A Year in Review:

Reckoning with Loss, Rising to the Moment

By Dr. José M. Zuniga

As 2025 draws to a close, the global HIV response stands at a crossroads defined by paradox: we have never possessed more scientific knowledge, biomedical tools, or community wisdom, yet we are confronting the most destabilizing political, financial, and institutional headwinds in more than two decades. This year has made clear that progress is not linear, rights can erode, and  achievements we once believed irreversible remain vulnerable. And yet, amid these challenges, the resilience and resolve of cities, communities, clinicians, advocates, and public health leaders provide the strongest evidence that our movement will not be undone.

For IAPAC, this has been a year of deep engagement with and commitment to the people and communities we serve, including our 30,000 clinician-members and the people living with and affected by HIV to whom our members deliver critical HIV services. It was also a year defined by financial hardship felt collectively across the non-profit sector, during which we were forced to embrace austerity measures and pursue creative strategies to deliver on our mission with fewer resources, including human. Even amid this strain, we took on additional unfunded mandates.

Among these mandates was the establishment of the Emergency HIV Clinical Response Task Force, which IAPAC chairs alongside our partners the American Academy of HIV Medicine (AAHIVM), Association of Nurses in AIDS Care (ANAC), GLMA, and the HIV Medicine Association (HIVMA). Together, and with support from our colleagues at Ready, Aim, Innovate, we are monitoring HIV service disruptions across the United States, documenting patterns that reveal the consequences of political retrenchment, weakened public health infrastructure, and shrinking safety nets. That we did this work without new funding is not a boast; it is a reminder that this movement has always persisted through collective will and shared responsibility.

In 2025, IAPAC also took an uncommon but necessary step into legal advocacy as one of the nine medical and public health organizations that filed Washington State Medical Association et al. v. Kennedy to challenge the politically driven removal of critical federal health data from public websites – a move that jeopardized access to evidence-based HIV information and broader public health guidance for clinicians, people living with HIV, and the American public. In September 2025, a negotiated settlement ensured the restoration of deleted webpages and data, reaffirming that science, truth, and transparency cannot be subject to ideological erasure and underscoring how access to reliable health information is foundational to quality HIV prevention, care, and treatment.

Beyond these policy and legal advocacy efforts, we also spent the year reaffirming science, solidarity, and urban leadership efforts. Throughout the year, we launched a series of virtual Fast-Track Cities townhalls, creating space for clinicians, community members, and policymakers to parse emerging data, highlight service disruptions, and surface the lived realities of HIV care in a rapidly changing political landscape. These conversations reinforced a truth we have long known: community voices remain the moral and strategic compass of the HIV response. The townhalls have also uncovered the  out-of-the-box ways our communities tackle challenges – big and small – that can derail the lives of the most vulnerable among us, including transgender individuals.

We marked a moment of global solidarity with a highly successful Zero HIV Stigma Day 2025 campaign on July 21st, during which advocates, cities, clinicians, networks of people living with HIV, and partners worldwide united under the theme #HIVStigmaWarriors. The campaign inspired local dialogues, cross-sector events, and policy conversations about U=U and other key messages, reminding us that stigma continues to be both a social determinant and a barrier – and that mobilizing against it requires sustained, intersectional action. Once again, we benefited from our partnerships with Ally Wellness, GNP+, and the Prevention Access Campaign (PAC), but also solidarity with community-based organizations around the world.

In June 2026, we convened Continuum 2025 in San Juan, Puerto Rico, where almost a thousand delegates explored implementation science, health systems strengthening, quality of life, and the evolving landscape of HIV prevention and treatment. The introduction of the Primary Care and HR-QoL track reflected an overdue shift towards whole-person, whole-health approaches – an ethos now embedded within the conference framework, in addition to a new Cardiometabolic Health track to further demonstrate the importance of integrated health responses in our Continuum 2026 program.

