Rio de Janeiro, Brazil — The global fight against HIV has never had more powerful scientific tools or faced greater political uncertainty.
More than 7,000 scientists, activists, policymakers and community leaders gathered in Rio de Janeiro for the opening of the International AIDS Conference. Global leaders warned that decades of progress against the epidemic could be reversed by shrinking international funding, geopolitical tensions and growing attacks on human rights.
The warning comes at a contradictory time in the HIV response.
Keep up with the latest headlines on WhatsApp | LinkedIn
Science has made breakthroughs that seemed impossible. It has changed HIV from a deadly diagnosis into a manageable condition. Researchers have developed highly effective long-acting prevention medicines and are working on simpler, longer-lasting treatment options. However, many of these gains are out of reach for millions of people because of political choices, funding gaps and rising inequalities. The science exists. The question confronting AIDS 2026 is whether the world can find the political will to deliver it.
In this context, the six-day conference began with the theme “Rethink. Rebuild. Rise.” This theme calls not only for celebrating scientific progress but also for reconsidering how it is funded, delivered, and safeguarded in an increasingly uncertain world.
International AIDS Society President and AIDS 2026 International Co-Chair Professor Beatriz Grinsztejn said the meeting comes at a pivotal moment for the global HIV response, with scientific advances colliding with mounting political and financial challenges.
“We are here because the world needs us to be – Rethink. Rebuild. Rise. And by meeting here in Latin America and the Caribbean, we are showcasing the value of investing in the creativity and strength of the Global South,” she said.
Grinsztejn said that the choice of Brazil as host reflected the country’s long-standing commitment to universal access to HIV care and treatment. The region is one of the few in the world where new HIV infections are still rising, even as case numbers fall elsewhere. Brazil has been a global leader in adopting a science-driven, human rights-based approach to HIV. It has also played a key role in advancing HIV prevention research.
The global HIV response, she said, is being battered by converging crises, geopolitical shifts, sudden funding cuts, and rising hostility toward the communities most affected by the virus. “We gather in the shadow of decisions made by a few and felt by too many in clinics and communities across the planet,” she said.
Despite those challenges, Grinsztejn said the HIV response has repeatedly demonstrated what science and political commitment can achieve. This year marks 30 years since the introduction of highly active antiretroviral therapy (HAART), which transformed HIV from a near-certain death sentence into a manageable chronic condition. It is also 15 years since the HPTN 052 trial results, presented in Rome in 2011, established the scientific basis for the principle of Undetectable = Untransmittable.
Since then, she said, treatment has moved from complex multi-pill regimens to single daily tablets and long-acting injections; this week’s program will preview a once-weekly oral treatment now in development. Prevention science, she added, has advanced just as far, with long-acting injectable tools that would have been unimaginable at the outset of the epidemic.
“These advances could bend the curve of the pandemic, if we follow the evidence on where and how to implement them, and if we make access the number one political priority,” she said.
However, Grinsztejn warned that scientific breakthroughs alone cannot end the epidemic. None of it matters, she said, without access, and access, thirty years on, remains the field’s unresolved problem. Nearly nine million people still cannot get life-saving treatment, a gap she attributed not to missing science but to political choices, financing failures, and a persistence of stigma and discrimination that no drug can dismantle on its own.
She also criticised the international response to financing the HIV epidemic.
Many of the countries carrying the heaviest HIV burden are simultaneously being pressured to fund their epidemic responses while servicing colonial debt.
She added that demands rebuilding the way we deliver the HIV response with a sustainable global solution, including debt restructuring and a serious reckoning with historical injustice. And social justice demands the realization of the right to health as a fundamental human right.
We must never forget that upholding democratic values is an integral part of public health.
“But to achieve that, we need political will,” said Grinsztejn. “We need far greater political commitment than was demonstrated at last month’s United Nations High-Level Meeting on HIV. The fact that some Member States turned their backs on the discussions and the Political Declaration itself shows just how significant the challenges ahead remain.”
“AIDS 2026 will be our moment to push back,” Grinsztejn said.
Grinsztejn said AIDS 2026 would put the scientific evidence on the record, hear the testimonies of communities most affected by HIV and help drive the political will needed to turn scientific evidence into policy and financing decisions around the world. She urged delegates to remain focused on the people most affected by the epidemic.
“We rise because the evidence is clear, our voices will not be silenced, and people living with and affected by HIV cannot wait,” said Grinsztejn.
UNAIDS Executive Director Winnie Byanyima said the world was entering a new phase of the HIV response, shaped by shifting geopolitical realities, funding uncertainty and growing inequality.
She thanked Brazil and the International AIDS Society for convening scientists, communities, policymakers, and activists in one room. She credited Brazil specifically for demonstrating, over decades, that universal access to health care is not an aspiration but a decision that governments can make.
That spirit, she said, is what the moment now demands. The global order has shifted profoundly since the field last met at this conference two years ago, and there is no reversing it.
“We are not going back… We must build something new, an AIDS response for the world that we have today, not the world we wish existed, not the world of yesterday,” she said. She pointed to the political declaration on HIV that UN member states adopted just weeks ago, despite deep geopolitical tension, as evidence that a shared global commitment to ending AIDS still holds, and as a roadmap the field now has to act on.
Geography, she argued, must never be what determines who lives and who dies.
She said every breakthrough in the response had come from confronting exclusion through science, human rights and global solidarity. However, she warned that many of those gains were now under threat. On rights, she argued that the AIDS response has always advanced by putting people and human rights at its center, driven by communities demanding dignity and treatment.
