“In a time of poor leadership, community is an act of resistance.” These powerful words, delivered by Sharon Hillier, PhD, from a poignant poem by Loryn Brantz, resonated through the packed auditorium for the opening of the Conference for Retroviruses and Opportunistic Infections 2025. The session set the stage for a deep dive into the alarming current status of the HIV/AIDS pandemic, especially in light of recent political changes.

Dr. Chris Beyrer, the director of the Duke Global Health Institute, opened his address by recognizing the invaluable contributions of the federal employees dedicated to HIV work, many of whom were unable to attend the conference. Their efforts, he emphasized, form the cornerstone of all initiatives aimed at preventing and treating HIV.

Beyrer underscored that the response to HIV must center around three essential tenets: diversity, equity, and inclusion. These concepts are not mere buzzwords but vital components that shape effective public health strategies. “We have to care about women, children, adolescents, and the queer community,” he stressed, “as well as marginalized populations including those who inject drugs in Eastern Europe and Central Asia.”

He also highlighted the critical need for equitable access to antiretroviral therapy (ART), arguing that only by ensuring all individuals living with HIV can receive treatment can the epidemic's spread be effectively curbed. Beyrer invoked the inspiring words of Archbishop Desmond Tutu regarding the dignity of LGBTQ+ youth, emphasizing that personal freedom is essential for societal progress.

Facing the HIV Crisis Head-On: Plans and Pitfalls for 2025

Despite efforts made over the years, Beyrer pointed out that targets set for 2025 are being missed. Currently, 23% of individuals living with HIV are not on ART, and the total number of new HIV infections is expected to reach 1.3 million in 2024, far exceeding the goal of reducing new cases to 500,000 annually. Moreover, Beyrer noted that areas like Eastern Europe and Central Asia are witnessing HIV rates swell, raising concerns about the lack of uninterrupted support from major programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID). If these disruptions continue, the rise in HIV incidences will likely accelerate.

The dream of controlling the epidemic by 2030 now seems increasingly unrealistic. Although there has been a surge in pre-exposure prophylaxis (PrEP) uptake over the last two years, much of this could be attributed to PEPFAR funding, which is currently under threat. Beyrer lamented the grim reality: “In Eastern Europe and Central Asia, while only 38,000 people have begun PrEP since 2012, 1.6 million have contracted HIV.”

To truly turn the tide on this epidemic, Beyrer called for sustained primary prevention programs—especially given the alarming pause on PEPFAR operations. He argued for the urgency of scaling up initiatives to put over 40 million of the most vulnerable individuals on PrEP to move toward epidemic control.

The Politics of HIV: A Bitter Battle for Resources

As political uncertainty looms, the potential long-term effects on the life expectancy of HIV-positive individuals, particularly in Africa, could be devastating. Beyrer noted that prior to PEPFAR, life expectancy for people living with HIV sank by 10 to 30 years, with 29 million lacking necessary treatment. The program has been credited with saving approximately 25 million lives and preventing many from being born with HIV.

However, Beyrer warned that if PEPFAR remains inactive, there could be a stark 400% rise in AIDS-related deaths, leading to a dramatic increase in the number of orphans left in the wake of this crisis. Although there are some signs of hope with Secretary Marco Rubio discussing resuming PEPFAR, much of the aid’s effectiveness hinges on the viability of USAID—another organization facing cuts.

“The countries that performed best will be hit the hardest,” Beyrer cautioned, referencing the tragic repercussions of these political maneuvers.

In conclusion, Beyrer urged the pressing need to restore PEPFAR, reauthorize it by its expiration on March 25, 2025, and form a new coalition to address the widening gaps in HIV prevention and treatment strategies. Quoting former President George W. Bush, Beyrer aptly ended his speech with a powerful message: “I have set before you life and death. Therefore, choose life.”

As the world continues to grapple with the HIV/AIDS pandemic amidst shifting political landscapes, the call to action rings louder than ever—lives depend on it.