Tracking Progress Toward US HIV Incidence Targets

Blog post by Dr. José M. Zuniga (September 15, 2025)

At the US Fast-Track Cities 2025 Summit held September 15-17, 2025, in New Orleans, Sindhu Ravishankar, Vice President of Global Health Strategy at IAPAC and the Fast-Track Cities Institute, delivered a compelling presentation on where the United States stands in achieving HIV incidence reduction targets in cities and counties. The session, titled Tracking Progress: Are We on Track to Achieve the US HIV Incidence Targets?, offered both encouraging signs of progress and sobering reminders of the work still ahead.

The US Ending the HIV Epidemic (EHE) initiative set ambitious goals: reducing new HIV infections by 75% by 2025 and by 90% by 2030. Using data from the CDC’s NCHHSTP AtlasPlus, Ravishankar showed that while Fast-Track Cities and Ending the HIV Epidemic (EHE) jurisdictions in the United States are making gains, the nation is not yet on track to meet these targets.

Across the 39 EHE jurisdictions analyzed between 2017 and 2022, HIV incidence trends showed a mixed picture:

• 6 jurisdictions achieved reductions of 40-50% in new infections

• 16 jurisdictions recorded reductions of 20-40%

• 18 jurisdictions saw minimal progress (0-20%)

• Alarmingly, 10 jurisdictions reported increases in new HIV cases

These findings underscore uneven progress across the country and highlight the need for sustained, data-driven interventions.

Ravishankar introduced IAPAC’s urbanized incidence-prevalence ratio (IPR) as an innovative tool to benchmark HIV epidemic control. Unlike incidence alone, the IPR compares new infections to the number of people living with HIV, providing a more comprehensive view of epidemic dynamics.

In the United States, the IPR control threshold is calculated at 0.028, based on life expectancy after HIV diagnosis and average time to diagnosis. Encouragingly, analysis showed that by 2022, 64% of EHE jurisdictions (25 out of 39) had achieved epidemic control by this metric, up from 33% in 2017. The average IPR fell from 0.032 in 2017 to 0.025 in 2022; evidence of meaningful, though incomplete, progress.

Despite these gains, service disruptions over the past 6 months pose significant risks to the nation’s progress. Drawing on results from an Emergency HIV Clinical Services Survey of clinical providers fielded in July 2025, Ravishankar highlighted alarming trends:

• Populations most affected by recent disruptions include homeless and unstably housed individuals, transgender people, and undocumented migrants.

• Loss to follow-up has worsened across these groups, threatening continuity of care and undermining HIV treatment and prevention outcomes.

• Many clinical providers anticipate further disruptions over the next 6-18 months

These findings are a stark reminder that progress toward incidence reduction targets cannot be separated from broader structural and social challenges.

The path forward requires vigilance, innovation, and collaboration. IAPAC and the Fast-Track Cities Institute are working with Fast-Track Cities and EHE jurisdictions to analyze monthly incidence trends through July 2026, quantifying the impact of service disruptions on HIV outcomes. Surveys will continue every six months to ensure that disruptions are tracked in real time, enabling rapid responses to emerging threats.

Ravishankar closed her presentation with a clear message: “While progress is evident, it is not enough.” Achieving the US HIV incidence targets will require scaling proven strategies, protecting vulnerable populations from service interruptions, and leveraging innovative tools like the IPR to guide and benchmark progress.

Dr. José M. Zuniga is President/CEO of IAPAC and the Fast-Track Cities Institute.

Leveraging Latinx Leadership for HIV Success in Uncertain Times

IAPAC hosted an April 30, 2025, session at the NaLa 2025 conference in Las Vegas, NV, USA, focused on leveraging Latinx leadership for HIV success in uncertain times. Following is a blogpost from IAPAC President/CEO Dr. José M. Zuniga, who opened the session with framing remarks. 

IAPAC is proud to have hosted a NaLa 2025 conference session, especially at a moment in which we are witnessing a calculated erosion of the very foundations that protect health and human dignity:

• public health infrastructure is underfunded,
• civil rights protections are being rolled back, and
• evidence-based policy is being replaced with ideology and fear.

This erosion hits the Latinx community especially hard – because our community is not monolithic and yet is often treated as such in policy and programs. Afro-Latinx people, LGBTQ+ Latinx individuals, migrants, and those living in rural communities face layered and compounding inequities.

Political attacks on immigrant rights, gender-affirming care, reproductive freedom, and health equity are not happening in isolation, they are part of a broader assault that undermines Latinx health, autonomy, and life. Federal and state budget cuts threaten essential services, especially HIV prevention and care programs rooted in community, cultural relevance, and trust.

We are not just fighting to preserve systems – we are called to re-imagine and rebuild responses that reflect our values, identities, and realities. This includes not only HIV services, but the full range of care and rights that enable Latinx individuals and families to thrive, including mental health, housing, and safety from violence and discrimination.

As Dr. Daniel Castellanos of the Latino Commission on AIDS noted in the session’s opening plenary, there are stark disparities in HIV outcomes among Latinx communities across the United States and Puerto Rico. These disparities are rooted not only in biomedical factors but in a complex interplay of social determinants of health – poverty, housing instability, lack of culturally and linguistically appropriate care, immigration status, systemic racism, and stigma.

Dr. Castellanos underscored the urgent need to dismantle structural barriers that perpetuate inequity, noting that Latinx individuals are disproportionately affected by delayed diagnosis, gaps in care, and lower rates of viral suppression. His call to action was clear: addressing HIV in the Latinx community requires us to address the full social context in which HIV risk and resilience exist, and to do so through Latinx-led strategies grounded in justice, trust, and community strength.

In my framing remarks opening our session, I laid out five recommendations to center and leverage Latinx leadership for HIV success in uncertain times:

1. Fund Latinx-Led Organizations and Initiatives. Direct more resources to Latinx-led CBOs and clinics, ensuring we are not only the face of service delivery but also the architects of strategy, policy, and implementation.
2. Build a Pipeline of Latinx Public Health Leaders. Invest in training and mentorship for emerging Latinx leaders, from community health workers to researchers and public officials, across generational and geographic lines.
3. Ensure Data Disaggregation and Community Input. Demand disaggregated data that reflects the diversity within our community (e.g., national origin, language, immigration status, gender identity) and center our voices in decision-making bodies at all levels.
4. Protect Intersectional Rights. Stand against all forms of legislation and regulation that target LGBTQ+, immigrant, and reproductive rights – because Latinx health is inseparable from civil rights and social justice.
5. Create a National Latinx Health Equity Action Plan. Launch a multi-sectoral effort, grounded in community, to guide investments, partnerships, and accountability structures that prioritize Latinx well-being and leadership for the long-term.

The fight does not end here. Now more than ever, we must raise our voices, claim our power, and move forward together. The future of our health, our rights, and our communities depends on our collective action. Adelante (Forward) – with strength, with dignity, and without fear!

