Advances in biomedical research in recent years mean that HIV is now preventable and treatable. Sadly, this progress has outpaced political and legal reform, and is undermined by continuing HIV stigma and discrimination against people living with and affected by HIV and AIDS.

Despite being transformed by advances in treatment and prevention, HIV and AIDS remain a critical public health challenge. Globally, since 2010, new HIV infections have fallen by about 40% and AIDS-related deaths by over 50%, but new infections remain high (≈1.3 million in 2024). Medical developments (e.g. long-acting Anti-Retroviral Therapy (ART), Pre-Exposure Prophylaxis (PrEP), vaccine research), adequate global financing (notably through the Global Fund), and addressing stigma, discrimination and human rights violations are all crucial to an effective response, and to support the ambition set out in the Sustainable Development Goals to end AIDS as a global health threat by 2030. 

Medical Advances and Prevention Tools

HIV treatment and prevention have made remarkable progress. Widely available ART means people with HIV can now live long, healthy lives. Clinical studies have firmly established that “Undetectable = Untransmittable (U=U)”: with sustained viral suppression on ART, HIV cannot be sexually transmitted. ART has achieved high global coverage, with around 77% of people with HIV worldwide on therapy by the end of 2024, while in England, the 95-95-95 UNAIDS targets have been met.

New prevention tools are also expanding. PrEP for those at high-risk of HIV acquisition is now more readily available in the UK and other countries. NICE and UKHSA have reported record PrEP uptake, which correlates with a small but not insignificant reduction in new HIV diagnoses. Of particular note, NICE has approved the first injectable PrEP (cabotegravir, every two months) for those unable to use daily pills. It is to be hoped that this will be followed by approval of twice-yearly injectable lenacapavir, likely to have an outsized impact in under-resourced regions that account for the majority of global HIV infections. Gaps in preventive medication remain, however. Uptake is much higher among gay/bisexual men (~80%) than heterosexuals (<40%), reflecting ongoing inequalities in prevention access. 

As for vaccine, there is some cause for optimism. The results of co-ordinated trials in Rwanda, South Africa and the US, published in Science this year demonstrate, for the first time in humans across diverse populations, that a germline-targeting, mRNA-delivered HIV vaccine can safely and reliably induce the precursor cells needed to generate broadly neutralising antibodies, a proof-of-concept widely regarded as a major step towards an effective global HIV vaccine.  Clinical efficacy in preventing infection remains to be demonstrated.

The Global Fund and Financing: A Challenge to the AIDS Response

Developing and sustaining biomedical advances in prevention requires stable financing. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is the world’s largest multilateral funder of global health grants in low- and middle-income countries. The current replenishment (for 2026–28) has so far fallen short, with just over US$11.3 billion of an $18 billion target confirmed by November 2025. Key public donors have reduced their contributions. The UK, co-host of the 2025 summit, cut its pledge from £1 billion to £850 million, a 15% reduction, and Germany cut its by 23% (€1.3 billion to €1bn). The Executive Director of Frontline AIDS, echoing the concern of other campaigners, has said that ‘there is a danger that this drop in its pledge will lead to reductions in other donor commitments, with real risks for people’s lives and for the global response to HIV’. 

Furthermore, analysis indicates that the 2025 suspension and restructuring of funding under the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has not been fully remedied by the new US Global Health Strategy. PEPFAR has historically supported antiretroviral therapy (ART) for over 20 million people worldwide and is credited with preventing more than 25 million AIDS-related deaths; evidence shows that even short-term interruptions to ART risk viral rebound, drug resistance, increased transmission, and excess mortality, particularly in sub-Saharan Africa where approximately two-thirds of the global HIV burden resides. While the US strategy reaffirms a formal commitment to HIV/AIDS programmes and proposes interim bridge funding alongside a shift towards bilateral, country-led delivery, it is vital that programme continuity and support for implementing partners is provided. Ongoing payment delays, reduced support for community-based and prevention services, and broader cuts to global health assistance mean that uncertainty persists.Funding challenges have coincided with calls for sustainable financing models. Several transition efforts are underway. For example, the new Seville Platform for Action, agreed at the 4^th International Conference on Financing and Development in July 2025, urges coordinated global reforms to strengthen health systems, advance debt restructuring, and enable more progressive taxation. African countries collectively receive far less in aid than they lose through illicit financial flows and debt servicing, with two-thirds spending more on debt than on healthcare. At the conference, Winnie Byanyima, Executive Director of UNAIDS, emphasised that donor nations must honour their commitments so that low- and middle-income countries can expand domestic health financing, and that debt relief and fair taxation are essential to creating the fiscal space necessary for realising the right to health. 

