HIV: tackling inequalities and sustaining access to care in an era of global health regression

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Abstract
Purpose of review: The global HIV response has entered a critical moment. Tools to prevent and treat HIV are more effective than ever, yet financing cuts, political and policy regression, and persistent inequalities threaten access to these tools. This review examines key developments over the past 18 months, focusing on how inequality is shaping progress in the global HIV response. Recent findings: Progress against HIV remains highly uneven across regions and populations. New infections are increasingly concentrated among key populations – including gay and bisexual men, sex workers, transgender people, and people who inject drugs – and among adolescent girls and young women in some regions, reflecting persistent criminalization, stigma, gender inequality, and economic exclusion. The 2025 global health financing shock has disproportionately disrupted prevention, treatment, community-led services, and monitoring systems, making its full impact difficult to assess. Meanwhile, lenacapavir and other long-acting prevention technologies could transform HIV prevention, but their impact will depend on financing, infrastructure, and whether they reach the populations most likely to benefit. Summary: Addressing these challenges requires less emphasis on developing new HIV technologies than on ensuring that existing and emerging tools reach the populations who need them most. Sustained progress will require financing, protection of human rights, community leadership, and health systems capable of delivering prevention and treatment to populations most affected by HIV.

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