La lucha no termina aquí! Hoy más que nunca, debemos alzar nuestras voces, reclamar nuestro poder y avanzar unidos. El futuro de nuestra salud, nuestros derechos y nuestras comunidades depende de nuestra acción colectiva. ¡Adelante, con fuerza, con dignidad, y sin miedo!

Cruel, Misguided, Remediable:

Reckoning with the Attack on America’s Public Health Institutions

Statement by Dr. José M. Zuniga

President/CEO, IAPAC

April 2, 2025 ▪ Washington, DC

There are moments when words fail us – when no adjective seems sufficient to capture the depth of destruction, the scale of harm, or the recklessness of decisions made under the banner of governance. While devastating might be apt, it feels hollow in the face of what has occurred. Three other adjectives rise to the surface: cruel, misguided, and remediable, and it is through these words that we begin to confront the scale of what has happened and envision a path forward.

What we are witnessing in the decimation of the CDC, FDA, and NIH is cruel. There is no other way to describe the targeted degradation of agencies whose sole mission is to protect and improve the health and well-being of the American people. What has transpired is not a passive neglect, but an active, calculated undermining of public trust, professional autonomy, and institutional capacity.

The CDC, once regarded as the gold standard for epidemiological surveillance and infectious disease response, has been hollowed out. Experts have been silenced, data manipulated, and the authority of science subordinated to political expediency. This cruelty is not abstract. It will translate into delayed responses to outbreaks, poor coordination during national health emergencies, and vulnerable communities left without credible guidance or resources.

The FDA, the guardian of drug and food safety, has not been spared. Political interference in the agency’s regulatory process will shake public confidence in the safety of life-saving medications and vaccines. This erosion of credibility is not without consequence. It breeds skepticism, fuels misinformation, and endangers lives. Americans depend on the FDA to ensure that what they ingest or inject is safe and effective. Undermining that faith is a cruel betrayal.

The NIH, the engine of biomedical innovation, has seen its scientific agenda distorted by ideological constraints. Research initiatives have been shuttered, funding weaponized, and entire areas of inquiry, particularly those addressing sexual health, gender identity, and racial health disparities, have been delegitimized. This is not just a loss for scientists. It is a loss for patients, for families waiting on the promise of medical breakthroughs, for communities striving to close health gaps that have persisted for generations.

The cruelty lies in the consequences: children who go unvaccinated, HIV services disrupted, communities left without accurate health data, researchers who flee public service, and a nation increasingly ill-equipped to face future health crises. This cruelty is neither accidental nor collateral. It is structural and, in many cases, deliberate.

The idea that weakening America’s public health institutions somehow makes the country stronger is not only wrong – it is both misguided and dangerously delusional. These attacks are rooted in a false narrative that frames public health as a threat to individual liberty rather than a cornerstone of national security. This ideological shift leaves the country exposed, fractured, and fundamentally unprepared for any public health crisis or emergency.

Public health is not partisan. It is pragmatic. It is preventative. And it is cost-effective. Every dollar invested in disease surveillance, preventive care, and health education saves lives and reduces long-term health expenditures. The misguided efforts to shrink, politicize, or privatize our public health infrastructure do not liberate Americans. These efforts endanger them.

The undermining of HHS agencies reflects a deep misunderstanding of their purpose. These institutions are not meant to serve any political ideology. They are meant to serve the people – all people. When public health becomes politicized, truth becomes optional, and science becomes suspect. This has real-world consequences, from declining vaccination rates to increased maternal mortality, from delayed cancer screenings to avoidable mental health crises.

Moreover, these misguided actions ignore the interconnectedness of modern health threats. Pandemics, environmental health risks, antimicrobial resistance, and chronic disease burdens do not respect state lines or ideological divisions. They require a coordinated federal response grounded in science and equity. Weakening that response capacity does not make America freer. It makes it more vulnerable – economically, socially, and existentially.

For all that has been lost, not all is lost. Damage can be repaired. Institutions can be rebuilt. Public trust can be restored, but only if we act swiftly and with moral clarity. Congress has both the authority and the responsibility to demand accountability and chart a course of redress. This begins with oversight – robust, non-performative oversight that examines how and why decisions were made to weaken our public health infrastructure. Who benefited? Who was harmed? What systems were corrupted or dismantled, and to what end? Transparency must be the first step toward justice.

But accountability is not enough. Restoration must follow. This means reinvesting in the people and systems that make public health possible. Rebuilding scientific integrity within HHS agencies requires legal protection for whistleblowers and career scientists. It demands a recommitment to data transparency and non-interference in regulatory processes. It also means funding. Not just emergency appropriations, but sustained, predictable funding that allows for long-term planning, talent retention, and innovation.

Congress must also engage the public. Health equity and public trust go hand in hand. Communities need to see themselves reflected in the priorities and personnel of our health agencies. They need culturally competent care, linguistically accessible communication, and policies that account for structural barriers to health.

This work is difficult, but it is not impossible. America has rebuilt before – after Watergate, after Katrina, after the 2008 financial crisis, after COVID-19. We have learned, painfully and repeatedly, that ignoring dysfunction only deepens it. The same lessons apply here. What has been broken can be repaired, but only if we resist the temptation to normalize the current situation. We must reject cruelty as governance. We must name misguided policies for what they are. And we must embrace the responsibility to remediate… to do the hard work of rebuilding in service of a healthier, safer, and more equitable nation.

The choice before us is stark. We can accept the dismantling of science, the erosion of trust, and the politicization of health. Or we can fight for institutions that live up to their mandate: to protect the health and dignity of every person in this country. The latter will take courage, leadership, and vision. But it is not just possible. It is necessary.

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About IAPAC: IAPAC represents more than 30,000 clinicians globally committed to ending AIDS as a public health threat.

An Open Letter to the Federal Employees Who Sustain the U.S. Health System

To the dedicated federal employees across the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), Food and Drug Administration (FDA), and other critical public health agencies, including those who have been unjustly terminated or silenced:

On behalf of the International Association of Providers of AIDS Care (IAPAC) and the Fast-Track Cities Institute, I write to convey our deepest gratitude for your service and sacrifice. You are the lifeblood of the U.S. health system – epidemiologists, clinicians, researchers, program officers, policy advisors, and countless others who labor each day to prevent disease, protect communities, and advance health equity. The country owes you more than it has given in return. You are the unseen yet indispensable force that keeps our health system functioning and evolving, often in the face of adversity.

Your efforts have never been more vital or more visible. From monitoring the spread of SARS-CoV-2 to expediting the development and delivery of vaccines, including mRNA, your work saved lives. Through HRSA’s Ryan White HIV/AIDS Program and CDC’s HIV prevention efforts, you have helped drive progress toward ending the U.S. HIV epidemic. At the NIH, your research has deepened our understanding of HIV pathogenesis and accelerated the development of next-generation treatments and vaccines. SAMHSA’s integration of behavioral health into HIV services has transformed care for communities affected by both substance use and HIV. And the FDA’s rigorous oversight has ensured the safety and efficacy of antiretroviral drugs and PrEP innovations that are now standard of care.

