"Fight against HIV at risk: political setbacks threaten achieved progress."

The fight against HIV, one of the most devastating pandemics in recent history, is at a critical crossroads. Despite scientific advancements that have led to the development of a new long-acting injection capable of providing protection for six months with a single dose, the public health landscape is threatened by a surge in populism and regressive policies that jeopardize the achievements made over the past decade. This situation raises the possibility of a monumental setback in the fight against HIV. The President’s Emergency Plan for AIDS Relief (PEPFAR), a bipartisan program in the United States that has saved approximately 25 million lives since its inception, is facing unprecedented scrutiny. The dismantling of this initiative could leave millions without access to essential medications, putting the progress made in HIV prevention and treatment in low- and middle-income countries at serious risk. The initial concern over the devastating impact of AIDS in these nations remains relevant, but the current political context threatens to reverse the gains achieved. In this tense environment, the National Institutes of Health (NIH) are under pressure, with some lawmakers questioning the validity of decades of scientific research in the field of HIV. The potential appointment of figures like Robert F. Kennedy Jr. as U.S. Secretary of Health adds an additional layer of risk. His skepticism towards vaccines and denial of the relationship between HIV and AIDS highlight a troubling disregard for scientific evidence. This type of scientific denialism, if solidified in government, could lead to a weakening of public health policies that are fundamental in the fight against HIV. Restrictions on human rights also remain a significant barrier to the global response to HIV. In 2024, Uganda ratified one of the world’s most severe anti-gay laws, reinforcing the correlation between punitive laws and higher rates of HIV. This pattern is repeated in many nations, especially in sub-Saharan Africa, where the criminalization of same-sex relationships contributes to the spread of the epidemic. In Russia, restrictive policies towards LGBTQ+ communities and punitive drug laws continue to exacerbate the HIV crisis. It is essential to recognize that undermining science and human rights opens the door to future pandemics. As the world faces emerging outbreaks such as mpox and H5N1 avian flu, HIV could be next on the list. However, an effective strategy to reverse this trend involves advocating for and promoting human rights as a key component of public health. Policies that protect vulnerable populations and eliminate criminalization are essential to preventing the spread of HIV and ensuring equitable access to treatment and prevention. The accumulated experience from four decades of fighting HIV demonstrates that the active participation of civil society is crucial. The activism of the most affected communities has shaped health policies and ensured that the needs of vulnerable groups are addressed. However, the continued restriction of funding to these organizations, often by governments that fear activism, poses a direct threat to the HIV response. Protecting civil society space is not just a matter of social justice; it is a public health strategy that saves lives. Recent efforts to establish a new pandemic treaty at the WHO have largely failed. This treaty should have addressed the inequalities that became evident during the COVID-19 pandemic, but the lack of agreement highlights how geopolitical dynamics can undermine public health. It is imperative that the voices of those who have been on the front lines of the fight against HIV are heard and that health equity is prioritized in all future negotiations. The reintroduction of the Global Gag Rule, which prohibits funding to organizations that provide abortion services or related information, is another illustration of how political agendas can undermine the HIV response. This policy not only limits access to reproductive care but has also been linked to an increase in new HIV infections. Given that the United States accounts for two-thirds of global funding for HIV, this regression would be devastating for public health programs worldwide. The decline in funding for HIV programs in 2024, which has fallen to less than 50% of what was available in 2015, is alarming. Institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria have been fundamental in saving lives, and their defunding could lead to a dramatic increase in new infections and deaths from HIV. Global health cooperation depends on a strong and sustained commitment from countries, and it is crucial that funding is prioritized to address this public health crisis. In conclusion, the future of the fight against HIV is at a crossroads. It is imperative that science, politics, and civil society come together to halt the regression and build on the achievements made. Defending human rights and promoting inclusive policies are not only a matter of justice but also of public health. As we face new challenges, we must learn from history and ensure that the fight against HIV not only persists but thrives in a world that desperately needs to make progress.