US isolationism, HIV, and primary care integration: the inflection point for low-income and middle-income countries is now

Summary The abrupt withdrawal of US global health funding, including major cuts to the President's Emergency Plan for AIDS Relief and US Agency for International Development, threatens decades of advances in global HIV control and progresss towards the UN 95-95-95 target by 2025. Despite more than US120 billion invested in Africa and 30 million people on antiretroviral therapy globally, the global HIV response remains short of the target, with 28% of those living with HIV still virally unsuppressed. As vertical HIV programmes collapse, integrating HIV services into primary health care offers a path forward. Primary health care, with its syndemic approach and infrastructure for chronic disease management, is well positioned to absorb HIV services while ensuring sustainability. Although challenges remain, especially in terms of resource reallocation and leadership, full integration is feasible, cost-effective, and aligned with universal health coverage goals. With coordinated national leadership, this funding crisis represents an opportunity to transform HIV control by integrating HIV services within resilient, sustainable, person-centred primary health-care systems capable of reaching the 95-95-95 target on the path towards achieving epidemic control, HIV elimination, and long-term health equity.