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    • Opinion
    • Global Health

    Opinion: The US legacy in HIV is unraveling

    With PEPFAR facing precarious uncertainty, shifting priorities and dwindling expertise raise alarms. Will the U.S. Congress intervene?

    By Mitchell Warren // 29 May 2025

    Right now, the U.S. global AIDS response could best be described as rearranging deck chairs while the ship drifts entirely off course.

    We are not witnessing bold reform, but an intentional unraveling of America’s legacy in global health. And it’s happening without the congressional engagement that has, historically, yielded such remarkable success.

    Reimagining and realigning global health programs is not inherently bad. In fact, it was a spirit of reimagination that led to the creation of the President’s Emergency Fund for AIDS Relief, or PEPFAR, the most successful global health program in our country’s history. But we were off track on global targets related to HIV before Jan. 20. To right the ship requires a thoughtful, intentional strategy. That is not what is happening.

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    More reading:

    ► PEPFAR at crossroads: Lawmakers debate future of global HIV program

    ► Why PEPFAR has bigger problems than reauthorization

    ► Following PEPFAR cuts, vulnerable Ugandans are dying, providers say

    • Funding
    • Global Health
    • Trade & Policy
    • Democracy, Human Rights & Governance
    • U.S. President's Emergency Plan for AIDS Relief (PEPFAR)
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    The views in this opinion piece do not necessarily reflect Devex's editorial views.

    About the author

    • Mitchell Warren

      Mitchell Warren

      Mitchell Warren has been AVAC’s executive director since 2004. He previously led Vaccine Preparedness at IAVI; directed international programs at Female Health Company; and directed PSI in South Africa and Europe. Member of PEPFAR Scientific Advisory Board and International AIDS Society Governing Council and president of the TB Alliance Stakeholder Association.

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