious danger, especially if it is consolidated at the highest levels of government.
Undermining science and human rights risks reversing progress and opens the door to future pandemics
Restrictions on human rights continue to challenge the response to HIV in the regions most affected by the epidemic. In 2024, it ratified one of the most severe in the world. At least half of the 67 countries that still criminalize same-sex relationships are in sub-Saharan Africa, where the burden of HIV is highest. Anti-gay laws are correlated with higher rates of HIV globally. In Russia, punitive drug laws and restrictive policies toward the LGTBIQ+ community continue to drive the world’s fastest-growing HIV epidemic.
Undermining science and human rights puts progress at risk and opens the door to future pandemics. The resurgence of HIV and H5N1 are warnings: HIV could be next. But there is a plan that can do the opposite and end HIV forever: defend human rights.
Protecting human rights is not just an ideological stance; It is a proven public health strategy. Punitive laws and discriminatory policies harm those who need it most and undermine HIV prevention and treatment. Urgent legal reforms are required to protect key populations and repeal laws that criminalize LGTBIQ+ communities, migrant workers, sex workers, people who inject drugs, and those incarcerated. Empowering civil society organizations, including those of people living with HIV, has been and continues to be the cornerstone of the HIV response.
Protect shrinking civil society spaces
One of the most powerful lessons from four decades of HIV response is that successful public health efforts require an engaged and empowered civil society. The activism of those most affected has shaped the response to HIV, from trial design to health policy. Civil society organizations provide vital services, especially for those whose access to public health systems is hindered by stigma and discrimination. Protecting these organizations—rather than defunding and persecuting them—saves lives. However, more than 50 countries have laws that restrict the foreign funding on which many HIV initiatives depend.
Geopolitical and economic power increasingly shapes international health policy to the detriment of global health equity
As organizers of the world’s largest HIV conferences, we feel the impact of shrinking civil society spaces. Countries most affected by HIV are often off-limits to our conferences due to safety concerns for the most marginalized and persecuted. In other cases, governments have threatened to interfere in the agendas and debates of our meetings, compromising the independence of our movement. We demand the protection of civil society spaces so that people can organize and assemble freely, because a functional public health response depends on it.
Depoliticize public health
Despite the lessons of the , efforts in 2024 by WHO Member States to draft were frustrated. The treaty was intended to address gaps exposed by Covid-19, such as unequal vaccine distribution and lack of global coordination. The failure to agree on a treaty text highlighted how geopolitical and economic power increasingly shapes international health policy to the detriment of global health equity. It is vital to resist this in the ongoing negotiations and adopt a strong public health-based treaty text at the World Health Assembly next May.
The likely return of the Global Gag Policy is another example of how unrelated political agendas undermine the response to HIV. First introduced under the administration and reinstated under the first Trump administration, it prohibits international organizations from receiving US funding if they offer abortion services or related information. Paradoxically, this policy increases dependence on abortion by limiting access to contraception. A study published in PNAS found that it contributed to 360,000 new HIV acquisitions in just four years (2017-2021). With two-thirds of international HIV funding coming from the US, the reintroduction of the Gag Policy would be devastating.
Strengthen international cooperation
According to the Joint United Nations Program on HIV/AIDS (UNAIDS), its funding in 2024 has fallen to less than 50% of the resources available in 2015. Other essential multilateral health institutions, such as the WHO, are also struggling to obtain more financing. Institutions like PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have saved approximately 90 million lives. They are worth defending, not defunding them. Funding gaps and inequities undermine global health cooperation.
Progress occurs when science, politics and civil society come together. The HIV movement is built on transformative social movements—women’s rights, LGBTQ+ rights, and civil rights—that have demonstrated that inclusive and collaborative approaches drive sustainable change. Today, we must build on this legacy, organize, resist anti-human rights movements and defend science as the foundation of our societies’ progress. The alternative is a place where humanity has been many times before, offering little more than regression and pain.
