The State of Our HIV Union in 2026 Is Stronger Than You Think

2025 was a year in public health that I’m sure none of us wants to repeat. But we, as an HIV Community, remained steadfast in holding control of our here-and-now existence. Our future, and our health, demand that we continue that momentum in 2026.

Exactly one year ago, Joseph R. Biden Jr. ended his term as president of the United States, and there was a peaceful transfer of power to President Donald J. Trump. Like much of the free world, the HIV-impacted community collectively held its breath: We feared a slowing of the progress achieved through Trump’s Ending the HIV Epidemic (EHE) initiative from his first term, which continued through the Biden era.

Optimistically, I know that some HIV leaders hoped (and even prayed) that EHE’s success would continue much in the same way as the United States President’s Emergency Plan for AIDS Relief (PEPFAR). After all, PEPFAR is a global health program initially led by Republican President George W. Bush and maintained with the bipartisan, bicameral support of Congress. This program is credited for saving millions of lives from HIV-related deaths by funding services for people with and/or impacted by HIV in countries bearing the largest brunt of the HIV pandemic.

But soon after Trump’s second inauguration, all hopes for a better (or even a status-quo) federal HIV response were dashed.

Taking Stock of What We’ve Lost

The U.S. government suspended PEPFAR; shuttered USAID, which provided most of the clinical support for HIV services; and even proposed eliminating institutions from the National Institutes of Health, with the majority of the 27 institutes lacking a permanent director. Moreover, the Trump administration proposed to eliminate the Division of HIV Prevention at the Centers for Disease Control and Prevention (CDC), eliminate funding for his own EHE initiative, and drastically reduce funding for HIV prevention and treatment programming, in addition to slashing funding for HIV research.

The impact has been sudden—and sometimes overwhelming to HIV service organizations and the communities that they serve. “What’s happening now isn’t theoretical,” says Masen Davis, M.S.W., the executive director of Funders Concerned About AIDS. “HIV organizations across the U.S.—particularly in the South—are already scaling back services, reporting staff furloughs, reducing HIV testing and outreach, and have canceled prevention programs as public funding has been delayed, cut, or thrown into uncertainty,” he says.

And it’s not just federal funding that’s under threat: Davis shares that in the past year, “U.S. HIV philanthropy for Black communities declined by $12 million, and funding for Latinx communities fell by 7%. While funding for transgender communities increased by 32%, those gains are occurring alongside a 25% drop in general operating support, which is the flexible funding community organizations rely on to keep doors open.”

As HIV community-based organizations struggled throughout this past year, we have also watched the brain drain from within the federal government as trusted leaders in the HIV response were pushed out of vital roles, such as Jeanne Marrazzo, M.D., M.P.H., who directed the National Institute of Allergy and Infectious Diseases (NIAID); Jonathan Mermin, M.D., M.P.H., who led the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention; and Carl Dieffenbach, Ph.D., who led the Division of AIDS within NIAID.

Guillermo Chacón, president of the Latino Commission on AIDS, tells TheBody that in the past year, the community “faced unprecedented actions at the federal level aimed at dismantling the public health infrastructure and losing our nation’s leadership role in [HIV] health care both domestically and globally.”

Balancing Hope and Hurt

Ironically, this brain drain comes at the very time when palpable progress was being made to rewrite effective HIV prevention and treatment options. Marrazzo, who now serves as CEO of the Infectious Diseases Society of America, tells TheBody that 2025 brought “evolution towards understanding of broadly neutralizing antibodies, [which] continues to be astonishing, with implications for HIV cure and vaccine; prospects for control of malaria with monoclonal antibodies; and better vaccines.” And she raves about the “uptake of PrEP and expanding access to long-acting agents like lenacapavir and cabotegravir!”

As a result, this mix of progress in HIV prevention and treatment alongside these unprecedented attacks has created intense tension. Across HIV, the general public health response, and the sociopolitical spectrum, leaders must do daily calculus to decide whether, and when, to lift their voices and use their bodies in protest against the seemingly nonstop political onslaught since the presidential inauguration last January.