The year also marked domestic engagement through the U.S. Fast-Track Cities 2025 Summit in New Orleans, where city and county health departments, clinicians and other service providers, community advocates and leaders, and corporate partners convened in the shadow of  political attacks on public health. U.S. cities reaffirmed their commitment to scaling PrEP and ART, addressing structural inequities, and protecting LGBTQ+ communities. In addition to hosting the Summit, IAPAC presented data informed by work from the Emergency HIV Clinical Response Task Force and released an HIV policy brief with recommendations for cities, states, and clinicians to mitigate harms from upcoming Medicaid work requirements that could disrupt access to HIV and other health services.

Globally, more cities signed onto the Fast-Track Cities network, now more than 600 cities working to end their HIV epidemics and address related health challenges within the context of breaking down silos and taking a diagonal approach to addressing a broad scope of health issues with which we all contend at some point or another in our lives. We welcomed to the network Asbury Park, Köln, Mannheim, Rome, Verona, and other cities whose commitment to public health stands in stark contrast to the weakening of the multilateral framework that has historically anchored the global health response. Fast-Track Cities are practicing multilateralism in real-time.

2025 has also illuminated vulnerabilities that demand frank acknowledgment. We have witnessed a loss of critical mass at WHO, including the erosion of staff and programmatic continuity. At the same time, UNAIDS senselessly faces an existential threat, with political currents  pressing towards sunsetting or radically downsizing the program by 2026. For a world where HIV continues to claim 630,000 lives a year and generate 1.3 million new infections (2024 UNAIDS estimates), such moves are shortsighted at best and dangerous at worst.

Compounding these pressures are uncertainties surrounding PEPFAR’s future, as well as the opaque “Health Cooperation Agreements” the United States is negotiating with several countries – agreements that lack clarity regarding accountability or sustainability, health data protections, and commitments to key and vulnerable populations. Meanwhile, although the Global Fund fared well in its replenishment, experience has taught us that nothing is guaranteed until the money is in the bank, particularly in a volatile geopolitical and economic climate.

But the risks extend beyond bilateral and multilateral agencies. IAPAC, along with many community and clinical non-profit organizations worldwide, is confronting the consequences of federal government retrenchment and uncertainty. Critical U.S. funding streams have been placed on hold, reduced, or eliminated. International support is increasingly unstable. And corporate funding – which has played an essential role in advancing HIV prevention, treatment, implementation science, and stigma reduction – has also diminished. While many corporate donors have doubled down on their commitment to non-profit missions, in some cases the opposite would appear to be the case due to explicit “starvation tactics” that aim to extract more output from fewer resources while signaling future disengagement.

These pressures affect the HIV services people receive, the innovations we can scale, the clinicians we can train to deliver innovations, the data we can generate to map our course, and the communities we can support without resorting to rationing. Specifically, they influence the speed at which we can respond to HIV outbreaks (they are coming!), the extent to which we can scale PrEP (no matter the hype!), the continuity of care across disrupted health systems (disruptions are real!), and the trust that communities place in institutions like ours (earned not assumed!). True to our mandate, IAPAC put out a special report in 2025 titled, Disrupt to Deliver: Reimagining PrEP, with recommendations for accelerating the pace of PrEP scale-up within the context of patient choice. But these recommendations are only text on a page if they are not actioned with robust support for all sectors responsible for advancing a cohesive, multisector HIV response.

We must also confront a persistent and uncomfortable truth: far too many people living with HIV remain undiagnosed, not on ART, or not yet virally suppressed. Treatment as prevention – now unequivocally affirmed through U=U – remains one of the most cost-effective, scalable, and immediately impactful interventions in public health, yet sustained investment in testing, rapid ART initiation, adherence support, and long-term retention in care is increasingly being overshadowed by enthusiasm for long-acting PrEP. This is not an argument against PrEP, but a call for balance. Epidemic control will not be achieved by sidelining proven fundamentals in favor of the “shiny new,” and ending HIV requires simultaneous scale-up of prevention and treatment with viral suppression for all people living with HIV at the center of our strategy.

