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.