We at IAPAC and the Fast-Track Cities Institute are proud to have partnered with many of you over the years, across agencies and disciplines, on initiatives that blend science with service. From amplifying Undetectable equals Untransmittable (U=U) as a life-affirming message to focusing on optimizing the HIV care continuum by strengthening syndemic responses that leverage clinical and behavioral science, our collective work has changed lives. These innovations are not abstract; they are made possible by your expertise, dedication, and the principled functioning of federal health institutions. You have helped ensure that our shared mission to accelerate health equity and improve outcomes for communities most affected by HIV is not just a vision, but a reality we are building together.

Yet today, many of you are being subjected to a campaign of disrespect, chaos, and politicization. Wrongful terminations, ideological censorship, and chronic underfunding threaten not only your livelihoods but also the health and safety of the nation. The politicization of science, erosion of trust, and devaluation of your labor are not isolated incidents – they are symptoms of a systemic crisis that undermines the integrity of our public health infrastructure. Many of you are also valued members of IAPAC, and your contributions to our association – as thought leaders, educators, clinicians, and advocates – have been instrumental in shaping our U.S. domestic and global HIV activities grounded in science, compassion, and equity.

To those of you who have been forced out or silenced, please know that your work was not in vain. The policies you shaped, the programs you implemented, the data you curated, and the innovations you helped bring to scale endure and will continue to serve as building blocks for future progress. You are not forgotten. We honor your service and affirm our solidarity with you during this profoundly difficult period. Your knowledge, principles, and experience remain vital to the future of public health, and we will continue to advocate for your reinstatement, recognition, and rightful place in this essential U.S. federal government workforce.

To those who continue to serve under immense strain: We see you. You are holding the line against disease, inequity, and misinformation. The strength and resolve you bring to your work, often without thanks or recognition, is nothing short of heroic. You embody the ideals of public service and the promise of evidence-based policymaking. We will continue to stand beside you, amplify your voices, and advocate for the resources and protections you deserve. Your perseverance reminds us that the heart of public health beats strongest in those who refuse to be silenced or sidelined, even when the path forward is steep.

The United States has long been a beacon of scientific excellence and innovation, particularly in HIV and public health. But these gains are fragile. They require an infrastructure grounded in science, protected by law, and supported by sustained investment. We call on elected leaders to reject the dismantling of our public health institutions, reinstate those who have been wrongfully removed, and recommit to the principles of integrity, equity, and accountability. We also call on our peers in health, academia, and civil society to raise their voices in defense of public health workers and institutions. If we allow this erosion to continue unchecked, we will all bear the consequences – not just in loss of talent, but in lives needlessly lost.

To every federal health employee, past and present, who has helped to advance the HIV response, safeguarded public health, and uphold the highest standards of service: Thank You. We value you, we support you, and we will fight alongside you to protect and preserve the institutions that make health, dignity, and justice possible.

With deep respect, unwavering solidarity, and unequivocal resolve,

Dr. José M. Zuniga, President/CEO, @IAPAC and @FTC2030

IAPAC Condemns USAID HIV and Humanitarian Contract Terminations

Statement by Dr. José M. Zuniga, IAPAC President/CEO
Washington, DC, USA (27 February 2025)

My fellow advocates, health professionals, and humanitarian allies, we are facing an unprecedented assault on global health and humanitarian programs that have saved millions of lives. The Trump administration has unilaterally terminated thousands of USAID contracts, bringing vital health and humanitarian services to a grinding halt. This reckless action includes the termination of contracts that fund PEPFAR-related programs in Kenya, South Africa, and other African countries – programs that have been a lifeline for individuals, families, and entire communities affected by HIV.

These cuts are not just numbers on a balance sheet. They represent the abrupt cessation of care for millions of people, including pregnant women, children, and families living with HIV. The Elizabeth Glaser Pediatric AIDS Foundation, a trusted partner in the fight against pediatric HIV, received termination notices for three of its primary USAID agreements – agreements that had already been approved to resume limited operations under the US State Department’s PEPFAR waiver. These programs were actively supporting more than 350,000 people on HIV treatment, including nearly 10,000 children. Now, these individuals are at risk of treatment disruption, disease progression, and, tragically, death.

The termination of USAID contracts also extends to critical funding for UNAIDS, the joint United Nations program coordinating our collective response to end the HIV epidemic. By cutting off this support, the Trump administration is deliberately dismantling the infrastructure that has allowed us to make historic progress in fighting HIV worldwide. These cuts also compound the already devastating funding losses for the WHO, weakening global health security at a time when coordinated action is essential, and raise serious concerns about the upcoming replenishment round for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which relies on strong U.S. leadership to sustain lifesaving programs. Implementing partners, NGOs, and community-based organizations that provide frontline services are being forced to shutter programs and lay off staff – devastating local health systems that took decades to build.

These cuts are not only affecting care and treatment but are also halting groundbreaking HIV prevention research. The termination of USAID contracts has resulted in the immediate cessation of several clinical trials, including Matrix and MOSAIC, which were evaluating new prevention options for women and girls – the populations that bear the highest burden of new HIV infections in many regions. By shutting down these trials, the Trump administration is deliberately obstructing scientific progress that could have delivered the next generation of HIV prevention tools. This is not just a funding issue – it is an ideological attack on evidence-based public health strategies.

Moreover, these actions further marginalize key populations most vulnerable to HIV. We know that stigma and discrimination remain among the greatest barriers to HIV prevention, treatment, and care. Now, the Trump administration is not just ignoring these barriers, but it is actively reinforcing them. The cancellation of USAID contracts for programs that have offered a lifeline to key populations sends a clear message: the lives of those most vulnerable to HIV do not matter. We reject that message outright. Every life matters. Every person deserves dignity, care, and the right to health.

Make no mistake – this is not an accident. These actions are deliberate and ideological, advancing an agenda designed to dismantle programs that serve the most vulnerable populations globally. We are witnessing an erosion of human rights, including the systematic defunding of global health programs, the rollback of protections for marginalized communities, and the weaponization of public policy against the most vulnerable – all of which serve as the foundation for the Trump administration’s latest actions. This is a targeted attack on global public health, an assault on human dignity, and an affront to the bipartisan commitment that has defined U.S. leadership in global health for over two decades.

But these horrific actions can and must be corrected. The funds that USAID is now withholding were legally appropriated by the U.S. Congress, and in relation to PEPFAR in a bipartisan fashion, including the support of former U.S. Sen. Marco Rubio, now US Secretary of State. If the Trump administration refuses to reverse course in dismantling USAID, PEPFAR, and other health and humanitarian agencies, the legislative branch has the authority – and the moral obligation – to intervene. We call upon every member of the U.S. Congress to act immediately to reverse these cuts, restore funding to critical health and humanitarian programs, and hold those responsible for these cancelled contracts accountable for the human lives they are putting in jeopardy.

