The good news first: HIV science has made remarkable progress. While we still lack a vaccine or cure, a single dose of a new long-acting injectable drug can now offer protection against HIV for up to six months. This breakthrough could revolutionize efforts to curb a pandemic that still claims a life every minute. However, the rise of populism and regressive governance threatens to unravel many hard-won gains in HIV and public health.

The United States has suspended funding to the President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved some 26 million lives over the past two decades. Even though a later waiver for “life-saving humanitarian assistance” applied to HIV testing and treatment and, narrowly, to HIV prevention for pregnant women, many PEPFAR-funded clinics had already closed, staff were sent home, and confusion remains. The future of PEPFAR is now uncertain, and more than 20 million people are in danger of losing access to life-saving medication.

The Trump administration has frozen operations of the National Institutes of Health and Centers for Disease Control and Prevention, with some policy makers and politicians questioning the validity of decades of peer-reviewed science. Robert F. Kennedy Jr., who is preparing to take office as head of the U.S. Department of Health & Human Services, is a vaccine sceptic who has for many years falsely linked vaccines to autism. Kennedy is also on record denying the causal relationship between HIV and AIDS. Treating evidence-based research as opinions that can be traded for other views without any scientific validity is a grave danger, especially if it takes hold at the highest levels of government.

Human rights restrictions continue to challenge the HIV response in regions most affected by the pandemic. In 2024, Uganda upheld one of the world’s harshest anti-gay laws. At least half of the 67 countries that still criminalize same-sex relationships are in central, eastern, southern and western Africa, where HIV burdens are highest. Anti-gay laws correlate with higher HIV rates globally. In Russia, punitive drug laws and restrictive LGBTQ+ policies continue to drive the world’s fastest-growing HIV epidemic.

Undermining science and human rights risks reversing progress and invites the next pandemics. The re-emergence of mpox and H5N1 bird flu are warning shots – HIV could be next. But there’s a blueprint that can do the opposite and end the HIV pandemic for good:

Protect shrinking civil society spaces

One of the most powerful lessons from four decades of the HIV response is that successful public health efforts require an engaged, empowered civil society. Activism by those most affected has shaped the HIV response, 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. Yet, over 50 countries have laws restricting the foreign funding that many HIV initiatives depend on.

As conveners of the world’s largest HIV conferences, we at the International AIDS Society feel the impact of shrinking civil society spaces. The countries most affected by HIV are often off-limits for our conferences due to safety concerns for the most marginalized and persecuted. In other instances, governments have threatened to interfere with the agendas and debates of our gatherings, compromising our movement’s independence. We demand the protection of civil society spaces so that people can organize and assemble freely – because a functioning public health response depends on it.

Strengthen international cooperation

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), its funding in 2024 has dipped to less than 50% of the resources available in 2015, and other essential multilateral health institutions, such as the World Health Organization (WHO), are also struggling for funding. This is compounded by President Trump’s order to withdraw the US from WHO. Institutions such as PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria have between them saved some 90 million lives. They are worth defending, not defunding. Funding shortfalls and inequities undermine global health cooperation.

Progress happens when science, policy and civil society unite. The HIV movement is built on transformative social movements – women’s rights, LGBTQ+ rights and civil rights – which have shown that inclusive, collaborative approaches drive sustainable change. Today, we must build on this legacy, organize, push back against anti-human rights movements, and defend science as the foundation of our societies’ progress. The alternative is a place humanity has been many times before, offering little but regression and pain.