A Year Lost: Assessing the Reversals in HIV Prevention and Treatment
The opening session of the Conference on Retroviruses and Infectious Diseases (CROI) 2026 wasn’t a celebration of progress, but a reckoning. Peter Staley, a veteran of the HIV/AIDS fight since his diagnosis in 1985 and co-founder of PrEP4All, delivered a stark assessment: 2025 was an “annus horribilis” for the HIV response. This isn’t hyperbole; it’s a measured response from someone who witnessed the earliest days of the epidemic and helped forge the activist movements that demanded a response. The significance isn’t simply that progress stalled, but that hard-won gains appear to be actively eroding, and the question now is whether the damage is repairable. Staley’s framing, echoing language used by The Lancet to describe a particularly devastating year in the past, signals a level of concern that demands careful examination.
Staley’s address, as reported by aidsmap, directly attributes this setback to the policies enacted following the inauguration of a second Donald Trump presidential term. While the specifics of those policies weren’t detailed in the initial report, the implication is a systematic dismantling of programs and protections established over decades. This isn’t a novel claim – concerns about the potential impact of a second Trump administration on public health were widely voiced before the election – but the speed and severity of the “destruction,” as Staley termed it, appear to have exceeded expectations. It’s crucial to understand that this isn’t simply a political critique; it’s a public health assessment based on observed outcomes. The core issue isn’t disagreement over strategy, but a demonstrable regression in key metrics related to HIV prevention and treatment access.
Drawn from eatg.org.
Beyond Politics: The Tangible Impacts on Access
The immediate consequence of these policy shifts, according to reports from CROI 2026 and related publications like AJMC, centers around the “4 I’s”: Innovation, Implementation, Improvement, and Inequity. While each area saw challenges, the most pressing concern is implementation – specifically, the disruption of access to PrEP (pre-exposure prophylaxis) and treatment for those already living with HIV. The Alliance for Public Health’s recent report, “25 Years of Lifesaving Impact,” highlights the fragility of progress even in contexts of prolonged stability, but the situation in the US, as described by Staley, suggests a deliberate dismantling of infrastructure. This isn’t merely about funding cuts; it’s about regulatory changes, restrictions on prescribing practices, and a concerted effort to undermine the evidence base supporting these interventions. The contrast with positive developments elsewhere, such as Benin’s adoption of a new law promoting HIV prevention and eliminating stigma, underscores the divergence in global responses.
It’s important to note that the available reports don’t yet quantify the extent of the damage. We don’t have precise figures on the number of people who lost access to PrEP or treatment in 2025, nor do we have a clear breakdown of the specific policies responsible. However, the consistent message from CROI 2026 is that the situation is dire. The concern isn’t just about preventing new infections, but about reversing years of progress in reducing viral loads and improving the overall health of people living with HIV. A rise in viral loads, even temporarily, creates opportunities for the virus to mutate and potentially develop resistance to existing treatments – a risk that looms large in the current climate.
Limitations to Consider: Data Gaps and Regional Variations
While the alarm raised by Staley and others is justified, it’s essential to approach these reports with a degree of caution. The initial assessments from CROI 2026 are largely based on anecdotal evidence and preliminary data. A comprehensive analysis of the impact of the new policies will require a more rigorous evaluation, including detailed epidemiological studies and a thorough assessment of healthcare access across different regions. It’s also likely that the impact of these policies will vary significantly depending on factors such as socioeconomic status, geographic location, and existing healthcare infrastructure. For example, states with more robust public health programs may be better equipped to mitigate the effects of federal cuts.
Furthermore, the focus on the US context risks overshadowing the challenges faced by other countries. While the situation in the US is particularly concerning, the global HIV response is facing a multitude of challenges, including funding shortages, political instability, and the ongoing impact of the COVID-19 pandemic. The report from the Alliance for Public Health, detailing “Four Years of Resilience in Wartime,” reminds us that even in the most challenging circumstances, progress is possible, but it requires sustained commitment and innovative solutions.
The Path Forward: Surveillance and Advocacy
The immediate priority is to gather more data on the impact of the policy changes enacted in 2025. This requires robust surveillance systems to track access to PrEP and treatment, monitor viral load trends, and identify populations at greatest risk. Simultaneously, advocacy efforts must focus on reversing the harmful policies and restoring funding for HIV prevention and treatment programs. Staley’s history with ACT UP and TAG demonstrates the power of grassroots activism in shaping public health policy, and a similar approach is needed now.
Looking ahead, the critical question is whether the damage done in 2025 is reversible. Will the gains made over decades be permanently lost, or can we rebuild the infrastructure and restore the momentum? The answer will depend not only on political will but also on the ability of the scientific community and advocacy organizations to provide compelling evidence and mobilize public support. We need to watch closely for changes in new HIV diagnoses in the coming year, specifically looking for increases in areas where PrEP access has been curtailed. The trajectory of these numbers will be a clear indicator of whether 2025 was truly an aberration, or the beginning of a dangerous new trend.