To our members, colleagues, and allies in the United States, I urge you to contact your Congress members today. Demand action. Call the U.S. Capitol switchboard at (202) 224-3121 to contact your representatives and tell them that these contract terminations must be reversed. I do not exaggerate when I say that millions of lives, including children’s lives, depend on swift Congressional action.

To our global members, I say this: Do not despair. Keep the faith. Document these atrocities. The world must know what is happening. We will not allow history to be rewritten with misinformation or political doublespeak. We will tell the truth. And we are certain that the American people – who have always stood for compassion and justice – will soundly reject this brazen abandonment of our longstanding commitment to humanitarian assistance.

To those individuals, institutions, and corporations playing the “quiet game,” hoping to stay on the sidelines while lives hang in the balance – now is not the time for silence. Silence equals death. We have seen this before, and we will not allow history to repeat itself. This is not just a political issue; it is a moral imperative. Every institution that has benefited from global health funding, every corporation that claims to champion social responsibility, every leader who has stood on a stage and pledged commitment to ending HIV – your voice is needed now more than ever. History will remember where you stood in this moment. Will you stand for justice and human life, or will you be complicit through inaction? The time for neutrality is over. Speak up. Fight back. Do not relent. Countless lives depend on our actions today and into the future.

My friends and colleagues in the struggle, we must stand together. We must act now with every tool in our collective toolbox. And we must ensure that those responsible for this betrayal of global health and human rights are held to account. We will not be silent.

IAPAC is a 40-year-old professional medical association representing more then 30,000 clinician-members committed to ending AIDS as a public health threat by 2030.

 

 

NAVIGATING THE FUTURE OF THE HIV RESPONSE

WASHINGTON, DC (14 February 2025) – With Trump administration executive orders and funding uncertainties rattling the HIV response in the United States and globally, urgent action is required to maintain momentum towards ending AIDS as a public health threat. In this wide-ranging Q&A, Dr. José M. Zuniga, President/CEO of IAPAC and the Fast-Track Cities Institute, discusses strategies for advocacy, service continuity, and contingency planning while envisioning new governance structures to bring decision-making closer to affected communities and new metrics to demonstrate bidirectional return on investment (ROI) for prioritizing the HIV response. Emphasizing an all-hands-on-deck approach from funders and the need for greater integration of HIV programs within broader health systems, Dr. Zuniga shares his perspectives on a path forward to sustain and strengthen the HIV response in an era of unpredictability.

The HIV response in the United States and globally is being reshaped by Trump administration executive orders, stop-work orders, and other policy directives, creating uncertainty for programs that are essential to saving and enhancing lives. What is your message to organizations, policymakers, and communities on ensuring continuity of HIV services and public health resilience in the face of these challenges?

Dr. Zuniga: The HIV response has always been an exercise in resilience, adaptation, and advocacy. Despite shifting political landscapes, we must remain steadfast in ensuring that services are not disrupted, that communities remain engaged, and that policymakers are continuously reminded of the public health imperative to sustain HIV programs. Our approach should be multi-tiered, emphasizing legal advocacy where necessary, leveraging municipal and state-level commitments, and securing alternative funding streams to mitigate risks at the national level. We should also be documenting and amplifying success stories from local HIV responses to demonstrate the effectiveness of decentralized solutions and to make the case for sustained investment even in challenging policy environments.

Beyond immediate advocacy efforts, we must proactively develop contingency frameworks that account for short-, mid-, and long-term scenarios. This includes strengthening municipal and subnational commitments to the HIV response, fortifying public-private partnerships, and expanding the role of community-based organizations in delivering essential services. We cannot allow uncertainty to stall innovation or prevent us from addressing critical needs, such as access to pre-exposure prophylaxis (PrEP), harm reduction, and rapid linkage to care. A critical component of this strategy must be expanding digital health interventions that provide remote access to HIV prevention and treatment services, ensuring that care delivery remains consistent even amid potential service disruptions.

Our messaging should remain grounded in science and human rights, countering any efforts to politicize public health. The HIV response must continue to advance evidence-based strategies that are also data-driven to achieve equitable health outcomes. As we navigate these policy shifts, a collective and unified approach will be key to maintaining the momentum towards ending AIDS as a public health threat, hopefully not too much past 2030. Engaging non-traditional allies, such as businesses, technology firms, and social justice movements, will be essential in sustaining pressure on decision-makers while broadening the base of support for HIV-related policies. If we fail to proactively safeguard HIV programs now, we risk losing not only funding and services but also decades of hard-earned progress towards global HIV targets.

With the possibility of funding rescissions and programmatic disruptions, organizations must act swiftly to safeguard critical services. How should global and US-based HIV stakeholders prioritize their responses to these significant threats?

Dr. Zuniga: The immediate priority is to assess vulnerabilities across HIV prevention, treatment, and care services and to identify where gaps may emerge. This requires rapid coordination between service providers, funders, and government agencies to ensure that essential programs – such as access to antiretroviral therapy (ART), PrEP, and harm reduction – remain intact. Organizations should also work with local and state governments to secure stopgap funding where possible, while engaging in direct advocacy to push back against detrimental policy shifts. Establishing emergency funding reserves and expanding financial contingency planning can provide a critical buffer against immediate service disruptions.

Beyond securing funding, we should all be focused on prioritizing workforce stability and continuity of care. Disruptions in federal funding often translate into hiring freezes or layoffs, which can destabilize service delivery. Ensuring that healthcare and community-based workers remain engaged and supported – whether through state-level funding, philanthropic investment, or innovative financing models – should be a top priority. Exploring task-sharing models, such as empowering pharmacists and community health workers to provide HIV-related services, can help mitigate the impact of workforce shortages. Additionally, leveraging digital tools to enhance workforce efficiency can help maintain service continuity even in the face of resource constraints.

Strengthening digital health strategies can also help mitigate access barriers. Person-centered telehealth, mobile outreach, and decentralized service delivery can sustain continuity of HIV and other health services in the face of physical and financial disruptions. As organizations, we must also take stock of our resilience mechanisms and reinforce these mechanisms to allow us to weather current and future political and financial turbulence. Strengthening regional and global collaboration, such as through knowledge-sharing platforms and joint funding initiatives, can provide additional stability and ensure that best practices are rapidly adapted to emerging challenges.

The HIV response has long been intertwined with advocacy, and today’s political landscape demands a recalibrated strategy. What approaches will be most effective in countering policy rollbacks and securing support for HIV programs?

Dr. Zuniga: Our advocacy must be bold, data-driven, and rooted in community mobilization. We need to galvanize not only HIV-focused organizations but also broader coalitions, including civil rights groups, healthcare advocates, and economic justice movements, to push back against policies that threaten the HIV response. Additionally, leveraging municipal leadership – such as mayors, county executives, city councils, and boards of supervisors – can serve as a powerful counterbalance to national policy changes, ensuring that local HIV commitments remain steadfast and laser-focused on addressing the needs of people living with and affected by HIV.

