World AIDS Day: united beyond difficulties

Overcoming challenges, transforming the response to AIDS: the slogan chosen for World AIDS Day 2025 is a call for global solidarity, in a historical moment marked by international closure and disengagement. The year ending was marked by unprecedented cuts in global aid against the epidemic caused by the HIV virus.

After decades of progress, and with transformative medicines finally within reach, we are helplessly witnessing the destruction of life-saving programs that could undo the efforts made so far. Yet, science, resilience and solidarity show us a clear and viable way out of the crisis.

There are 40.8 million people in the world living with HIV. In 2024, there were 1.3 million new infections and 660,000 deaths due to AIDS. Still 9.2 million people do not have access to treatment.

As recalled by the new report from UNAIDS, the United Nations Program on HIV and AIDS, published on December 1st for World AIDS Day, the abrupt interruptions in international aid against the AIDS epidemic triggered by the Trump administration’s cuts have aggravated existing funding gaps, and caused massive damage to HIV prevention and support services managed by local communities.

Thousands of people who worked on the PEPFAR program (the President’s Emergency Plan for AIDS Relief, the largest single country initiative against AIDS, launched by the United States in 2003, which had saved tens of millions of lives) were fired. Efficient and functioning health facilities were closed, million-dollar contracts were torn up, already funded projects were interrupted while supplies of antiretrovirals, pre-exposure prophylaxis drugs and HIV tests ran out.

As a result of these cuts, the OECD estimates that external HIV healthcare will decline by 30-40% in 2025 compared to 2023. The halt in global funding has particularly impacted HIV prevention programs by placing a burden on the most vulnerable populations, such as young women and girls aged 15-24. Already in 2024, 570 new HIV infections were recorded per day in this age group.

The closures dictated by the stop to funding have led to the suspension of the activity of over 60% of women-led organizations in the area for the fight against AIDS. Services targeting other key HIV populations, such as men who have sex with men, prostitutes, people who inject drugs and transgender people, have also been severely affected, while the number of countries criminalizing same-sex sexual activity and gender expression with human rights laws has increased for the first time since 2008.

Yet, never before have we had drugs capable of transforming HIV prevention and preventing infections in high-incidence contexts. We have an antiretroviral that could stall the global HIV epidemic and which is injected only twice a year: it is lenacapavir, capable of preventing all new HIV infections in people free from the virus but at high risk of infection.

In its generic version, it could be sold for around 40 dollars a year for each patient, but its distribution in developing countries that need it most urgently also depends on international programs affected by cuts.

Furthermore, many countries have responded to the interruption of international funding by increasing resources at a local level and obtaining stable numbers of infections or even an increase in AIDS patients receiving antiretroviral drugs: this is the case of Nigeria, Uganda, Ivory Coast, South Africa and Tanzania, which all represent an example of resilience.

On World AIDS Day, the appeal of the scientific community and of anyone involved in the fight against this epidemic is to reaffirm the value of multilateralism and international cooperation in this challenge, which we can only win together, maintain funding to support the countries most affected by HIV infections, support scientific innovation and make medicines available at affordable prices, support human rights by fighting stigma and recognize the precious value of services within communities.