The HIV movement has witnessed numerous executive leaders leaving their roles over the past year, for a variety of reasons. Their successors are stepping into this environment, which requires intentional emotional pacing for the marathon/obstacle course set before them. Chacón shares his personal strategy to navigate these muddy waters: “I remind myself that self-care requires us to be relevant, thoughtful, action-driven, patient, humble, and full of hope that tomorrow will be better. Because then, together, we can care for each other.”

Tatyana Moaton, Ph.D., chief strategic officer of the San Francisco Community Health Center, shares how she is doing personally: “Honestly? I’m exhausted in ways that don’t show up on a body scan. This year has felt like running triage on a battlefield I thought we’d already secured. It truly has been a study in cognitive dissonance. Every executive order, every funding freeze, every policy reversal; it’s not abstract to me. I’m a Black trans woman who came up through this movement. When I see a [presidential] administration dismantling PEPFAR, threatening Ryan White, and openly pathologizing transgender existence, it’s personal.”

Moaton is one of many who are confident that the HIV public health response has been intentionally set on fire. She goes on to say that “all the proposed and completed funding cuts for HIV prevention and care are not policy differences. It’s a public health catastrophe by design.” As a result, across all organizations and systems, leaders have hard decisions to make: Do they attempt to fly below the radar of a federal government that is seemingly focused on doing the greatest harm to the people we care about? Or, alternatively, do they publicly fight for their communities and accept that they might be directly targeted?

This difficult situation mirrors what we’ve seen in the fight to sustain our support for diversity, equity, and inclusion (DEI) in our workplaces and organizations. As Davis notes, programming focused on the racial and ethnic communities most impacted by HIV (e.g., Black, Indigenous, Latinx) has been slashed as the government is aggressively defunding organizations that openly support diversity in the workplace, believe health equity is beneficial, and/or showcase the power of inclusion on health outcomes. These DEI-centered community-based organizations have become a trusted lifeline to so many historically excluded populations. Now these organizations must adapt their successful public health business model or face closure.

Moaton reminds us: “When facing an existential threat to your [health care] sector, you have two choices: compete for shrinking resources or build integrated power. The HIV movement has overwhelmingly chosen the latter.”

Our Resilience and Our Togetherness Are Our Strength

Despite the devastation of the past year, the collective efforts to lift the voices of the HIV Community have not been stopped. In fact, the opposite is true: Nearly all threats to HIV-related services are met with organizing and direct political engagement, from the state houses to the U.S. Capitol.

For example, despite the efforts of the Trump administration, the U.S. Congress is still charged with deciding how American funding is used. And congressional leaders like Rep. Sara Jacobs (D-CA) have been relentlessly advocating on our behalf. Rep. Jacobs, a member of both the Congressional HIV/AIDS Caucus and Congressional LGBTQ Equality Caucus, tells TheBody, “Cuts to domestic HIV funding threaten to undo the decades of progress we’ve made to bring epidemic control within our reach. Without enough federal funding, the immense burden of care, education, prevention, and awareness will fall solely on local community organizations, and we’ll lose more lives that could have been saved. Ending the HIV epidemic is possible, but only if we have the full buy-in and support from the federal government.”

One thing is crystal clear. Over the past four decades, the Community has taught the world that we have the strongest resolve for supporting our siblings from all walks of life while also holding some of the greatest political, medical, and population-health minds in the modern age. Marrazzo speaks for so many when she proclaims, “It’s not hyperbole to say this has been a year of grieving. Grieving for lost opportunities, collaborations, data, and integrity at some of the most respected scientific institutions in the world. But moving on to other opportunities is giving me and others a way to fight back with all of our hearts and minds. That’s what it’s going to take to bring back science for the community in 2026 and beyond.”

It is with the knowledge of where we have been and where we are going that this author can confidently say, “We got this,” while still being painfully realistic about the challenges that lie ahead.

Onward. Together.

Any views expressed above are the author's own and do not necessarily reflect the views of HealthCentral LLC.