We are closer than ever to ending AIDS, but budget cuts threaten decades of progress. Continued investment and prevention are essential to achieve the 2030 goals.
When the first was presented International Sida Day In 1988, I had just finished my first immunology course, in which we began to learn more about a mysterious virus: the human immunodeficiency virus (hiv). At that time, no one knew much about this stealth virus.
Three years later, Freddie Mercury’s death brought global attention to an epidemic that had already claimed millions of lives. Most had died anonymously, leaving behind unfinished lives and grieving loved ones. None of them lived to see the breakthrough of 1996: the triple antiretroviral therapy (which combines three drugs in a single treatment). For those living with HIV, this moment was as momentous as man landing on the Moon: HIV was no longer an automatic death sentence and became a chronic, manageable disease.
A revolution shared unequally.
However, this revolution remained a privilege of the rich countries. It took almost a decade to bring this life-saving treatment to low-income countries, especially those in sub-Saharan Africa. As people in richer countries got their lives back, around 30 million people people around the world were living with HIV, most without treatment, and were becoming infected every year 3.8 million further. In countries like South Africa, Mozambique and Zambia, HIV remained a death sentence, the epitome of global inequality.
Two revolutionary changes that saved millions of people
So what changed around 2002-2003 to make HIV treatment available to tens of millions of people? Two major initiatives transformed the global response:
These enormous coordinated efforts brought in unprecedented resources, and continue to do so. By the early 2020s, they were jointly contributing around 10 billion dollars annuallywhile funding for HIV research continued to increase, leading to important advances in prevention, diagnosis and clinical treatment.
We are so close to ending HIV, to ensuring that millions of people can lead full, healthy lives. To back down now would be both a moral and strategic failure.
Since the implementation of antiretroviral treatment in the regions most affected by HIV, they have been saved more than 20 million lives and have been avoided almost 40 million new infections. With the treatment, people on the verge of death literally came back to life within weeks of starting to take the pills: many called it a miracle. Even as a rational scientist and not one to believe in miracles, she could understand how such a spectacular return to health could be perceived as the work of a supernatural power.
Each year, UNAIDS consistently reported progress: fewer new infections, fewer AIDS deaths and a significant reduction in mother-to-child transmission, as treatment evolved from multiple daily doses to a single pill. And what increased was the life expectancy. is South AfricaHe went from about 56 years old in 2000 to 67 years old today.
Science advanced. In recent years, advances in prevention, such as injectable pre-exposure prophylaxis (PrEP) with cabotegravir every two months and semiannual injections of lenacapavir, have brought us closer than ever to End AIDS by 2030.
2025: a dangerous step backwards
Then came 2025. Donald Trump’s US administration dismantled key international aid mechanisms, cut most of USAID, and reduced funding for PEPFAR and the Global Fund.
Just a few months after the cuts, the effects are already visible: dismissal of health workers, closure of clinics and people without access to treatment. A recent modeling study warned that a 24% reduction in funding could suppose 3 million additional deaths related to AIDS and 4 and 11 million new infections for HIV by 2030.
We’re too close to turn back
We are so close to ending HIV, to ensuring that millions of people can lead full, healthy lives. Going back now would be a both moral and strategic failure.
It’s like building your family’s house from scratch, spending years laying bricks, investing your savings and taking care of every detail. All you have to do is paint the front door and you’ll be done. Would you really leave after coming this far? Would you give up your home and lose all the money and sacrifices you’ve made?
Finish what we started
We cannot stop when we are close to the goal. Around the world, health systems are moving towards integrated care, where HIV is managed alongside chronic diseases and infections such as tuberculosis and malaria, often through primary care services. These models have proven to be sustainable, profitable, community-focused and replicable.
Ending AIDS by 2030 remains possible, but only if we choose to finish what we start
Ensuring uninterrupted antiretroviral treatment is essential to saving lives and keeping HIV under control. But we will not end the epidemic if we fail to stop new infections: the prevention. Promising tools like lenacapavir as PrEP (the closest thing we’ve ever had to a vaccine) must reach high-incidence regions and people at highest risk.
We must also address the stigma and the discriminateas they remain major obstacles for many people.
To reach those most in need it will be necessary collaboration between governments, international donors, researchers, the pharmaceutical industry and affected communities.
Ending AIDS by 2030 remains possible, but only if we choose Finish what we started.