The HIV movement has weathered adversity before, but the present moment calls for an honest accounting of the risks we face and a renewed insistence that we cannot end the HIV epidemic with weakened institutions, shrinking funding, and piecemeal support. So, since 2025 insisted on handing us both lemons and the occasional slice of cake, it is only fair that we review the challenges and opportunities it delivered – sometimes in the same breath. Following is my attempt at taking stock of both with equal parts realism and resolve.

Top 5 Challenges Moving Into 2026

1. Policy reversals, attacks on LGBTQ+ rights, and budget cuts are undermining national and local HIV responses. A fragmented federal apparatus cannot sustain the scale of action required to halt rising infections and avertible deaths. As these pressures intensify, it becomes even more essential that communities – not just institutions – lead response strategies, a principle reflected in IAPAC’s integration of lived experience across 100% of our activities through our Community Advisory Board.
2. The weakening of WHO’s technical capacity and ongoing threats to UNAIDS pose direct hazards to coordination, surveillance, normative guidance, and accountability. These risks are compounded by uncertainty surrounding PEPFAR’s long-term trajectory and ambiguity within the new Health Cooperation Agreements, as well as the reality that while the Global Fund’s replenishment appeared successful, nothing is certain until pledges are converted into actual resources that reach countries and communities.
3. In too many countries – including the United States – PrEP uptake remains inequitable, stigma persists, and prevention infrastructure is fragile. Long-acting injectable PrEP will not scale itself; systems must be strengthened to deliver it, clinicians supported to initiate and maintain its use, and patients empowered to make informed decisions about their preferred PrEP modality.
4. Reduced philanthropic and corporate commitments, austerity-driven donor landscapes, and shifts in domestic spending priorities threaten the sustainability of community-led programs and clinical services. The resulting gaps risk widening inequities and undermining epidemic control. Without support, community and clinical leadership will struggle as a stabilizing force, threatening outreach and support to vulnerable communities and disrupting HIV and other health services.
5. Data blind spots and fragmented accountability are also real challenges. The ability to track incidence, monitor viral suppression, identify service disruptions, and map inequities is increasingly compromised. Without data, accountability collapses and inequities widen. In the United States, whole groups of people are being made invisible (transgender individuals) or driven underground (immigrants and undocumented individuals), masking the true impacts of bad policies and reduced resources.

Top 5 Opportunities for 2026

1. Urban health leadership through Fast-Track Cities helped to ensure continuity of HIV services during the COVID-19 pandemic. Cities continue to model integration, innovation, and equity-centered approaches. Their commitment remains unwavering, and their capacity to drive measurable progress remains strong if properly resources. In 2026, the opportunity lies in scaling proven urban innovations across the broader network, allowing cities to accelerate their work through shared learning, data-driven decision-making, and coordinated multisectoral action.
2. Integrating communicable diseases, NCDs, mental health, and climate-related threats allows for more resilient systems and better patient outcomes. This whole-health lens better aligns clinical pathways with the realities of people’s lives. The year ahead offers a pivotal moment to operationalize these integrated models within city health systems, transforming fragmented services into cohesive care pathways that meaningfully improve population health. This is a goal we are striving to support through our global Fast-Track Cities 2026 conference in Berlin, as well as partnerships with other urban health initiatives, including C/Can (City Cancer Challenge).
3. Community-led HIV service delivery models continue to show extraordinary impact in sustaining adherence, reducing stigma, and addressing disparities. Peer networks demonstrate unique strengths in reaching those most affected by systemic inequities. In 2026, strengthening and institutionalizing these peer-led approaches across clinical and public health settings will allow for more agile service delivery. Formalizing these models within health systems – supported by sustainable financing and workforce development – will ensure they can expand reach and deepen impact over time.
4. Long-acting HIV prevention and treatment options, digital health tools, and new diagnostic platforms offer transformative potential. But innovation only delivers impact when aligned with real-world experiences. The opportunity now is to build the workforce, procurement pathways, data systems, and reimbursement mechanisms required to ensure that breakthrough technologies achieve widespread and equitable uptake. Pairing innovation with implementation science and supporting the clinical, public health, and community sectors, will support us to accelerate towards real-world impact.
5. Reclaiming accountability as a movement is imperative to moving forward and building back better. The HIV movement has a renewed opportunity to reclaim accountability as a collective responsibility. This moment allows us to redefine the standards against which progress is judged. By establishing clear expectations for performance across stakeholders, we can re-anchor the HIV response in measurable progress that guides investment, strategy, and trust. In doing so, we create a more predictable and evidence-driven ecosystem that protects gains, highlights disparities, and promotes accountability.

