By Benjamin Brooks, Associate Director of Policy and Education, The Institute for Health Research & Policy at Whitman-Walker

As we turn the page from 2024 to 2025, The Institute for Health Research & Policy at Whitman-Walker is taking stock of what has been accomplished this past year and what we hope to achieve in this new one.   

Scientific progress is nothing short of a miracle of human achievement but should not be taken for granted. The lives saved by scientific and medical advancements are the legacy of thousands of dedicated people, their brilliant minds, and unwavering commitment. It takes a worldwide movement to shift the resources to respond to and eventually end a disease. Our movement is better resourced, better equipped, and better positioned than at any point in the past, and we aren’t finished yet. 

In 2024, largely thanks to the continued investments in HIV science and policy made over the course of decades, we saw huge wins: more options for HIV treatment and prevention with increasing efficacy, increased support from the Centers for Disease Control and Prevention (CDC) to repeal outdated HIV criminalization laws that persist in many states, updates to important federal non-discrimination laws that protect people living with HIV in their workplaces, schools, and insurance plans, and more.

Here is what we expect to see in 2025:

Expect Challenges. We can expect the people who make up the HIV workforce and patient population will experience new political headwinds, creating conditions that make our work harder. The first Trump presidency rolled out the Ending the HIV Epidemic Plan and spent federal dollars to support essential expansions in programming to reduce the spread of HIV. However, the policy agenda of the second Trump administration, as expressed in Project 2025, has the potential to undermine the legal and public health consensus that supports a vision of the future that decriminalizes and destigmatizes people living with HIV (PLWH), LGBTQ+ people, and people who inject drugs. Project 2025 includes policies that criminalize transgender people, undermine sexual and reproductive health, defund education, reduce public housing support, reduce access to public insurance, and further criminalize and stigmatize drug use. Instead of treating economic and social inclusion as key to supporting and promoting public health, we must closely track and respond to efforts to weaponize the federal government against underserved communities. In addition to the advancement of this harmful policy agenda, we all must be concerned about stigmatizing messages that are often detrimental to the mental health of the communities we serve and represent and that will increase fear, stress, economic precarity, and feelings of political disenfranchisement.

Funding Streams. Funding for AIDS Service Organizations and Community Based Organizations (ASOs/CBOs) that serve PLWH is in danger. Many of the organizations advancing the science and practice of HIV care and prevention and spearheading health equity efforts are funded by US programs like President’s Emergency Plan for AIDS Relief, (PEPFAR), the Department of Health and Human Services (HHS), National Institutes of Health (NIH), Centers for Medicaid and Medicare (CMS), CDC, and the Health Resources and Services Administration (HRSA), and others. The incoming administration and Congress have promised to try to restrict key public health and health care funding, dismantle domestic insurance programs, and limit access to essential health care services that will undermine the ability of PLWH, especially LGBTQI+ people, to receive the care they need. The administration could defund PEPFAR or only fund domestic and international health programs with added riders prohibiting grant recipients from participating in activities that promote equitable participation in civil society, like human rights advocacy, family planning, abortions, sex worker organizing, and LGBTQI+ rights. Pharmaceutical companies will probably continue to shave away at the 340B Drug Pricing Program (created by Congress in 1992 to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services), which many ASOs/CBOs rely on for funding necessary health promotion engagement and retention programs. In the absence of Federal aid to support their operations, ASOs/CBOs may need to turn with renewed vigor to the private industry partners, philanthropy, community supporters, and to state and local governments.

Long-acting Injectables. New advancements in HIV science include an increasingly large suite of long-acting injectable treatment and prevention options. If the Affordable Care Act (ACA) survives attempts to end its coverage reforms, patients should see an increase in choices to help them meet their health care goals. Recent litigation in the United States has shed doubt on whether coverage mandates for PrEP–-an FDA-approved medication that reduces the risk of getting HIV by at least 99% when taken as prescribed—will continue in US jurisdictions. On the global scale, many countries will need to develop licensing agreements to improve access to these highly effective prevention and treatment modalities. International development organizations, like the World Bank Group and InterAmerican Development Organization, and their health arms in the World Health Organization and Pan American Health Organization should invest in technical cooperation programs that build capacity for manufacturing and development of health technologies.

Telemedicine Expansions. Expect more access to HIV medications, tests, and counseling over the internet. Mail-order PrEP programs grew during the relaxed telehealth regulations during the pandemic health emergency. The COVID-19 crisis forced a rapid expansion of telehealth provision for infectious diseases, shifting resources and upsetting institutional inertia about the quality of virtual care. Proponents will need to be attentive to the digital divide, particularly in rural and developing areas of the world. However, funders and administrators should look out for opportunities to leverage technology to leapfrog over legacy models of healthcare delivery to achieve access goals.  

The Fight Ahead. The previous Trump administration showed disregard for scientific evidence, due process, and legal reasoning in its rulemaking processes. The HIV movement will need to assert and defend the legal rights of PLWH and those at risk of HIV. People will be called to serve:

• as plaintiffs, and as lawyers to fight these battles in court,
• as scientists and researchers to combat mis- and disinformation,
• as advocates to help block harmful Congressional actions, like repealing the ACA, and,
• as organizers to keep our communities focused and working together.

A future in which we have stopped the spread of HIV is a future where all people—including those living with HIV and those at risk for HIV—can live free from fear. For decades there has been a consensus among public health and human rights advocates that people, including those living with HIV, are not vectors of disease, but partners in this shared project. As we move into the relative unknown of a second Trump presidency and wonder what the future holds, it bears remembering that the people working diligently in the HIV movement have faced similar moments in the past. Instead of trepidation, the familiar sight on the horizon should inspire us to gather our communities together, celebrate our wins, and carry each other into a future of our own making.