shloboe boe
Denise Naniche
When the first International Aids Day was marked in 1988, I had just completed my first immunology course, where we were beginning to learn more about a mysterious virus — the human immunodeficiency virus (HIV). At the time, nobody knew much about this stealthy virus.
Three years later, Freddie Mercury’s death brought global attention to an epidemic that had already taken millions of lives. Most died anonymously, leaving behind unfinished lives and grieving loved ones.
None of them lived to see the breakthrough of 1996: triple antiretroviral therapy (combining three drugs into one treatment). For those living with HIV, this moment was as momentous as humans landing on the moon —HIV went from an automatic death sentence to a chronic, manageable condition.
A revolution unevenly shared
Yet this revolution remained a privilege of wealthy countries. It took nearly a decade for this life-saving treatment to reach low-income regions, especially sub-Saharan Africa. While people in wealthier countries were reclaiming their lives, around 30 million people worldwide were living with HIV, mostly untreated, and 3,8 million were newly infected each year. In countries like South Africa, Mozambique, and Zambia, HIV remained a death sentence — the epitome of global inequity.
Two game-changers that
saved millions
So, what changed around 2002 to 2003 to make HIV treatment available to tens of millions? Two major initiatives reshaped the global response: The Global Fund to Fight Aids, Tuberculosis and Malaria, and Pepfar, the US President’s Emergency Plan for Aids Relief.
These huge co-ordinated efforts poured in unprecedented resources, and continue to do so. By the early 2020s, they jointly contributed around US$10 billion annually, while HIV research funding continued to increase — leading to major advances in prevention, diagnosis, and clinical management.
Since the rollout of antiretroviral treatment across regions hardest hit by HIV, more than 20 million lives have been saved and nearly 40 million new infections prevented. With treatment, people on the brink of death literally came back to life within weeks of starting treatment — many called it a miracle.
Even being a rational non-miracle-minded scientist, I could understand how the dramatic return to health could be seen as the work of a supernatural power.
We are so close to ending HIV — of ensuring that millions can live full, healthy lives. To pull back now would be both a moral and strategic failure.
Every year, UNAids consistently reported progress: fewer new infections, fewer Aids deaths, and major drops in mother-to-child transmission — while treatment evolved from multiple doses per day to a single tablet.
And what went up was life expectancy. In South Africa, it went from about 56 years in 2000 to 67 years today.
Science moved forward, too. In the past few years, breakthroughs in prevention, such as injectable pre-exposure prophylaxis (PrEP) with cabotegravir every two months, and twice-yearly lenacapavir, have brought us closer than ever to ending Aids by 2030.
2025: A dangerous
step backward
Then came 2025. The US administration under Donald Trump dismantled key international aid mechanisms, hacked away most of USAid, and slashed funding for Pepfar and the Global Fund.
Only months after the cuts, the effects are already visible: health workers are being let go, clinics are closing, and people are unable to access treatment. A recent modelling study warned that a 24 percent reduction in funding could mean three million additional Aids-related deaths and 4 to 11 million new HIV infections by 2030.
We’re closer than ever to ending Aids, but funding cuts threaten decades of progress. Continued investment and prevention are essential to meet 2030 goals.
We’re too close to turn back
We are so close to ending HIV — of ensuring that millions can live full, healthy lives. To pull back now would be both a moral and strategic failure.
It’s like building your family’s house from the ground up, spending years laying down the bricks, pouring in your savings, and caring for each detail. You just need to paint the front door and you are finished. Would you really walk away after coming so far? Would you give up your home and lose all of the money and sacrifices you made?
To finish what we started
We cannot stop as we near the finish line. Around the world, health systems are moving towards integrated care, managing HIV alongside chronic diseases and infections like tuberculosis and malaria, often through primary care services. These models have been shown to be sustainable, cost-effective, and community-centred and can be generalised.
Ending Aids by 2030 is still possible. But only if we choose to finish what we started.
Ensuring uninterrupted antiretroviral treatment is essential for saving lives and keeping HIV under control. But we won’t end the epidemic if we fail to halt new infections — prevention cannot be ignored. Promising tools like lenacapavir as PrEP, the closest we have ever been to a vaccine, must reach high-incidence regions and those most at risk.
We must also tackle stigma and discrimination, as they remain major barriers for many.
Reaching those most in need will require collaboration across governments, global donors, researchers, the pharmaceutical industry, and affected communities.
Ending Aids by 2030 is still possible. But only if we choose to finish what we started. – isglobal.org
Online Reporter