The global HIV/AIDS response is facing its most serious crisis in decades. Despite expanded access to antiretroviral therapy (ART) and the growing availability of prevention tools such as oral preexposure prophylaxis (PrEP), and long-acting PrEP, progress toward the UNAIDS 2025 targets has stalled. HIV incidence remains unacceptably high across key populations and geographic regions, while treatment coverage gaps and preventable deaths persist. The abrupt 2025 suspension of U.S. foreign aid programs, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID), has further disrupted service delivery, particularly for prevention programs and marginalized groups. This editorial assesses the underlying structural, political, and programmatic failures that led to missed targets and highlights the compounded risks posed by policy reversals. Drawing on recent epidemiological data and modeling, we estimate the impact of prevention gaps, disparities in access, and policy changes on global HIV trajectories. We argue that a path forward requires reforms, renewed political will, and sustainable financing. In a moment of rising global polarization and shrinking public health budgets, the HIV response must be reimagined around equity, inclusion, and collective action. Without such recalibration, the vision of ending AIDS as a public health threat by 2030 will remain out of reach.
Beyrer et al. (Thu,) studied this question.