Officially, this year’s 26th International AIDS Conference, held July 26-31 in Rio de Janeiro, advanced a clear and timely theme: “Rethink. Rebuild. Rise.” A community well-versed in resilience would respond to devastating losses in funding and political support with strategies for rising above all obstacles and ending HIV/AIDS.

Yet, over the course of the week, as thousands of scientists, researchers, healthcare providers, advocates, administrators, journalists, community leaders, and people living with HIV attended more than 150 sessions, a new rallying cry emerged around the sprawling Riocentro Convention Center: “Innovation without access is injustice.”

The sentiment might have originated before this conference, but most attendees likely heard it first at the opening general assembly in a speech by Dr. Alexandre Padilha, Brazil’s Minister of Health. He addressed the week’s largest audience in Portuguese, but his message, re-quoted by other speakers in other sessions, was delivered in translation.

“Innovation needs to go hand in hand with access,” Padilha said. “Innovation without access is injustice.” Meaning, it’s unjust that although science has provided drugs and treatments that can save the lives of people living with HIV, still around 570,000 people died from AIDS-related illnesses worldwide in 2025, according to the latest UNAIDS Global AIDS Update.

Also, it’s unjust that despite massive global uptake of PrEP and other tools that prevent acquiring the virus in the first place, not everyone who needs those tools has access to them. In 2025, 1.2 million people worldwide newly acquired HIV, with rates of new infections increasing in 21 countries.

Around the world, more than 40 million people are living with HIV, according to the UNAIDS report, and 78% of those are accessing antiretroviral therapy, but thousands without access to those interventions die daily due to AIDS-related illnesses, at a rate of one per minute.

“Access is more than a matter of public health. It’s a moral and ethical imperative,” declared Dr. Jarbas Barbosa, Director of the Pan American Health Organization and Regional Director for the Americas of the World Health Organization, at the AIDS 2026 opening press conference.

Winnie Byanyima, Executive Director of UNAIDS and an Under-Secretary-General of the United Nations, who presented the Global AIDS Update at the press conference, put it another way. “Scientific breakthroughs alone will not end AIDS. Access will,” she said.

The UNAIDS report reiterates the extraordinary scientific progress made so far in the HIV response. “Today, we have prevention medicines so effective that if they reached everyone who needs them, we can realistically end AIDS as a public health threat,” said Byanyima.

“Long-acting HIV prevention medicines are changing what is possible: monthly pills, monthly injections, six-monthly injections, providing protection approaching vaccine-like effectiveness. For the first time, ending new infections is no longer simply an aspiration. It’s scientifically achievable.”

However, as Byanyima also noted, “these medicines remain out of reach for most of the people who need them.” Access is threatened or denied by political choices and business decisions. “Funding cuts, rising inequality, attacks on human rights, shrinking civic space — together, they are putting decades of progress at risk,” said Byanyima.

Funding cuts, waning political will, and rising inequality, as much as scientific innovation, have been lead stories at the International AIDS Conference the past two years.

At AIDS 2024 in Munich, by sharp contrast, hope was the story. I interviewed Mark Franke, one of then-seven individuals who had been cured of HIV through extremely specialized and challenging stem-cell treatments. (The number now stands at 13.) Franke and the small coterie of cure patients strolled the conference halls with the aura of astronauts who’d returned from the far reaches of space.

That year also was buzzing with news about long-acting PrEP injectable Lenacapavir proving in studies to be astoundingly effective at preventing HIV. Progress, innovation, and choice within the market for PrEP dominated the conversation.

Then the shift came quickly. In 2025, the global AIDS community gathered in Kigali, Rwanda, freshly reeling from the new Trump administration’s severe DOGE cuts to government agencies like USAID, formerly “the largest implementing partner of PEPFAR,” now shut down completely.

This year, the world showed up at AIDS 2026 to report and assess the cost of those cuts. Delegates representing every region of the globe — from Brazil and throughout Latin America and the Caribbean, Southeast and Central Asia, China and Japan, Europe, Australia, Fiji and the Pacific Islands, and nations of Africa great and small in population and political influence — had a story to relay.

In response to claims by DOGE hatchet man Elon Musk and others that there have been zero deaths because of DOGE cuts, the people brought numbers, data, and first-person knowledge of the consequences they’re seeing in their own communities.

At a media roundtable discussing the impact of PEPFAR cuts in Africa, Kenneth Ngure, the incoming President-elect of the International AIDS Society, reported that global funding in the HIV/AIDS response had fallen back to 2008 levels.

Global funding fell farther and faster than ever last year. Even in nations that were on a path to increasing domestic investment in their HIV response, the sudden 25% deficit in funds led to disruptions in treatment, testing, reporting, and clinic services.

Additionally, more sweeping CDC cuts will take effect in early 2027, noted Mathume Joseph Phaahla, South Africa’s Deputy Minister of Health. “Another 10,000 people will be out of work,” no doubt causing further disruptions.

Florence Riako Anam, of the Global Network of People Living with HIV (GNP+), described people not getting services and losing access to PrEP, or losing services altogether due to staff shortages.

At another session dedicated to protecting LGBTQ+ health in hostile climates, Shayna, representing trans healthcare platform Ally Heart, based in Delhi, India, reported that gender care facilities in their region closed within months of the USAID cuts. Michael Ighodaro, Executive Director of Global Black Gay Men Connect, reported that a whopping 1,700 clinics, safehouses, and drop-in centers had closed across multiple countries.

Such disruptions cause more than mere inconvenience. As Byanyima warned in the opening press conference, “When prevention disappears, infections rise. When treatment is interrupted, people die.”

The U.S. government funding cuts aren’t solely to blame for any stalling in progress. The UNAIDS report also documents “another deeply troubling trend,” Byanyima noted. “Around the world, human rights are moving backwards. For the first time since UNAIDS began monitoring legal environments, criminalization is increasing rather than declining.”

Data demonstrates that criminalization of same-sex relations and gender identity constitutes a significant barrier to people getting tested, taking PrEP, or getting treatment. Similarly, stigma about acquiring or living with HIV also continues to be a serious barrier to people getting tested, taking PrEP, or getting treatment.

So, myriad factors, including the prohibitive licensing and manufacturing decisions executed by pharmaceutical companies like Gilead, ViiV Healthcare, and Merck, have led to unfortunate worldwide declines in key HIV indicators.

A new Clinton Health Access Initiative (CHAI) HIV market impact memo distributed at the conference showed that, in 2025-26 analysis of select countries in Africa and Asia, PrEP initiations fell 42%, HIV testing dropped 12%, viral load testing declined 21%, and the number of adults on treatment declined 9%.

“Progress is slowing,” Byanyima said, referring not to just one nation, but the world. “The HIV pandemic is not over. Without urgent action, it could resurge. The world stands at a crossroads. The report shows that we are no longer facing a future funding crisis. We are living through one now.”

We also are living through “one of the most exciting moments in the history of HIV science,” she asserted. “Science has done its job. Now politics has to do its job.”