A strong media and public engagement strategy is also critical. We must amplify the voices of people living with HIV and affected communities to emphasize the real-world, life-or-death consequences of funding cuts or policy restrictions. Personal stories, paired with compelling epidemiological data, can create a powerful narrative that resonates with both policymakers and the public, even if it takes time to win over entrenched minds and hearts. This is a moment that calls for out loud visibility to counter a cultural thrust towards further marginalizing and outright trying to erase whole communities of people in a clear violation of human rights.

The global HIV advocacy agenda must also extend beyond traditional approaches. Engaging with multilateral organizations, leveraging trade agreements, and forming new alliances with sectors outside of health – such as finance and technology – can provide additional pressure points to sustain support for HIV and related health programs. I would argue that much like the COVID-19 pandemic, there is an opportunity for us to harness digital health and health AI, thus the importance of outreach to the technology sector cannot be overstated, and this is a space we are actively exploring, including through the development of our Total Patient Care™ app.

HIV service providers and policy advocates are reporting disruptions in HIV programs and service delivery. How should organizations plan for short-, mid-, and long-term contingencies in this uncertain policy climate? And what contingency frameworks should be put in place to protect progress?

Dr. Zuniga: Short-term strategies should focus on triaging immediate risks, such as funding cuts or policy restrictions that may impact specific populations. Establishing emergency funding reserves, strengthening municipal commitments, and expanding community-led service delivery models can help ensure that immediate disruptions do not translate into service gaps. Rapid-response advocacy teams should be mobilized to challenge harmful policies through legal mechanisms and public awareness campaigns. Moreover, organizations should develop data-driven impact assessments that quantify the consequences of potential funding or policy shifts, enabling more effective lobbying efforts and resource reallocation.

Mid-term planning requires re-evaluating program sustainability and diversifying funding sources. This includes cultivating philanthropic partnerships, engaging private sector actors, and exploring alternative financing mechanisms such as social impact bonds. Organizations should also consider shifting towards more decentralized service delivery models, which can be more resilient in the face of national-level policy turbulence. Investing in capacity-building programs for local healthcare providers and community-based organizations will help create more autonomous, adaptable systems that can operate independently of shifting national priorities. Furthermore, strengthening cross-sector collaborations with education, housing, and social protection initiatives will help create a more holistic and durable response to HIV.

Long-term planning must envision new operational structures that ensure sustained impact regardless of federal policy shifts. This means advocating for the devolution of funding authority to local jurisdictions, strengthening the capacity of community-based organizations, and embedding HIV services within broader healthcare systems to insulate them from political fluctuations. Investing in policy safeguards can provide a long-term buffer against federal instability. And, leveraging emerging technologies, including AI and predictive analytics, can improve service efficiency and allow for adaptive, data-driven decision-making. A future-proof HIV response will depend on our ability to build systems that are flexible, innovative, and deeply rooted in resilience.

Traditional metrics for assessing return on HIV investments often focus on cost-effectiveness and health outcomes, but they fail to capture the broader economic, security, and diplomatic benefits. How should we rethink measurement frameworks to better reflect the mutual benefits of domestic HIV spending and foreign aid in advancing global health priorities?

Dr. Zuniga: New metrics are essential to move beyond a narrow focus on immediate health outcomes and demonstrate the full-spectrum impact of HIV investments. Domestic spending on HIV prevention, treatment, and care not only improves public health but also enhances workforce productivity, reduces long-term healthcare costs, and mitigates economic disparities that contribute to broader social instability. Similarly, foreign aid directed towards global HIV programs strengthens diplomatic ties, supports economic development, and reinforces international stability – outcomes that directly align with national security and trade interests. To effectively advocate for sustained or increased investment, we need metrics that quantify these bidirectional benefits in concrete economic, geopolitical, and social terms.

A recalibrated measurement framework should include indicators that capture cross-sectoral impacts, such as the effect of HIV investments on national workforce participation, reductions in dependency on emergency healthcare, and long-term cost savings from preventing new infections. For foreign aid, metrics should assess how global HIV investments contribute to political stability, economic growth, and pandemic preparedness in recipient countries – factors that ultimately reduce risks for donor nations as well. These indicators should be paired with qualitative assessments of diplomatic goodwill and regional cooperation, reinforcing the idea that investments in global health are not acts of charity but strategic imperatives that yield tangible returns for donor and recipient nations alike.

Moreover, we must adopt more dynamic and real-time data systems to measure the evolving impact of HIV spending, allowing for adaptive decision-making that aligns with both national and global priorities. This means integrating financial modeling with epidemiological and economic forecasting tools to project the downstream benefits of sustained investment. By framing HIV spending as a high-impact, dual-benefit strategy – one that strengthens national economic resilience while advancing foreign policy objectives – we can secure greater buy-in from policymakers, funders, and the private sector. The future of global health financing depends on our ability to articulate these bidirectional returns with precision and urgency.

 As federal funding becomes more uncertain, the role of funders becomes more critical. How can they adopt an “all-hands-on-deck” approach to support the HIV response? And what role should funders – traditional and non-traditional – play in mitigating the risks posed by policy shifts?

Dr. Zuniga: All funders must recognize the urgency of the moment and respond with agility. Traditional donors, such as the Global Fund (to Fight AIDS, Malaria, and Tuberculosis), must explore mechanisms for rapid response funding that can fill gaps created by policy shifts. Meanwhile, private sector partners – including pharmaceutical and diagnostic companies, corporate foundations, and high-net-worth philanthropists – must step up to ensure that critical services remain uninterrupted. The business community has a vested interest in a healthy workforce and population, making HIV prevention and treatment investments aligned with long-term economic sustainability. A broader coalition of philanthropic and corporate actors can ensure that funding volatility does not translate into increased HIV infections or diminished access to care.

Beyond financial support, funders can contribute by creating an enabling environment for innovation and sustainability in HIV programming and service delivery. An enabling environment must include investing in digital health platforms, supporting community-led initiatives, and incentivizing differentiated service delivery models that enhance cost-effectiveness while maintaining high-quality care. Flexible funding mechanisms that allow for adaptation to emerging challenges will be key to ensuring program continuity. Funding must also be structured to allow flexibility in responding to emerging crises, ensuring that programs are not constrained by rigid, bureaucratic grant cycles. Innovative funding mechanisms, such as pooled global emergency HIV funds or challenge grants to leverage local government contributions, could further protect HIV responses from political unpredictability.

Non-traditional funders, including impact investors and technology companies, can also play a transformative role. We need new financial instruments, such as social impact bonds, as well as strategic investments in infrastructure that enhances HIV service delivery resilience. A more diversified and forward-thinking funding ecosystem will be critical in sustaining progress to avoid an overreliance on national funding that threatens HIV responses when political winds shift in troubling directions. Leveraging AI and data-driven funding models could also optimize resource allocation, ensuring that investments have the highest possible impact on HIV prevention and treatment outcomes. By reimagining how HIV programs are financed, we can build a system that is not only sustainable but also more responsive to emerging needs and opportunities.

