Don’t abandon the program now, the end of AIDS is near

The Endgame of AIDS: The Role of Research, Trade–offs, and Government Policies in the Treatment of HIV and Other Chronic Diseases

There was concern that before the Trump administration withdrew funding, there were problems. As AIDS deaths declined and living with an HIV infection became more manageable, it was increasingly difficult to evoke the same urgency and political will, says Brendan Bell, a microbiologist at the University of Sherbrooke in Canada. Domestic funding to tackle HIV declined for the fourth year in a row, whereas international funding has been falling for the last few years. Bell says that they have become victims of their own success. “With the success of antiretrovirals, why go further?”

Eric Goosby, a former US global AIDS czar and an infectious-disease physician at the University of California, San Francisco, stated that it was an abandonment of care.

Beyond the strong political and financial commitment at the time, what made the endgame attainable was an unprecedented understanding of AIDS. We understand how the virus moves through an individual, attacks their immune system and what parts get attacked more preferentially.

Pre-exposure prophylaxis, orPrEP, is a medication that protects against HIV infections, thanks to research. HIV became a manageable, preventable chronic condition, according to Deb.

Ntombi Ginindza, a former nurse from M-Bane, Eswatini, says that a positive HIV test used to be a death sentence in most LMICs. Life expectancy there was slashed to 39 years in 1998 due to the AIDS epidemic.

The cost and regulatory delays will be difficult to overcome, according to the director of the Institute of HIV Research and Innovation in Bangkok. Still, she is hopeful about a promised partnership between Gilead Sciences and generic manufacturers to make low-cost doses of lenacapavir for 120 LMICs.

In the agreement, there is reference to the fact that grass-roots activism and market interventions have put life-saving tools within reach of millions. The cost of branded antiretrovirals has been lowered on the basis of a nation’s income, region and HIV burden since 2000. In parallel, some governments, including Thailand’s, have invoked public-health exemptions to bypass patents and produce affordable generic drugs domestically.

Complacency is especially common among younger generations, who never witnessed the full horror of the AIDS epidemic, Moracha says. The rate of HIV infections in people under the age of 25 is one-quarter due to declining condom use and low testing rates. “There is now a whole new generation that doesn’t see HIV as a big deal,” she says.

The world will soon get a reminder. The virus starts replicating 6–8 hours after a person with HIV stops taking antiretrovirals. They can see their viral load within a week. After a few weeks, the body’s white blood cells start to get destroyed by HIV, leaving the body vulnerable to infections. “The average number of infections you’d get through is three or four, before it kills you,” Goosby says. Hospitals will be overrun with patients who will die in hallways and car parks if it takes three to six months for the treatment to begin, he predicts.

Terminated research grants from USAID and the US National Institutes of Health (NIH) have also derailed promising advancements and innovations, says Glenda Gray, chief scientific officer at the South African Medical Research Council in Cape Town. Grays HIV vaccine trial was shut down, and the Institute of HIV Research and Innovation was recently closed because of the history of testing life-saving interventions. More than 30% of the grants that had been terminated were related to HIV/AIDS.

There are some fears that Trump will further undermine HIV policy reforms by placing restrictions on funding that promotes gender ideology. Thailand continues to criminalize sex work, ban the distribution of clean needles and syringes, and forbid legal gender recognition for trans individuals. She thinks that, because of US actions, Thai policymakers could be more emboldened to block ongoing reform efforts. It is not an enabling environment to tackle HIV.

The George W. Bush Institute, a think tank based in Dallas, Texas, is right to say that the US Congress needs to authorize PEPFAR for another five years, so that the programme can complete its mission and so that countries, organizations and funders can plan for the transition to a world without USAID by strengthening local health systems, investing in primary care and establishing local medicine supply chains.

Critics of aid programmes say that aid should assist nations with their immediate needs and support them to become self-sufficient. Improving plans are established with recipient countries.

The 90-day review period on Donald Trump’s executive order to freeze nearly all foreign aid has been extended until 20 May. The US Agency for International Development (USAID), the world’s largest single aid donor, was dissolved. In 2024, it distributed some US$44 billion for disaster recovery and long-term projects, from growing free markets to treating and preventing diseases.