Advances and challenges in the fight against HIV: human rights and public health united.

The fight against HIV has been a journey marked by significant scientific advances and a collective commitment to addressing this public health crisis that still persists over time. In recent years, the scientific community has achieved important milestones, such as the development of a new long-acting injection that can offer protection against the virus for six months with just one dose. This breakthrough, which promises to transform the way HIV is prevented, comes at a time when the pandemic continues to claim a life every minute. However, the rise of populism and regressive policies are seriously jeopardizing these achievements and the health of millions of people globally. In the United States, the President's Emergency Plan for AIDS Relief (PEPFAR) has been a stronghold in the fight against HIV, saving approximately 25 million lives over the past two decades. However, this vital program faces an attack that threatens its continuity. Conceived in a context where there was concern that the AIDS pandemic could devastate entire generations, its potential dismantling could leave millions of people without access to essential treatments that have been key to containing the spread of the virus. As the debate over HIV research funding intensifies, the National Institutes of Health (NIH) find themselves under scrutiny from lawmakers questioning the validity of decades of peer-reviewed research. This situation is exacerbated by the appointment of figures like Robert F. Kennedy Jr., who has questioned the scientific evidence regarding HIV and promoted misinformation about vaccines. This kind of delegitimization of science is an imminent danger that could lead to monumental setbacks in the progress made thus far. Restrictions on human rights add to this complicated landscape. In 2024, Uganda ratified one of the most severe anti-gay laws in the world, a symptom of how discrimination and repressive policies continue to complicate the response to HIV, especially in sub-Saharan Africa. The criminalization of same-sex relationships has proven to be correlated with an increase in HIV rates, creating a vicious cycle that affects the most vulnerable populations. This scenario is further aggravated in countries like Russia, where punitive drug laws and repression against the LGBTQ+ community have led to an alarming increase in the HIV epidemic. Undermining human rights is not only ethically questionable but also jeopardizes the progress made and opens the door to future pandemics. Recent history has shown us that HIV may not be the last virus humanity faces if effective measures are not taken to address these issues. In the face of this adversity, it is clear that the defense of human rights is not just an ideological stance but a necessary public health strategy. Evidence shows that punitive laws and discriminatory policies hinder access to HIV care and treatment for those who need it most. Legal reforms are urgently needed to eliminate the barriers faced by key populations, from LGBTQ+ communities to migrant workers and people who inject drugs. The importance of an empowered civil society cannot be underestimated. The response to HIV has been shaped by the activism of those most affected, who have played a crucial role in designing policies and public health programs. However, the growing repression and defunding of civil society organizations threaten the continuity of this vital work. The lack of funding and the stigma surrounding these communities mean that many people still lack access to the necessary care. The holding of international conferences on HIV has been a key space for discussion and progress in the fight against the virus. However, the increasing censorship and restriction of civil society spaces in the most affected countries have led to the exclusion of critical voices. This situation not only compromises the global movement but also limits efforts to address the epidemic effectively. Looking to the future, it is crucial to learn from the lessons of the COVID-19 pandemic. The failure of WHO member states to draft a new pandemic treaty in 2024 highlights the need for a coordinated and equitable approach to global health. Health policy cannot be shaped solely by geopolitical or economic interests, as this undermines efforts to achieve fair and accessible healthcare. Finally, the reintroduction of the Global Gag Rule, which prohibits international organizations from receiving U.S. funding if they provide abortion services, underscores how political agendas can have devastating consequences in the fight against HIV. This policy, by limiting access to reproductive health and contraception services, has contributed to a notable increase in new HIV infections, demonstrating that the interconnection between reproductive health and HIV is a crucial axis in prevention. The way forward requires an alliance between science, inclusive politics, and a robust civil society. We must build on the progress made and resist the forces that seek to dismantle it. By defending science, human rights, and equitable access to care, we are not only protecting those living with HIV but all of humanity. The alternative to this struggle is a return to a past of suffering and helplessness that we cannot afford to repeat.