The current policy environment highlights the vulnerability of siloed HIV programs. How can we shift toward an integrated approach that ensures sustainability and improves health outcomes for people living with and affected by HIV?

Dr. Zuniga: Integration must be at the heart of a more resilient and sustainable HIV response. The days of HIV being treated as an isolated health issue are long past – our work must be embedded within broader health systems, from primary care to mental health services to non-communicable disease management. This approach not only strengthens the overall healthcare system but also ensures that HIV services do not become easy targets for defunding, as they are essential components of comprehensive health and social care. Let’s also remind policymakers that the HIV infrastructure and workforce was critical during the COVID-19 pandemic, and this return on investment should never be forgotten.

To operationalize integration, we must break down barriers between disciplines and funding streams. Policymakers, donors, and implementers must incentivize collaborative models where HIV testing, treatment, and prevention are delivered alongside services for chronic disease management. This level of integration is particularly critical for populations that face multiple, overlapping health risks, such as key populations and individuals in lower-resource settings. Strengthening cross-sector partnerships with social services, housing, and employment programs will also help address social determinants that influence health outcomes. Embedding HIV services within broader healthcare ecosystems will create a more sustainable and resilient response that remains effective even in times of political or financial instability.

Ultimately, integration strengthens health equity by making services more accessible and less fragmented. If we want to future-proof the HIV response, we must embed it within universal health coverage efforts and ensure that every touchpoint with the healthcare system – whether a routine visit with a general practitioner or a mental health consultation – becomes an opportunity to reinforce HIV prevention, testing, and care. And in relation to HIV treatment, integration will allow for an accelerated and wider implementation of U=U as a driver for leveraging treatment as prevention to curb new HIV infections and end AIDS-related deaths, while also destigmatizing an HIV diagnosis.

Given uncertainties at the national level, cities and municipalities are once again emerging as key leaders in sustaining HIV programs, much as they modeled public health leadership during the COVID-19 pandemic. What role should municipal and community-led efforts play in ensuring the resilience of the HIV response?

Dr. Zuniga: City and municipal governments are on the front lines of public health, and their role in sustaining the HIV response has never been more crucial. Municipal leaders understand the immediate needs of their communities, are often more agile than national governments, and have demonstrated a growing willingness to step up when national policies fall short. This urban public health leadership has been evident in the Fast-Track Cities initiative, through which urban leadership has accelerated progress in HIV prevention, testing, treatment, and stigma reduction over the past decade since the launch of the now 550-plus global Fast-Track Cities network. Cities and municipalities can leverage local healthcare systems, allocate municipal budgets to sustain HIV programs, and build multi-sectoral partnerships that foster long-term resilience. The success of Fast-Track City-led approaches underscores how localized action to achieve global health goals can drive real impact even in challenging political environments.

Community-led action is equally critical, as civil society organizations are often the first to detect emerging challenges and respond with tailored, culturally competent interventions. Strengthening their role means ensuring sustainable funding, integrating them into formal health systems, and giving them a seat at the decision-making table. Community-based organizations also serve as trust bridges between healthcare providers and marginalized populations, ensuring that services remain accessible, particularly for key populations facing stigma or legal barriers. Moreover, investing in capacity-building for grassroots organizations ensures that they can expand their reach, influence policy decisions, and continue providing life-saving services despite shifting national priorities. True resilience in the HIV response requires putting more decision-making power in the hands of affected communities, ensuring that solutions are driven by lived experience and frontline expertise.

Moving forward, we must ensure that local strategies are not simply stopgap measures but are institutionalized as part of a longer-term vision. This requires securing city and municipal budget allocations for HIV programs, expanding public-private partnerships, and leveraging innovative financing models to ensure continuity. We must also create formal mechanisms that embed HIV program sustainability into urban health governance, preventing political turnover from derailing local progress. Local action is not just a response to national uncertainty – it is a model for how the HIV response should be structured globally, ensuring resilience through decentralization and grassroots leadership. Cities and municipalities must be empowered with greater autonomy in health policy making and funding decisions so that they are not wholly dependent on fluctuating national policies.

With increasing unpredictability in global health governance, traditional structures may not be well-suited for the future. What changes are needed to ensure that HIV programs remain adaptive and responsive to the realities of those most affected?

Dr. Zuniga: The current governance ecosystem for the HIV response – spanning UN agencies, global health organizations, national governments, NGOs, and funders – must become more agile and decentralized. Traditional, top-heavy models have often struggled to respond to emerging crises, whether it be shifts in political leadership, pandemics, or funding volatility. We need a shift from hierarchical global decision-making to participatory governance models that engage local leaders, civil society, and affected populations in shaping policies and resource allocation. Without a more distributed power structure, the response will remain reactive rather than proactive, limiting its ability to evolve alongside emerging public health threats. Greater transparency and accountability mechanisms must be embedded into governance frameworks to ensure that resources are equitably allocated, and that decision-making reflects the needs of those most affected.

Achieving this vision means rethinking how funding flows, how accountability is maintained, and how partnerships are structured. Regional and municipal governance mechanisms should have greater autonomy, with resources directed to where they are needed most without unnecessary bureaucratic hurdles. A shift toward more flexible, locally driven funding and implementation models will ensure that HIV programs are not held hostage by global politics. We must also invest in data systems that allow for real-time monitoring and course correction, ensuring that local programs can adapt dynamically to epidemiological shifts and funding constraints. Establishing a global HIV resilience fund, which could be activated in times of political or economic crisis, could provide further stability and allow for rapid intervention when traditional funding mechanisms are delayed.

Additionally, multilateral institutions must recalibrate their priorities to align with real-world needs. The post-2030 agenda for global health must reflect lessons learned from past governance challenges, ensuring that power is distributed equitably, and that the HIV response remains community centered. If we do not evolve, we risk stagnation at a time when agility is most needed. A successful recalibration of governance structures must be built on transparency, accountability, and a renewed commitment to human rights, particularly for the most marginalized populations. The next decade of global health will be defined by those who embrace adaptability, inclusion, and innovation as core principles of governance.

History has shown that changes in political leadership can have profound effects on public health programs. What insights can we draw from past transitions to ensure that HIV progress remains resilient, regardless of political shifts?

Dr. Zuniga: One key lesson is that progress is never guaranteed. The HIV response has faced setbacks due to policy reversals, funding reallocations, and ideological shifts, but resilience has always come from proactive advocacy and strategic contingency planning. Organizations must not only react to political change but anticipate it, developing safeguards that ensure continuity even in the most challenging environments. This means creating legal and financial mechanisms that make HIV funding less susceptible to partisan shifts, such as multi-year budget commitments and endowments that sustain critical programs. We must also strengthen partnerships with subnational governments, ensuring that city and municipal commitments can serve as a buffer against national policy fluctuations.