With the close of this difficult year two weeks away, the HIV response stands at a juncture shaped by institutional fragility, shrinking resources, rising political hostility, and persistent inequities. However, equally important is extraordinary innovative breakthroughs, the resilience of cities and municipalities, the strength of communities, and the determination of those who refuse to let progress slip away.

As someone who has devoted more than three decades to this work – witnessing triumphs, losses, and countless turning points – I know our path forward will be defined not by the challenges we confront but by how we confront them together. In 2026, our solidarity, our courage, and our shared accountability will determine the future we deliver for communities worldwide. Let us reckon with our loss and rise to the moment.

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

World AIDS Day 2025: A Moment of Reckoning and of Resolve

By Dr. José M. Zuniga

Each year, World AIDS Day invites the global community to reflect on progress, confront persistent gaps, and recommit to ending AIDS as a public health threat. But this year’s reflection is marked by an unmistakable tone of alarm. The newly released UNAIDS 2025 World AIDS Day report delivers a stark message: Our hard-won gains are under threat, and the world is not on track to meet its commitments.

The report outlines a convergence of financial, political, social, and structural crises that are undermining the stability of HIV responses worldwide. HIV funding is shrinking at the very moment global needs are expanding. Key populations continue to be marginalized, criminalized, or excluded from essential services. Prevention efforts are undercut by service disruptions and growing inequities. And political pressures in several regions are weakening the foundations of community-led and rights-based responses.

This year’s World AIDS Day theme, “Overcoming Disruption, Transforming the AIDS Response” resonates because disruption has become the defining feature of the global health landscape over the past year felt through a series of shocks, including policy shifts and funding retrenchment. But the report wisely emphasizes that disruption can be dual-edged: it is a threat, but also an opportunity for transformation if we choose to act with urgency and purpose given the fragility of progress we have made collectively over four decades.

The UNAIDS report underscores several troubling trends. Funding shortfalls – measured in the billions – have real consequences. Across low-. middle-, and high-income countries (USA writ large), these gaps translate into reduced outreach, insufficient commodities, fewer providers, and weakened community systems that are already strained. Service disruptions are rippling across the HIV care continuum. Interrupted treatment, delayed diagnoses, and reduced viral load monitoring are fueling preventable morbidity and mortality. These gaps undermine the very foundations required to achieve the UNAIDS 95-95-95 targets and the HIV-related Sustainable Development Goals (SDGs). The report also calls attention to environments where stigma, discrimination, and criminalization have intensified. These conditions not only violate human rights, but they also drive people away from the very services that could save their lives.

Amid these warning signs, the report reaffirms an enduring truth: communities remain the backbone of successful HIV responses. Yet community-led systems are increasingly expected to do more with less. The global community must reverse this trajectory by restoring and protecting the resources, political space, and autonomy needed for community leadership to flourish. This is especially true in the world’s cities. Urban areas continue to bear a disproportionate share of the global HIV burden, as well as the intersecting challenges of poverty, housing insecurity, gender-based violence, substance use, mental health conditions, and climate-related impacts. Cities are where progress is made or lost.

