For decades, HIV attracted extraordinary political attention, billions in international funding, and an activist movement that changed global health. Now, donor funding is shrinking just as science has delivered powerful new medication that could dramatically cut new HIV infections. The International Aids Conference in Rio de Janeiro, held in August, marked a turning point as the event became one of the smallest gatherings in its 40-year history. Delegates gathered amid an unprecedented funding crisis, with talk in the corridors focused on layoffs rather than viral load reductions.
Funding cuts reshape the response
The United States government made sharp, sudden cuts to HIV funding in developing countries in 2025, including South Africa. The result was the closure of 1,714 HIV clinics and drop-in centers across 46 countries, along with the loss of more than 16,000 full-time jobs. Most of these services were run by nongovernmental organizations funded through the U.S. government’s Aids programme, Pepfar, which cut its support by a quarter in just one year. Other wealthy countries have since either cut or flatlined their contributions, pushing donor funding for HIV down to levels last seen before 2008.
Almost none of the organizations that lost U.S. support have managed to replace it. Many are scrambling to survive rather than finding money to send staff to international conferences. A cruel irony emerged as the money disappeared: science delivered lenacapavir (LEN), an injection given twice a year that makes people who use it for HIV prevention extremely unlikely to contract the virus. This breakthrough only works if people can access it. The drug costs money to produce, buy, and roll out, and if too few people use it, even a highly effective preventative will not make a meaningful dent in new infections.
The meeting marked the conclusion of a period in which AIDS held a singular status within global health. It had long been regarded as an outlier. Disagreements over the virus’s discoverer grew so intense they reached the highest tiers of government. In 1987, President Ronald Reagan of the United States and Prime Minister Jacques Chirac of France signed a pact to resolve a clash between American and French researchers regarding the identification of HIV and the patent for a blood test. That same month, the two scientists at the heart of the dispute, Robert Gallo and Luc Montagnier, co-authored a paper in Nature outlining the chronology of the discovery.
Very few illnesses have attracted comparable scientific and political focus. Former South African leader Nelson Mandela and ex-U.S. President Bill Clinton were frequent participants at International AIDS Conferences, while public figures such as Magic Johnson, Princess Diana, Whoopi Goldberg, Bono, Elton John and Charlize Theron openly challenged the stigma and bias linked to HIV. In 1994, the United Nations launched its dedicated programme UNAIDS.
These developments secured unprecedented levels of global financing for HIV. Two major funding streams emerged: the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria. This capital propelled rapid scientific progress, powered powerful activist networks, and provided life-saving drugs to low-income nations that could not otherwise afford them.
Only a handful of illnesses enjoy as many dedicated meetings. The International AIDS Society alone coordinates three major biennial events: the International AIDS Conference, the Conference on HIV Science, and HIVR4P. Africa hosts its own biennial gathering, the International Conference on AIDS and STIs in Africa (ICASA). Additionally, each year scientists convene for the Conference on Retroviruses and Opportunistic Infections (CROI), a venue where many landmark HIV discoveries are presented.
What’s next?
Delegates left Rio with many questions. The world is still trying to understand how to maintain momentum as science delivers new tools and funding shrinks. The future of the HIV movement depends on whether the community can adapt to a new era where Aids is no longer exceptional.
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