Another critical takeaway is that legal and policy frameworks matter. The most durable progress has come when HIV programs are embedded in laws, regulations, and binding agreements that cannot be easily overturned. Municipal ordinances, state-level commitments, and international accords can serve as bulwarks against regressive policies, ensuring that the gains made over decades are not undone by a single administration’s agenda. We must also reinforce the importance of HIV programs to the general public, making it politically costly for any government to dismantle them. If we do not create public accountability mechanisms that protect HIV services, we will continue to be vulnerable to policy swings that jeopardize lives and progress.

Although it is hard to take the long view when we are enduring so much trauma, we must remember that no administration lasts forever. While immediate advocacy is critical, long-term movement-building must remain a priority. Investing in the next generation of leaders – activists, scientists, and policymakers – ensures that the HIV response remains strong, adaptive, and driven by evidence, regardless of political fluctuations. By institutionalizing leadership pipelines and knowledge-sharing networks, we can ensure that the global HIV response is not only sustained but continues to evolve in response to emerging challenges of any kind, including political and financial.

The evolving global health landscape demands a reassessment of how we approach the HIV response. What immediate and structural changes should be prioritized to ensure the response remains effective and future-proof in the face of uncertainty?

Dr. Zuniga: First, we need an immediate mobilization of stakeholders to safeguard existing HIV programs and protect against regressive policy shifts. This mobilization includes legal advocacy, emergency funding mechanisms, and coordinated efforts to hold policymakers accountable. HIV should remain a priority in the broader health agenda, and we must counter any attempts to deprioritize it with data-driven advocacy. Additionally, we need to strengthen legal frameworks at municipal and state levels that can insulate HIV programs from national-level disruptions and ensure civil and human rights protections for key populations. I am happy to see the HIV community doubling down on strategic litigation where necessary to challenge discriminatory policies and defend the right to equitable healthcare.

Second, we must invest in long-term structural changes that make the HIV response more resilient. This means integrating services within broader health systems, securing multi-sectoral partnerships, and ensuring that funding models are diversified beyond reliance on single sources. The traditional global health funding model must evolve, embracing more flexible and decentralized mechanisms that empower local and regional decision-making. We also need rapid response mechanisms that allow programs to pivot quickly in response to political, economic, or public health crises.

Finally, we need to shift the HIV response from a reactive to a proactive stance. Political and funding landscapes will always fluctuate, but if we build an ecosystem that is community-led, financially sustainable, and integrated into broader health and social systems, we can ensure that progress is not easily reversed. The time to recalibrate is now – we cannot wait for the next crisis to force change. If we fail to take decisive action today, we risk undoing decades of progress and allowing political uncertainties to dictate the future of the HIV response.

 

About IAPAC: The International Association of Providers of AIDS Care (IAPAC) is a global association representing more than 30,000 clinicians and allied health professionals dedicated to improving the quality of prevention, care, and treatment services for people living with and affected by HIV and comorbid conditions. For more information about IAPAC, please visit: https://www.iapac.org

About FTCI: The Fast-Track Institute (FTCI) supports cities and municipalities worldwide in their efforts to achieve global health-related goals, including SDG 3.3 (ending the epidemics of HIV and TB), the World Health Organization goal of eliminating HBV and HCV, and the urban development-focused SDG 11 (making cities and human settlements inclusive, safe, resilient and sustainable). For more information about FTCI, please visit: https://www.ftcinstitute.org

 

IAPAC Calls for Re-Imagining the Global HIV Response

WASHINGTON, DC, USA (1 January 2025) – As we approach the midpoint of the timeline to achieve Sustainable Development Goal (SDG) 3.3 of ending AIDS as a public health threat by 2030, the global community stands at a critical juncture in the HIV response. Despite considerable progress, HIV remains a formidable public health challenge, exacerbated by inequities in access to care, pervasive stigma, and emerging health threats.

With five critical years to make progress towards and achieve SDG 3.3, Re-Imagining the Global HIV Response for 2030 and Beyond offers a comprehensive roadmap with 35 cross-cutting recommendations across seven policy and programmatic domains to guide clinical, public health, and public policy decision-makers and practitioners. The recommendations were released on World AIDS Day 2024 by the International Association of Providers of AIDS Care (IAPAC) and Fast-Track Health.

“On New Year’s Day 2025, we must re-commit to addressing the evolving nature of the HIV epidemic, persistent disparities in access to HIV services, and the intersection of HIV with other health and social determinants – all of which require we re-imagine the global HIV response so that it is fit for purpose,” said Dr. José M. Zuniga, President/CEO of IAPAC and Fast-Track Health. “We call on stakeholders engaged in the HIV response to action the 35 consensus-driven recommendations we propose to accelerate focused action to end AIDS as a public health threat by 2030.”

The IAPAC recommendations for 2025-2030 were published on World AIDS Day 2024 and seek to align the global HIV response with current realities, leveraging data-driven strategies, innovations in HIV prevention and treatment, digital health and health Al, integrated service delivery, community involvement, and political leadership to achieve SDG 3.3 and build a sustainable and equitable future for all.

Within the context of addressing a call for sustainability in the HIV response, IAPAC’s recommendations include:

• DEVELOPING NATIONAL SUSTAINABILITY FRAMEWORKS: Create a national HIV sustainability framework that aligns with global best practices, emphasizing equity, social justice, and human rights, and integrating HIV services into broader health systems at all relevant jurisdictional levels, including subnational and municipal.
• SECURING LONG-TERM FINANCING: Prioritize increased domestic and international financing dedicated to the HIV response, ensuring that resources are allocated equitably and that bilateral and multilateral funding mechanisms, including the Global Fund to Fight AIDS, Tuberculosis & Malaria, are stable and sustainable.
• PROMOTING MULTISTAKEHOLDER ENGAGEMENT: Strengthen multistakeholder engagement mechanisms and engage in public-private partnerships that
  include government, civil society, the private sector, and communities affected by HIV, to collaboratively develop, implement, and monitor sustainability initiatives.
• INTEGRATING HIV SERVICES INTO UNIVERSAL HEALTH COVERAGE (UHC): Ensure that HIV services are fully integrated into national UHC packages, including prevention, treatment, care, and support services, to guarantee long-term sustainability and access, within the context of person-centered care.
• MONITORING AND EVALUATING SUSTAINABILITY EFFORTS: Implement robust monitoring and evaluation systems to track the progress of sustainability efforts, ensuring that equity-based principles are adhered to and that the impact on health outcomes is continuously assessed.

IAPAC also offers recommendations for re-defining and focusing data parameters to inform the HIV response, including:

• STRENGTHENING DATA COLLECTION SYSTEMS: Invest in national and subnational electronic health information systems to collect disaggregated data that captures key demographic and socioeconomic variables, enabling more accurate and targeted HIV interventions, with an additional focus on related health conditions, health concerns, and cost-efficiency.
• ENHANCING DATA QUALITY AND RELIABILITY: Implement standardized protocols across regions and healthcare facilities to improve the accuracy and consistency of HIV and other data, with a focus on resource-limited settings where data collection challenges are most pronounced.
• INTEGRATING ADVANCED DATA ANALYTICS: Adopt and integrate advanced data analytics tools, including Al and machine learning, into national HIV data systems to enhance the predictive accuracy of models and to generate real-time insights for policymaking.
• FOSTERING COMMUNITY-LED DATA MONITORING: Support and institutionalize community-led monitoring initiatives by providing training and resources to communities, ensuring that their data contributions are systematically included in national HIV data systems.
• ESTABLISHING DATA-SHARING PARTNERSHIPS: Facilitate data-sharing partnerships with international organizations, research institutions, and other countries to improve the global HIV data landscape, ensuring that best practices and innovations are disseminated and adopted.

