Global Status of HIV/AIDS Pandemic Takes Center Stage in Opening Session

“In a time of poor leadership, community is an act of resistance.” The quote from a poem written by Loryn Brantz rang out over the speakers of the packed opening session, read by Sharon Hillier, PhD, to thunderous applause from all attendees. The Conference on Retroviruses and Opportunistic Infections 2025 began with the reading of a poem to introduce Chris Beyrer, MD, MPH, director of Duke Global Health Institute, to speak about where the global HIV/AIDS pandemic is now, even as the HIV/AIDS field is under fire by the new administration.

Beyrer spent his introduction acknowledging the federal employees working in HIV who could not be at the meeting, through whose work, he said, all other careers working to prevent and cure HIV could not be possible.

Defining HIV response could really be summarized into 3 words, said Beyrer: diversity, equity, and inclusion. Although these words have been loaded with new meaning in the past couple of months, these words are fundamental to the way that HIV care needs to be approached.

“We have always had to pay attention to diversity because we have an incredibly diverse pandemic,” Beyrer said. “We have to care about women and children. We have to care about adolescents and newborns. We have to care about men. We have to care about our queer community in magnificent cities like San Francisco. And we have to care about people who inject drugs from Eastern Europe, Central Asia, [and] Southeast Asia.”

Equity is fundamental to curbing the spread of HIV, as making sure that all people living with HIV have access to antiretroviral therapy (ART) means that viral suppression is achieved and the spread can be reduced. Beyrer also cited Archbishop Desmond Tutu’s words on inclusion of LGBTQ+ youth: “Never let anyone make you feel inferior for being who you are. When you live the life you were meant to live, in freedom and dignity, you put a smile on God’s face.”

CROI 2025 opened with a session reflecting on where we are as a society when it comes to the global addressing of HIV/AIDS | Image credit: reddish - stock.adobe.com

Addressing the HIV Pandemic in 2025

The talk shifted to recounting the goals for 2025 that were missed even prior to the change in administration. There are still 23% of people living with HIV who are not on ART. Deaths due to HIV are also not at the 2025 goal, even if the overall mortality was declining through 2023. The goal to bring incidence down to 500,000 new cases per year is also significantly underachieved through 2025, with an estimated 1.3 million new infections in 2024. Underestimation of this number is also extremely likely in some countries, said Beyer. Eastern Europe, Central Asia, the Middle East, and North Asia are all still seeing the expansion of HIV. If the President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID) continue to be disrupted, the incidence of HIV will continue to rise.

Controlling the HIV epidemic by 2030 is now considered unrealistic. Although the initiation of pre-exposure prophylaxis (PrEP) saw an uptick in 2023 and 2024, much of that was due to the US President's Emergency Plan for AIDS Relief (PEPFAR), which is facing challenges from the Trump administration. Functionally, said Beyrer, there is no PrEP without PEPFAR. In Eastern Europe and Central Asia, only 38,000 people started using PrEP since 2012, at the same time that 1.6 million people acquired HIV. Although people in Eastern and Southern Africa had a higher initiation rate of PrEP, with 6.4 million starting it since 2012, it was still lower than the 8.8 million who acquired HIV in that same time span.

“This is part of the fundamental problem. We are not implementing prevention, effective prevention, where it’s needed most, and we are not at all top incidents,” said Beyrer. He also noted that there are still notable disparities in the incidence of HIV. For example, Black men who have sex with men (MSM) still have a much higher incidence of HIV compared with White MSM. Reaching out to people at most risk to convince them to use PrEP and get the products to them, which makes vaccines or cures still worthy goals.

Achieving epidemic control will require more primary prevention programs, which makes the pause on PEPFAR even more noteworthy. Long-acting forms of PrEP may be able to improve the scale of patients taking preventive medicines but will need to be given to these patients in scale to properly account for disparities. Epidemic control, said Beyrer, is only possible if more than 40 million of the most vulnerable people are on PrEP.

The Current Politics of HIV

The pause in PEPFAR could mean lasting consequences on the life expectancy of people living with HIV in Africa, as life expectancy was plummeting by 10 to 30 years and 29 million people did not have access to treatment for HIV prior to the implementation of PEPFAR. Beyrer stated that approximately 25 million lives have been saved as a result of PEPFAR, with 20.5 million on treatment and 5.5 million babies born without HIV.

He also presented data that estimates that there will be a 400% increase in deaths due to AIDS should PEPFAR remain paused indefinitely, which would double the number of orphans due to AIDS. Although Secretary Marco Rubio has walked back the pause of PEPFAR specifically, much of PEPFAR is implemented through USAID, which has been dismantled, along with parts of the HHS and CDC.

“It’s the countries that were doing the best that, of course, will now fare the worst,” said Beyrer.

The Supreme Court ordered that the Trump administration had to resume funding on Monday, March 10, so it remains to be seen if this important funding will be given to those who need it most as the fight against the HIV/AIDS pandemic persists.

Beyrer concluded by saying that the key parts of current politics that need to happen to continue work in the field, including restoring PEPFAR, reauthorizing PEPFAR before its authorization expires on March 25, 2025, and establishing a new coalition to close gaps on addressing the pandemic.

“When [former president] George W. Bush was leaving after the first PEPFAR replenishment on his way to Africa, he quoted from Deuteronomy…and that’s how I want to end,” said Beyrer. “I have set before you life and death. Therefore, choose life.”