The global HIV response is at a critical juncture. For much of the last decade, HIV treatment was treated as settled — largely assumed to be affordable, accessible, and principally resolved. Today, that assumption is unraveling. Treatment is entering a new phase, shaped by shrinking donor funding, intellectual property barriers, unequal rollout of long-acting technologies, and health systems under pressure. These shifts raise urgent questions about who decides how innovation is used, who benefits, and whose voices shape the response.
This moment carries a troubling echo of the early 2000s, when treatment was pitted against prevention in a false choice that communities fought hard to reject. Two decades later, as funding contracts and long-acting prevention technologies dominate the headlines, the question of where a shrinking dollar goes is being asked again — and treatment is losing ground. The community movements that built the case for universal access in the 2000s must be rebuilt and resourced now, with the same clarity: prevention and treatment are not competing priorities. A response that abandons one to fund the other will fail both.
Alongside these shifts, the way communities connect, organize, access information, and seek care is also changing. For LGBTQ+ communities, key populations, and people living with HIV, digital platforms have become central to how people build networks, access health information, navigate stigma, and engage with prevention and treatment services. These platforms are no longer peripheral; they are part of the infrastructure of contemporary community life. Increasingly, they are also the surface on which AI systems, algorithmic decision-making, and new forms of surveillance are being built, often without community input, and often on data that communities generated.
This moment is a crossroads. Innovation and digital transformation can reinforce existing inequalities, or communities can help shape the technologies, platforms, and systems that increasingly determine access. The difference between these two futures depends on who holds power: who designs the tools, who governs the data, whose knowledge counts as evidence, and whose leadership is resourced.