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It was against this backdrop that global collaboration, cooperation and funding systems were developed. PEPFAR, or the President’s Emergency Plan for AIDS Relief, was established in 2003.

Dr Grinsztejn explained that PEPFAR had been responsible for the majority of PrEP (the highly effective HIV prevention medication) access globally. But with the US funding cuts, which came into effect in January, PrEP supply had been limited to pregnant women, meaning that many population groups at risk of HIV were left without.

The broad global funding model of PEPFAR had been replaced by bilateral agreements between the US and specific countries, presenting an opportunity, but with critical gaps. The new agreements, she said, focused on financing health care workers and HIV antiretroviral treatments, but concerningly, left out community-run non-governmental organisations, which under former global funding models provided the majority of HIV care, especially in countries where homosexuality was highly stigmatised and even illegal.

“It’s a very critical moment, and this is certainly already impacting HIV new infections and HIV related deaths, especially among children,“ said Dr Grinsztejn. But also, it was impacting, severely, the rollout of new prevention technology – long-acting antiretrovirals.

“There is a huge global public health risk, and it’s all about safety; we need to invest because it’s safe for the entire planet.”

Priorities to meet needs now and into the future

While there had been a reliance on US funding for global health, Dr Grinsztejn pointed to other funding sources, such as The Global Fund, as well as the opportunity that the new bilateral agreements presented for countries to set their own resourcing priorities.

“Countries have the opportunity to put together their agenda where the resources could fit best to strengthen their own health systems,” she said. “This affirms the principle of national ownership.”

Dr Grinsztejn said that science and manufacturing should be among the highest priorities to enable countries to manufacture medicines locally, and that once the infrastructure was in place, this could be done much more cheaply. She drew on the example of the COVID-19 pandemic, during which those countries with the capacity to manufacture vaccines locally were ultimately able to vaccinate their populations and bring the pandemic under control much more quickly.

Referencing her home country, Brazil, Dr Grinsztejn said that US investment via the National Institutes of Health (NIH) “brought us conditions to do truly amazing, important research” and facilitated global HIV clinical and vaccine networks. These would need to be bolstered into the future, along with platforms for community voices to be heard, an initiative that the IAS prioritised.

“The world has the tools to end AIDS as a public health threat by 2030,“ she said. “What is missing is sustained political will, predictable and adequate funding and the courage to confront inequity head-on.

“We also need to preserve investment in science and in preparing the new generation of scientists to continue the work.”

Ultimately, Dr Grinsztejn said, we ought to be optimistic because of the immense progress made over the four decades since the HIV pandemic began, thanks to global collaboration.

“The HIV response that was born from activism, solidarity and science remains one of humanity’s greatest collaborative achievements,” she said.

Paying tribute to a pioneer in HIV research and advocacy

To open the event, Dr Swan asked Kirby Institute Director, Scientia Professor Anthony Kelleher, to reflect on the legacy of the late Prof. Cooper.

“David Cooper was all about health equity through evidence,” said Prof Kelleher. “He did that by identifying strategic interventions that would make a difference across all communities for all patients, but that had to be based on scientific rigour.

“He managed to bring together elegant scientific approaches with community consultation on a global basis to come up with solutions that were not just practical but highly accessible, and those interventions still underpin many of the approaches we have to treating and preventing HIV to this day.”

Dr Grinsztejn, who had also worked with Prof. Cooper, also emphasised his human rights-based approach to health science.

“His legacy continues to shape the way many of us think about science and solidarity,” she said. “David believed that science was not only about discovery, but also about responsibility to communities, to equity, and to the global sharing of knowledge.”