Across IAPAC and the Fast-Track Cities network, we see daily examples of how city leaders, public health systems, and communities can accelerate or revive progress through integrated, equity-driven responses. Data transparency, targeted interventions, community-centered prevention, and innovation in service delivery are proving that urban leadership is indispensable. But cities cannot lead effectively if global and national systems withdraw support. We must strengthen rather than erode the enabling environments that have helped more than 550 Fast-Track Cities worldwide make measurable gains against HIV and other communicable and non-communicable diseases.

World AIDS Day 2025 must serve as a turning point. With less than five years remaining to achieve the health-related SDGs, the global community is out of time for incrementalism. The UNAIDS report calls for boldness, accountability, and sustained political commitment. These three principles must sit at the heart of every national, subnational, and global HIV response. At IAPAC, our focus remains clear:

• Protect and expand community-led responses, ensuring they remain properly resourced and central to decision-making.
• Strengthen integrated health systems that address HIV alongside comorbidities, mental health, and noncommunicable diseases.
• Ensure access to prevention, testing, treatment, and care, regardless of geography, gender identity, socioeconomic status, or legal environment.
• Champion data transparency and accountability, enabling cities and countries to track progress, identify disparities, and act on evidence.
• Mobilize political will to restore funding levels and reaffirm the imperative of a rights-based, people-centered HIV response.

World AIDS Day is, more than anything else, a call to courage. Courage to tell the truth about the fragility of our progress. Courage to confront stigma and discrimination in all their forms. Courage to demand that political leaders honor their commitments. And courage to reimagine what an equitable, integrated, resilient HIV response must look like for the next generation.

The UNAIDS 2025 World AIDS Day report does not ask us to despair. It asks us to act. It asks us to stand together – cities, communities, clinicians, advocates, policymakers, and people living with HIV – and to transform disruption into momentum. This is our moment to overcome disruption and transform the AIDS response. Not for the few, but for all of us.

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

Click here to read the UNAIDS report, “Overcoming Disruption, Transforming the AIDS Response.”

View Dr. José M. Zuniga’s World AIDS Day message:

A Warning from the Frontlines: Protecting a Disrupted US HIV Response

By Dr. José M. Zuniga

The US HIV response stands at a perilous crossroads. After decades of progress driven by bipartisan support, scientific breakthroughs, and community resilience, the programs that could bring us within reach of ending the HIV epidemic are now under threat. In response to mounting restrictions and proposed cuts to federal funding for HIV prevention, care, and treatment, five leading professional associations joined forces to launch the Emergency HIV Clinical Response Task Force.

The Task Force – comprising the American Academy of HIV Medicine (AAHIVM), Association of Nurses in AIDS Care (ANAC), GLMA, HIV Medicine Association (HIVMA), and International Association of Providers of AIDS Care (IAPAC) – represents the clinicians, nurses, and allied health professionals who form the backbone of the US HIV response. Together, we are committed to identifying, monitoring, and addressing service disruptions that threaten the health and dignity of people living with and vulnerable to HIV.

To assess the early impact of policy and funding shifts, the Task Force conducted a national survey among its member networks. The response was sobering: 526 clinicians shared firsthand accounts of how federal policy and funding headwinds are already disrupting HIV services. The data reveal a system under strain – one where disrupted testing, prevention, and treatment services threaten the lives of the people whose members our respective Task Force organizations represent and support.

The survey findings are not abstract. They represent the lived reality of clinicians who, every day, diagnose, treat, and support people across the HIV continuum of care. As noted in the Task Force’s data brief released October 20, 2025, 70% of survey respondents reported service disruptions in their clinical settings, with gender-affirming care (33%), housing support (26%), and HIV PrEP and PEP (25%) most impacted. The populations most affected by the disruptions include transgender individuals (41%), immigrants or undocumented individuals (38%), and people experiencing homelessness or unstable housing (29%), LGBQ individuals (29%), and Latinx/Hispanic individuals (29%).

