March 8 marks International Women’s Day 2024. To celebrate, we interviewed one of our female Academic Editors, Dr. Siaw Shi Boon, who…
World AIDS Day 2025 – “Overcoming disruption, transforming the AIDS response”
Each year, Worlds AIDS day commences on the 1st of December. World AIDS Day 2025 highlights the theme “Overcoming disruption, transforming the AIDS response”. Two years ago, we discussed the field of HIV/AIDS research with PLOS One section editor Professor Limin Mao (see here), and we are excited to share a follow-up interview. Global HIV research has been affected by changing healthcare priorities, funding pressure and emerging epidemics during the last two years, and we were thrilled to discuss this topic with Professor Mao, who, together with colleagues Brent Mackie and Dr. James Gray, aimed to provide a community-engaged perspective.
Prof. Limin Mao is at the Centre for Social Research in Health, UNSW Sydney. She’s affiliated with UNSW’s International Centre for Future Health System and Ageing Futures Institute.
HIV research has always been about people: their courage, creativity and determination to care for one another. HIV is not only a disease but also magnifies socioeconomic disparities.
Limin Mao
The field of HIV research evolves rapidly. Looking back over the last two years, what developments or discoveries do you think have had the biggest impact, scientifically or clinically, on the fight against HIV/AIDS?
During the last two years, rapid advances in science and technology make HIV virtual elimination a possible reality in some nations. Whereas for some other nations, funding cuts and emerging challenges such as climate change, migration and conflicts, push the decades’ HIV advances and gains backwards.
There has been a growing interest in antiretroviral therapies, vaccines and functional cure strategies such as gene therapy and immunotherapy. Which of these areas do you think is showing the most promise right now? And what would you say are the biggest challenges we are facing before these advances can reach patients?
Growing biomedical advances in the availability and affordability of HIV antiretroviral drugs with improved potency and decreased side effects, along with the new hopes rising from COVID-19 like mRNA vaccines and functional cure strategies based on the rapid genomic spaces, truly make HIV global elimination a possible reality.
In real life, this means millions of people can live longer with a better quality of life without fear of stigma and discrimination and with a strong sense of belonging to diverse communities. However, real-life implementation, as we learnt in the past, can often be hampered by lack of government support, barriers to obtain and uptake new technologies and treatment options, and last but not the least stigma and discrimination surrounding HIV.
Our HIV elimination efforts are further challenged by a growing population of older adults living with HIV, many of whom are experiencing a quite demanding ageing process due to disease progression, long-term treatment side effects and social isolation. Their heroic survivorship and resilience, including their critical contribution as HIV advocates and peer mentors, need to be fully recognised and harnessed to sustain the global momentum to end HIV.
As my Australian colleague, James Gray from Health Equity Matters, put it: “Engagement with affected communities are central to the successful future of HIV elimination strategies.”
Global HIV care has been affected by changing healthcare priorities, funding pressure and emerging epidemics. With consideration of this year’s World AIDS Day focus on “Overcoming disruption, transforming the AIDS response”, how do you think these factors have shaped HIV research or impacted patient outcomes in recent years?
…ending HIV requires more than just scientific progress
Brent Mackie
We have learnt a lot from our fight against HIV and our ambitious goal to end HIV globally. Over the past two decades, remarkable progress has been made in the global HIV response prior to the funding cuts. They are characterised by dramatic reductions in both new HIV infections and morbidity rates on a global scale, both high, middle and low-income countries. This remarkable global achievement is underpinned by meaningful community engagement, quality research and rapid advances in clinical care.
Recent setbacks, including large government funding cuts on a global scale, have seriously affected the ongoing efforts along the entire HIV continuum of care, from prevention, treatment to care.
What we have learnt from HIV, such as vaccine development and emergency responses to infectious diseases outbreaks, has already contributed to other strategic approaches, for example, to the COVID 19 pandemic in the past few years.
The global HIV communities, particularly those living with HIV and those affected by HIV through their personal relationships, work and practice, including peer support and grassroots activism, have demonstrated resilience to overcome challenges and identify opportunities over the last four decades. This resilience building itself is transformational as it demonstrates humanities in the face of life-threatening adversity.
As another Australian colleague, Brent Mackie from ACON, put it: “These experiences remind us that ending HIV requires more than just scientific progress. It also depends on maintaining compassion and trust, especially during tough times. It is equally important to acknowledge that this resilience has its limits when overstretched communities and health services are asked to do more with much fewer resources.”
Equity remains a key theme in global health. What progress has been made in closing the gap between high-income and low-income settings when it comes to HIV prevention, testing and treatment access? What do you think are the main barriers to progress that remain, and do you have any ideas for how we might overcome them?
Equity is dignity, justice and human rights all in one place.
Limin Mao
Visible gains have been obtained in closing the gap between high- and low-income countries across the globe in areas of screening for HIV (e.g., HIV self-testing kits), prevention (PrEP uptake daily or on-demand, the availability of long-term injecting PrEP) and universal treatment access (e.g., Australian government’s extension of free HIV antiretroviral treatment to non-Medicare eligible residents). However, these gains may not become sustainable with the recent setbacks of large-scale funding cuts globally and priority agenda shifting away from HIV elimination. This, translated to real-life impact, could mean that while high income countries may be able to continue to aspire for HIV virtual elimination, other nations may be forced to fight to stop from going backwards. This can widen the disparities we have been striving to narrow down over the past two decades.
A whole-of-society approach, built on alliance from government, community, research and healthcare sectors, shows promises in tackling complex problems such as HIV, including deep-rooted stigma and discrimination surrounding people’s identifies, relationships and ways of living.
The past few years have also seen more integration of digital tools, AI and real-time data in public health research. How is technology influencing HIV research or clinical practice today?
Digital tools as well as AI chatbots have been used to enhance health literacy and assist with clinical management of many common chronic diseases. Real-time data, sometimes visualised at the individual and group aggregated form, is increasingly used to support person-centred disease self-management and clinical care.
HIV remains a stigmatised chronic disease. HIV-related research and practice are also expected to benefit from these technologies and tools. In Australia, for example, since COVID, online platforms and telehealth have increased connections with people previously isolated due to geography and confidentiality concerns. Together, these tools have contributed to reductions in social isolation and clinical disengagement and increases in the sense of belonging. However, digital divides can also worsen existing inequalities for those lacking access to digital tools for various reasons.
We firmly acknowledge that all the advances in technologies and tools can assist but not completely replace the central role of people in our community-led HIV response globally. It is also up to a coalition of policy makers, clinicians and researchers to work with people living with and affected by HIV to address concerns by safe-guarding privacy and confidentiality, reducing unwanted personal data breaches and minimising bias stemming from selective representation.
Engagement with affected communities are central to the successful future of HIV elimination strategies.
James Gray
Finally, as we mark World AIDS Day, what message would you like to share with young researchers entering this field?
Today, there are still people dying of advanced AIDS defining illnesses in high-income countries, often due to late HIV diagnosis. Universal HIV screening is still out of reach, largely due to stigma and discrimination. Punitive legal and immigration policies continue to make people fearful of HIV screening, HIV status disclosure and medication uptake during their encounters with our healthcare systems, which should protect them from infection, save their lives and increase their quality of life.
As new generations of researchers join this field, I hope they remember that ending HIV is as much about empathy, inclusion, and justice as it is about science.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
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