IAPAC offers recommendations for leveraging antiretroviral (ARV) drug and diagnostic technologies to optimize HIV outcomes:

• PRIORITIZING RESEARCH AND DEVELOPMENT: Increase investment in R&D for new ARV drug and diagnostic technologies, with a focus on long-acting ARV formulations and community-based and self-testing multiplex diagnostic tools, to overcome current HIV treatment and prevention barriers, but with an equal focus on equitable access for all communities.
• FACILITATING ACCESS TO INNOVATIVE ARV DRUGS: Work with pharmaceutical companies and international partners to accelerate the regulatory approval and distribution of innovative ARV drugs, ensuring equitable access to the latest treatments across all geographic regions, without exception.
• EXPANDING NATIONAL DRUG PROCUREMENT PROGRAMS: Strengthen national drug procurement programs to include new ARV drug technologies, ensuring that they are available in both urban and rural settings and that supply chains are robust and reliable.
• SUPPORTING COMMUNITY EDUCATION ON ARV DRUG INNOVATIONS: Launch awareness campaigns and training programs to educate healthcare providers and communities about new ARV drug innovations, while stressing patient choice regarding oral, injectable, and other future ARV formulations.
• REMOVING STRUCTURAL BARRIERS TO ACCESS: Identify and address legal, policy, and logistical barriers that hinder access to innovative ARV drugs and diagnostics, including reducing regulatory delays and improving healthcare infrastructure, including person-centered innovation to improve access and utilization of HIV services.

IAPAC proposes recommendations for integrating digital health and health AI innovations into the HIV response, including:

• DEVELOPING NATIONAL DIGITAL HEALTH STRATEGIES: Create or update national digital health strategies that incorporate health Al-driven solutions for the HIV response, ensuring these strategies address ethical concerns and are aligned with international standards.
• INVESTING IN DIGITAL INFRASTRUCTURE: Allocate resources to strengthen digital infrastructure, particularly in underserved regions, to support the deployment and scalability of digital health and health Al tools in the HIV response.
• ENHANCING DATA PRIVACY AND SECURITY: Implement strict data privacy and security measures for digital health and health Al systems, including robust legal frameworks and encryption protocols, to protect sensitive health data and build public trust.
• PROMOTING DIGITAL HEALTH LITERACY: Launch national campaigns to improve digital health literacy among healthcare providers and patients, ensuring that digital tools are accessible and usable for all populations, particularly in rural and resource-limited settings.
• ENCOURAGING PUBLIC-PRIVATE PARTNERSHIPS: Foster public-private partnerships to drive innovation and scale in digital health and health Al, leveraging the expertise and resources of the private sector while ensuring that solutions are equitable and sustainable.

To optimize HIV outcomes, IAPAC offers recommendations for optimizing integrated HIV and other health responses:

• SCALING UP DIFFERENTIATED SERVICE DELIVERY: Implement and scale up differentiated service delivery (DSD) models nationally, ensuring they are integrated into the broader health system and tailored to the specific needs of different populations, particularly those with high HIV burden.
• INVESTING IN HEALTH WORKFORCE TRAINING: Provide ongoing capacity-building for healthcare workers on DSD and other health innovations, as well as HIV stigma elimination in health settings, to ensure they are equipped to deliver person­ centered, integrated care.
• INTEGRATING HIV SERVICES WITH PRIMARY CARE: Facilitate the integration of HIV services into primary healthcare, promoting a comprehensive approach that addresses multiple health needs, including the management of comorbidities and syndemic conditions.
• SUPPORTING TASK-SHIFTING INITIATIVES: Expand task-shifting programs to enable paraprofessional healthcare workers, such as community health workers, to take on additional responsibilities in delivering HIV services, thereby extending the health system’s reach.
• MONITORING AND EVALUATING HEALTH SYSTEMS INNOVATIONS: Establish monitoring and evaluation frameworks to assess the impact of DSD and other health systems innovations on HIV outcomes, using this data to continuously refine and improve service delivery.

IAPAC proposes recommendations for meaningfully involving affected communities to lead the HIV response:

• ESTABLISHING COMMUNITY LEADERSHIP PLATFORMS: Create platforms that empower communities to lead HIV response efforts at national, subnational, and municipal levels, ensuring that their voices are central to decision-making processes at all levels of government.
• PROVIDING FUNDING FOR COMMUNITY-LED INITIATIVES: Allocate specific funding streams to support community-led HIV initiatives, including public HIV awareness campaigns, ensuring these resources are sustainably accessible to marginalized groups.
• INTEGRATING COMMUNITY-LED MONITORING INTO NATIONAL HEALTH SYSTEMS: Institutionalize community-led monitoring as a key component of national HIV data systems, providing training and resources to communities to enable accurate data collection and reporting.
• PROMOTING LEGAL AND POLICY REFORMS: Advocate for legal and policy reforms that remove barriers to community involvement in the HIV response, including addressing HIV and intersectional stigma, and the criminalization of key populations.
• DEVELOPING CAPACITY-BUILDING PROGRAMS: Implement capacity-building programs for community organizations to strengthen their technical and organizational capabilities, enabling them to effectively manage and lead HIV response initiatives.

Underpinning the previous recommendations, IAPAC offers recommendations for achieving equity, equality, and justice for all in the HIV response:

• IMPLEMENTING EQUITY-FOCUSED HEALTH POLICIES: Develop and implement national health policies that prioritize equity, equality, and justice and engage all relevant government institutions, ensuring these principles are embedded in all aspects of the HIV response.
• ADDRESSING SOCIAL DETERMINANTS OF HEALTH: Launch initiatives that tackle the social determinants of health, such as poverty, education, and gender inequality, which contribute to disparities in HIV outcomes.
• PROMOTINGE INCLUSIVE DECISION-MAKING: Ensure that marginalized and vulnerable populations are represented in decision-making processes related to HIV policy and program development, giving them a voice in shaping the response.
• ENHANCING DATA COLLECTION ON HEALTH DISPARITIES: Improve data collection and analysis on health disparities within the HIV response, ensuring that data is disaggregated by key demographics and used to inform targeted interventions.
• ADVOCATING FOR HUMAN RIGHTS PROTECTIONS: Champion human rights protections for people living with and affected by HIV, including repealing laws criminalizing key populations, reforming discriminatory laws and practices, and eliminating stigma in all its forms.

Click here to access the full recommendations, including rationale and rationales, objectives, and key points, across the document’s seven domains.