Human Rights, Stigma, and Discrimination

As Chair of the National AIDS Trust, whose mission is not only to end new HIV transmissions but to stop HIV from standing in the way of health, dignity and equality, I am particularly concerned about the negative impact of human rights violations, stigma and discrimination on the global HIV response.

Social determinants profoundly affect HIV outcomes. In the UK, despite legal protections, evidence shows alarming ignorance and unfair treatment. The National AIDS Trust’s 2025 report Equality in name only? found widespread breaches of rights in healthcare, work, and services. For instance, 23% of surveyed NHS staff erroneously believed HIV could be spread by spitting, and over 50% said they would feel “worried” drawing blood from a patient with HIV. These findings reflect outdated fears and have serious consequences. As NAT’s Director of Policy notes: ‘Discrimination against people with HIV is not only unlawful, but also harmful … and can result in people withdrawing from HIV treatment, being afraid to go to healthcare settings, or ending their employment’.

Data privacy is also a challenge. The UK Information Commissioner has highlighted persistent data breaches resulting in the disclosure of people’s HIV status. ‘People living with HIV’, he has said, ‘are being failed across the board when it comes to their privacy and urgent improvements are needed across the UK. We have seen repeated basic failures to keep their personal information safe – mistakes that are clear and easy to avoid.’ Stronger legal and technical measures are needed (better staff training, reporting, and redress) to protect HIV-related health data. As NAT has stated: ‘People living with HIV need the confidence to know that they have recourse when their data rights are breached, and to prevent risk of further discrimination and harassment. Someone’s HIV status is personal data, and it should be a person’s choice to decide whether or not they share that information.’

Travel and immigration restrictions are a further example of HIV-related discrimination. As of 2025, 50 countries still impose HIV-specific travel or residence bans. These range from outright entry bans (in places like Kuwait, Malaysia, the UAE, some African states) to more subtle requirements of mandatory HIV testing for visa applicants. Such laws are punitive and stigmatizing. They have the effect of forcing people living with HIV into hiding (to avoid deportation or loss of livelihood) and directly infringe on the human rights of free movement and non-discrimination. Similarly punitive are laws that criminalize HIV itself or key populations, with evidence repeatedly showing that such laws (against HIV, sex work, homosexuality, drug use, etc.) increase HIV risk. Indeed, countries that criminalise key populations tend to lag behind in testing, treatment and viral suppression compared to those with protective laws. Despite campaigning by UNAIDS and others, progress has been uneven. In the UK, the Equality Act 2010 makes HIV a protected disability (from the time of diagnosis); but as NAT’s report shows, loopholes and ignorance still allow unlawful mistreatment. NAT and allies continue to push for better enforcement of Equality Act protections – for example, tightening confidentiality rules and extending time limits to pursue claims. One positive development, announced by the MOD on World AIDS Day this year, is that there are now no roles in the military where living with HIV is a barrier to serving.

Criminalisation of HIV Transmission

One of the most controversial legal issues is the criminalisation of HIV non-disclosure or transmission. Many countries (including some US states, parts of Eastern Europe, Asia, and Africa) impose criminal penalties on people living with HIV for “reckless” or “intentional” transmission or even for simply not disclosing their status. Global data presented at IAS 2025 reveal that reported prosecutions for HIV-related offences actually increased in 2024–25. In 2024 there were at least 65 known criminalisation cases across 22 countries (up from 50 in 2022). Furthermore, there is evidence of disproportionate and selective enforcement targeting marginalized groups. The HIV Justice Network, which leads the global monitoring and advocacy in this area, has argued that ‘To reach the UNAIDS target of fewer than 10% of countries with punitive laws by 2030, we must: prioritise science over stigma, invest in community-led monitoring’ and ‘demand legal reform grounded in human rights’. 

