AIDS 2026 and the Urgency of Now:
Defending Progress While Building What Comes Next
By Dr. José M. Zuniga
As the global HIV community convenes this week for AIDS 2026 in Rio de Janeiro, it does so at a moment that demands both honesty and resolve. International AIDS conferences are opportunities to memorialize achievements, reaffirm commitments, and look towards the future. Those moments matter today just as much as they did in when researchers, clinicians, and activists convened in Atlanta for the first international AIDS conference in 1985. But AIDS 2026 also presents an opportunity for us to engage in an unflinching assessment of where we stand.
The truth is that the global HIV response enters this conference from an imperfect baseline. Long before the current wave of political, financial, and ideological attacks on public health, persistent inequities continued to shape the epidemic. Millions of people still lacked access to prevention, treatment, and care. Even as remarkable scientific breakthroughs transform what is possible, far too many people and countries remain excluded from their benefits, creating what can only be described as an “innovation apartheid.” Stigma and discrimination undermined health-seeking behavior. Criminalization, gender inequality, and structural racism remained powerful drivers of vulnerability.
Extraordinary progress had been made, but the work was far from finished. Today, those unfinished challenges are being compounded by new ones. Across multiple countries, investments in HIV programs are under pressure. Scientific expertise is increasingly questioned. Public health institutions are being weakened. Community organizations are being forced to do more with less. Human rights protections that have long served as pillars of the HIV response are being challenged. Hard-won gains that once seemed secure now require active defense.
None of this diminishes the remarkable work being done every day by clinicians, researchers, advocates, public health practitioners, policymakers, and communities. Quite the opposite. The continuity of HIV services that has been maintained in so many settings despite extraordinary headwinds reflects resilience, ingenuity, and commitment of the highest order. Countless individuals have refused to allow political uncertainty or financial instability to interrupt care for people living with or vulnerable to HIV.
That work deserves recognition. But resilience alone cannot become the long-term strategy. The urgency of this moment requires the HIV community to think both defensively and offensively as I layout in my new book, “Aftershocks: Trump 2.0, Public Health, and Our Better Angels.” It is not enough to preserve what remains of the HIV response; we must simultaneously defend the scientific, public health, and human rights foundations that made progress possible while boldly advancing new strategies that are more resilient, equitable, and prepared for the challenges ahead.
Defensively, the priority must be protecting what generations before us built. That means safeguarding evidence-based prevention and treatment programs, defending scientific integrity, preserving surveillance systems, supporting frontline providers, protecting community-led organizations, and insisting that human rights remain central to every HIV response. It also means documenting the consequences of policy decisions that undermine health so future generations understand exactly what was lost—and why.
The HIV response must also move offensively by reimagining what its next era can become. The future cannot simply be about restoring what existed before recent disruptions. If the ambition is limited to rebuilding yesterday’s systems, there is a risk of recreating many of the vulnerabilities that left those systems exposed in the first place. Instead, this moment should be seized to strengthen integration across health conditions, responsibly leverage advances in digital health and artificial intelligence, build more resilient municipal health systems, deepen partnerships between governments and communities, and create financing models that are more sustainable and less vulnerable to political cycles.
Cities remain especially important in this effort. Urban areas continue to shoulder a disproportionate share of the global HIV burden, but they also possess unique strengths: proximity to communities, operational flexibility, data-informed governance, and the ability to innovate rapidly. Municipal leadership has repeatedly demonstrated that local action can sustain momentum even when national environments become more difficult. As a Fast-Track City, Rio de Janeiro therefore provides an appropriate backdrop for these conversations. The city reminds us that progress has never been inevitable. It has always depended on courageous leadership, scientific excellence, community activism, and sustained solidarity. Those qualities remain the HIV response’s greatest assets.
As delegates exchange research findings, debate policy, and forge new collaborations throughout AIDS 2026, there is value in resisting two equally unhelpful impulses. One is despair – the belief that recent setbacks have erased decades of progress. The other is complacency – the assumption that incremental improvements alone will carry the response to its shared goals. Neither reflects reality. The HIV response has always succeeded because it adapted faster than the challenges before it. It combined science with social justice. It transformed patients into partners, communities into leaders, and local innovation into global policy. That same spirit is needed now. The urgency of this moment is not a call for panic. It is a call for purpose.
History will judge this period not only by the obstacles placed before the HIV response, but by how the global community responded to them. If what must be protected is defended while what must come next is built with equal determination, future generations may look back on this difficult chapter not as the beginning of decline, but as the moment the HIV response renewed itself with greater resilience, broader partnerships, and an even stronger commitment to health equity. That work cannot wait. The urgency is now.
Dr. José M. Zuniga is President/CEO of IAPAC, Fast-Track Health, and the Fast-Track Cities Institute.
