World AIDS Day and the Future of HIV Policy in the United States

Each year, World AIDS Day, which was observed last month, serves as a moment to honor those we have lost, recognize the strength of people living with HIV, and renew our commitment to ending the epidemic through public health initiatives. Since HIV was first identified in 1981, it has caused over 44 million deaths worldwide. Today, approximately 40 million people are living with the virus, including about 150,000 in California. Nearly 100,000 Californians have died from HIV, highlighting the epidemic’s profound impact on communities and the urgent need for better access to care and prevention. World AIDS Day is a powerful reminder that the fight to eradicate HIV continues. As we move into a new year, the lessons of World AIDS Day remain urgent and unresolved.

In late 2025, the US State Department advised staff and grantees not to use federal funds for publicly recognizing World AIDS Day. This restriction applied to social media, speeches, and other forms of communication, although employees could still discuss their global health work or attend external events. Notably, the White House has publicly recognized other observances in 2025, such as World Autism Awareness Day and National Manufacturing Day. Many advocates see this forced silence as a painful reminder of the early HIV epidemic, when a lack of public attention worsened the crisis. The message from that period remains relevant today: silence equals death.

World AIDS Day usually coincides with the State Department’s annual report to Congress on the President’s Emergency Plan for AIDS Relief (PEPFAR), the main source of US global HIV funding. Entering 2026, however, substantial cuts threaten the program’s continuation. The Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a report stating that funding reductions implemented in 2025 are already damaging crucial prevention and treatment efforts, such as PrEP, which lowers the risk of HIV infection by 99%. The global AIDS response is now in “crisis mode” as the US, responsible for about 75% of international HIV funding, cuts back its support.

Over the past decade, AIDS-related deaths dropped by over 50%, and new HIV cases have declined by 40%. However, this progress is now at risk. UNAIDS estimated that by October 2025, 2.5 million people who had been using PrEP in 2024 lost access to the medication solely because of funding cuts. These losses highlight the central role of PEPFAR, launched in 2003 under Republican President George W. Bush and long considered the backbone of global HIV prevention and treatment funding. If PEPFAR funding ends, there could be an additional 6.6 million HIV infections and over 4.2 million AIDS-related deaths by 2030, many among children. Additionally, around 3 million children might become orphans. These numbers highlight the urgent need for continued US leadership and steady global HIV funding.

A similar trend is developing in the United States. The Fiscal Year 2026 budget eliminated the Domestic HIV and AIDS Prevention and Research Program and nearly all HIV prevention funding from the Centers for Disease Control and Prevention (CDC). Since the CDC handles about 90% of federal HIV prevention funds, this represents a 78% reduction from Fiscal Year 2025, or roughly $794 million. It also dismantled the CDC division responsible for national HIV surveillance and prevention initiatives. The combined effect of these cuts is a weakened public health system with fewer tools to monitor HIV trends, prevent new infections, support evidence-based interventions, and respond rapidly to outbreaks, thus reversing decades of progress in reducing HIV transmission.

Not only is prevention at risk, but so are key HIV care programs. Policy changes enacted in 2025 eliminated Part F of the Ryan White Program, which funds dental care, clinical training, and community research. Funding reductions have also affected the Minority AIDS Initiative at the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), along with housing supports for people living with HIV. These cuts are harmful because they strip resources from programs designed to reach communities most affected by HIV and to address the housing, behavioral health, and structural barriers that determine treatment access, adherence, and health outcomes. Additionally, the Department of Health and Human Services (HHS) plans to cease maintaining federal HIV clinical guidelines by June 2026. Advocates worry that without strong federal oversight, these guidelines could become outdated or politicized, weakening standards of care and endangering insurance coverage for over a million people living with HIV in the US.

HIV research has also faced notable setbacks. Since early 2025, the NIH has canceled at least 191 HIV-related grants, including support for more than one hundred active clinical trials. Similarly, a recent study found that funding disruptions caused the shutdown of 383 clinical trials nationwide, affecting over 74,000 participants. These losses slow scientific progress, limit future treatment options, and reduce the evidence policymakers rely on for public health decisions.

As we enter 2026 and reflect on the direction of HIV policy, this moment calls for renewed commitment from the health policy community. HIV still carries heavy stigma and continues to impact those with limited access to care. Cuts to prevention, treatment, and research threaten to deepen these disparities. We urge health policy leaders to stay engaged and advocate for evidence-based HIV services. Support organizations providing prevention and care. Stay informed about the evolving needs of at-risk communities and people living with HIV. Most importantly, use your influence—speak out when science is ignored or stigma influences policy and encourage leaders at all levels to protect programs that save lives and promote public health.

Author bio: 

Alex Dubov, PhD

Dr. Dubov is an Associate Professor for the School of Behavioral Health. His research interests lie in applying scientifically rigorous approaches (i.e. conjoint analysis) to better understand and improve both patient and physician decision making. He is also interested in leveraging emerging technologies as innovative approaches for supporting the implementation of combination (biomedical, behavioral, health system) interventions to prevent HIV infection among groups that are epidemiologically at high-risk for infection and whose prevention needs are complicated by their socially marginalized statuses in their communities.

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