The UK does not have HIV-specific criminal statutes, and prosecutions are initiated under general offences against the person legislation. Both experts and civil society in the UK have argued this is unjustified. The BHIVA position statement (2024) acknowledges that intentional or reckless transmission is technically criminalisable, but reliable scientific data confirm that a person living with HIV but with undetectable viraemia poses no risk (U=U). This has not stopped people being investigated for offences, even if no prosecution follows. Consistent with the position of the Global Commission on HIV and the Law, BHIVA concludes that ‘the use of criminal law in relation to HIV transmission does not contribute to public health aims of reducing the number of new infections or reducing stigma’. NAT likewise condemns HIV criminalisation, its 2024 briefing insisting that treating HIV transmission as a criminal matter fails to reduce transmissions, infringes individual rights, and contributes to stigma

UK Legal and Policy Context

It was mentioned above that the Equality Act 2010 provides strong legal protections: HIV is classified as a disability from diagnosis, meaning that it is per se unlawful to discriminate on grounds of HIV status in employment, healthcare, housing, or the provision of services. This formal legal position complements the significant medical advances outlined earlier in this article, particularly the progress on 95-95-95 targets. However, as NAT notes, enforcement gaps persist and lived experience often falls well short of both legal and clinical progress. Employers are required to make reasonable adjustments once aware of an employee’s status, but misunderstandings and stigma, including among healthcare professionals, continue to undermine these protections. One structural weakness is that part of the Act – the socio-economic duty on public bodies—has yet to come into force in England (although it applies in Scotland and Wales). It is hoped that this will be implemented, because, as NAT has explained, ‘Changes to the welfare system and the funding cuts that came with austerity since 2010 have disproportionately affected people already at risk of discrimination and disadvantage, including many people living with HIV below the poverty line. The socio-economic duty would have forced the Government to demonstrate how these policies would reduce, not perpetuate, socio-economic inequality.’

In public policy, the most significant, and welcome, development is the UK Government’s HIV Action Plan for England 2025–2030. This sets out a comprehensive national strategy to end new HIV transmissions by 2030, backed by more than £170 million in targeted investment. Centred on five priorities (Prevent, Test, Treat, Thrive, and Collaborate) the plan expands equitable access to prevention, including a strengthened national HIV prevention programme and efforts to increase PrEP uptake among underserved heterosexual and ethnic-minority populations. It significantly scales up testing through extensive opt-out HIV testing in Emergency Departments, the introduction of NHS App–enabled home testing, and a review of wider digital pathways for PrEP, PEP and diagnostic services. Treatment and care are reinforced through the first national retention and re-engagement programme, designed to reconnect people who have fallen out of care and to support long-term treatment adherence. Alongside these clinical measures, the plan addresses stigma and discrimination through mandatory HIV-awareness training for health and social care staff, targeted anti-stigma initiatives, and improved integration of HIV care within women’s health services. Delivery depends on strengthened system-wide collaboration, with DHSC oversight, a National Delivery Group, and a requirement for local authorities and NHS partners to undertake needs assessments and develop local HIV plans by 2026. Framed against recent rises in new diagnoses and recognition of the epidemic’s growing complexity, the plan emphasises the unprecedented nature of eliminating HIV transmission without a vaccine or cure, underscoring that success will depend on sustained partnership, targeted interventions, digital innovation, and effective engagement with communities most at risk. 

Conclusion

Globally, HIV/AIDS is at a crossroads. There have been extraordinary advances in medical science, but socio-legal factors threaten to stall progress. People living with HIV can now aspire to normal lifespans and zero transmission under ART; but austerity-driven funding cuts across the world and persistent stigma risk eroding those gains. Ending AIDS requires both biomedical and structural interventions. It demands ensuring access to prevention and treatment (NICE approvals, funding commitments, equitable service delivery) while simultaneously safeguarding rights (decriminalising HIV, preventing discrimination, protecting privacy). NAT, as the UK’s HIV rights charity, champions this integrated approach, combining legal advocacy with public education and research. Only by addressing HIV in its full social context can the promise of the science be fully realized. The HIV Action Plan for England 2025-30 represents significant progress, but there is a need for continued vigilance, evidence-based policy, and a reaffirmation that HIV is a health issue, not a crime or a moral failing.