The United States has made extraordinary advances in HIV prevention and treatment, including over the last six years of the federal Ending the HIV Epidemic (EHE) initiative. Biomedical innovations like PrEP and ART for treatment as prevention or U=U have dramatically reduced HIV acquisition, transmission, and mortality. But science alone cannot sustain progress without political commitment and reliable funding. If the current trajectory continues, the goal of ending the US HIV epidemic will slip further from reach.

This Task Force’s first data offers a snapshot of what is at stake. The survey findings are both a warning and a call to action to address the urgency of now. HIV service disruptions are no longer predicted or anecdotal. Life-saving services for vulnerable communities are being disrupted, with more disruptions projected because decisions affecting people’s health are being informed by ideology – not public health rationale. For me, the message from the frontlines is clear: If we fail to act now, we face the prospect of a resurgence in new HIV infections and AIDS-related deaths.

Click here to read the Task Force’s data brief.

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

Endless Urgency: Saving Our Strength for an HIV Response in Crisis

By Dr. José M. Zuniga

I recently came across a Substack titled “Endless Urgency,” two words that, when paired, feel almost painfully familiar to anyone engaged in the HIV response. The phrase has lingered with me, not only for its accuracy but for the weight it carries. Ours has always been a field defined by urgency: the urgency to diagnose, to treat, to prevent, to fund, to legislate, to defend human rights, to preserve hard-won progress. But what happens when urgency becomes endless? When it is no longer a rallying cry, but a way of life?

For those providing care, the sense of perpetual crisis has become the quiet backdrop to every clinic day. There is fear in the waiting rooms. The needs more complex, particularly for highly marginalized and vulnerable populations of people. The service disruptions have very real world affects on human lives. There is little time to pause, to reflect, or to grieve the political ideology that make the work harder than it should be. For advocates, it feels like running a marathon that never ends. We find ourselves shouting over political noise, countering misinformation, and pushing against policy shifts and budget cuts that threaten to roll back decades of progress. The pandemic years intensified this strain, but the truth is, the feeling of endless urgency predates COVID-19. It is built into the very DNA of a response that has always had to fight for attention, for funding, and for justice.

In the United States, we are again reminded of how fragile progress can be. Budget cuts, policy shifts, and growing threats to civil liberty are unravelling much of what has been achieved in the US HIV response, including the federal Ending the HIV Epidemic (EHE) initiative. Globally, the same story plays out in different forms, with tragic reversals precipitated by the dismantling of USAID, paralysis at PEPFAR, disinvestment in WHO, and threats to UNAIDS. Yet the people doing the work carry the same exhaustion in their bones. The emotional toll is real: burnout, moral distress, compassion fatigue. We rarely speak of these things aloud, perhaps out of fear that naming them makes them heavier or reflects weakness. But acknowledgment is not weakness; it is honesty.

Still, there is something extraordinary about the HIV community. The endless urgency we feel is born not of panic, but of care. It is the heartbeat of people who refuse to accept preventable suffering and hastened deaths. It is what drives clinicians to stay late, case managers to keep calling, advocates to organize one more rally, researchers to test one more hypothesis. That collective persistence is both our community’s burden and our strength, as it has been for many decades  on our collective journey to end AIDS as a public health threat.

But we must also learn that urgency cannot be sustained without rest. The HIV movement has always drawn its power from solidarity – from people and institutions lifting each other up when the weight becomes too much to bear alone. That solidarity must now extend to the realm of self-care. We need to normalize rest as resistance, reflection as renewal, and community as medicine. The work will not stop, but neither should our humanity. We must preserve our strength for the continuing onslaught on our common humanity through dehumanizing government action and inaction.

If endless urgency defines our history, perhaps enduring hope can define our future. Let us continue the good fight with empathy, with truth, and with care for one another. Because the HIV response has never just been about laboratory values. The HIV response has always been about dignity, love, and the shared belief that no one is beyond the reach of healing.

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