That progress, she said, is now under strain for the first time since UNAIDS began tracking rights globally; criminalization is rising rather than falling, with more countries criminalizing same-sex relationships last year alone. She pointed to Senegal, where she said fear has displaced trust and HIV services for the people who need them most are closing as a result. Facing that reversal, she said, will require broader coalitions than the field has built before, uniting the HIV response with women’s movements, LGBTQI movements, and democracy movements, since she argued health, gender justice, and democracy will rise or fall together. “History tells us that organized people eventually defeat organized money,” she said.
Such policies, she said, were already forcing vulnerable communities away from HIV services.
She praised researchers for transforming laboratory discoveries into life-saving medicines available around the world. But she said access to the latest HIV prevention technologies remained far too slow. Two years ago, at the same conference, trial results identified a twice-yearly injectable as the most effective HIV prevention tool yet developed. Today, she said, the rollout is moving far too slowly. She said the world should already be working towards reaching 20 million people rather than only a fraction of that number. She rejected the idea that the higher target is unrealistic.
“During COVID, 4.5 billion people received vaccines within a year… We can move just as urgently to deliver HIV prevention,” said Byanyima.
Byanyima also called on pharmaceutical companies to expand licensing agreements and technology sharing so that low- and middle-income countries, particularly in Latin America and Africa, could gain affordable access to new HIV medicines. Her call to industry was direct: open access, scale production, and share the underlying technology.
“Open the gates. Scale production. Share technology,” she urged. “Millions of lives depend on the speed of implementing this.”
She also warned that the global HIV response was facing one of its greatest financial challenges in decades. She described the response as one of the largest acts of global solidarity in public health history, built through the Global Fund, PEPFAR, UNITAID, governments, and communities, and now under unprecedented pressure. International HIV financing fell by more than US$1.5 billion last year, she said, while many heavily affected countries were spending more servicing debt than investing in health. She said it cannot substitute for external funding cut abruptly.
“This is not economic inevitability. This is the result of political choices,” Byanyima said, calling for debt restructuring, fairer international taxation and sustained international solidarity alongside increased domestic investment.
Despite the challenges, she said there were still reasons for optimism, pointing to renewed commitments by African governments, Brazil’s leadership on regional pharmaceutical production and growing international efforts to reform global financing.
“The world has changed,” Byanyima said. “But our values have not changed and will not change. We still believe that every person deserves dignity. We still believe that scientific progress must benefit everyone. And we still believe that inequality can be defeated.”
She said ending AIDS as a public health threat remained within reach if governments matched scientific innovation with political commitment, equity and global solidarity.
Progress is real, but it’s fragile
WHO Director-General Dr Tedros Adhanom Ghebreyesus said the global HIV response stood at a defining moment. He warned that decades of progress were under threat but could still be protected through renewed commitment to science, communities and stronger health systems.
Tedros praised Brazil’s leadership, saying that Luiz Inácio Lula da Silva had demonstrated the power of political commitment to expand treatment access. He cited Brazil’s defense of free HIV treatment, its work making medicines more affordable, its support for production partnerships in Africa, and its record on protecting human rights.
“For more than four decades, HIV has tested humanity – not only our science, but our solidarity,” he said. “Again and again, when the world predicted failure, communities proved it wrong.”
He said that scientists, working alongside affected communities, had transformed HIV from a fatal diagnosis into a manageable condition. Countries have expanded lifesaving treatment to millions of people. But he warned that the global response was now facing its most serious disruption in a generation. “We have not come to Rio to mourn what is at risk,” he said. “We have come to defend it. And to build what comes next.”
He said the conference theme, Rethink. Rebuild. Rise, reflected what was needed to keep the world on track to end AIDS as a public health threat by 2030.
“We must rethink how we deliver services, making them more integrated, more people-centered, and more resilient. We must rebuild partnerships that put countries and communities at the center of every decision. And we must rise, not by lowering our ambition, but by renegading it,” he said. “The goal of ending AIDS as a public health threat by 2030 is still within our reach,” Tedros said. “But only if we’re willing to act differently.”
Tedros launched WHO’s progress report on its Global Health Strategy on HIV, viral hepatitis, and sexually transmitted infections for 2022–2030, which he said tells two stories at once: evidence that new infections and AIDS-related deaths have fallen sharply where countries have invested in health, science, and communities, alongside proof of how quickly funding cuts, emergencies, and inequality can reverse those gains.
He also announced new WHO guidance on HIV surveillance and updated service delivery recommendations designed to help countries strengthen routine monitoring, improve long-term care, and integrate HIV services into broader primary healthcare systems. He committed WHO to continuing to fold HIV services into primary health care and universal coverage more broadly, and to accelerating access to innovations from long-acting prevention and treatment to diagnostics and digital tools.
He said that a scientific breakthrough only counts once it reaches everyone, not only those who can pay for it. That integration, he said, will extend to tuberculosis, viral hepatitis, sexually transmitted infections, sexual and reproductive health, mental health, and noncommunicable disease services, alongside continued work to eliminate mother-to-child transmission of HIV, syphilis, and hepatitis B.
“A scientific breakthrough only matters when it becomes a public health breakthrough for everyone, everywhere – and not only for those who can afford it,” he said.
None of it, he said, works without communities, whom he described not as optional partners but as the architects of the response. These are the ones who reach people health systems cannot, defend human rights, and hold everyone else accountable. Tedros urged countries to protect HIV financing, strengthen community-led organisations and repeal laws that criminalise key populations. “Progress is real, but it’s fragile,” he said.
“We have the science. We have the tools,” Tedros said. “What we need now is what has always mattered most in this fight – the will to stay united and the determination to finish what we started.”
