In a single year, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. (RFK Jr.), made such extensive damage to the extraordinarily successful HIV prevention program that leaves the country almost defenseless against an emerging HIV pandemic, just as elimination seemed possible.
These unprecedented actions have astonished and alarmed many who work in the field. But I know from past personal experience that strong science promoted by strong advocacy can lead us back to the path of HIV elimination.
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Gay men were the primary risk group. The number diagnosed with AIDS was exploding exponentiallyand all died slow, lingering, excruciating deaths. Patients were blinded and emaciated, vomited and suffocated and covered in sores, often abandoned by neighbours, family and friends because of the fear of infection.
Stonewall had come and gone, Harvey Milk had been murdered, and now fundamentalist preachers thundered from the pulpit that AIDS was God’s righteous vengeance on sinners.
Then there was the soft speech, low expenses, laissez-faire approach, with the implication that AIDS was nature’s way of removing undesirables.
Right after my time in the AIDS ward, the cause of AIDS was identified: human immunodeficiency virus (HIV).
For more than 28 years, Charles LeBaron worked as a medical epidemiologist at the Centers for Disease Control and Prevention (CDC).
Backed by science, AIDS activists refused to accept that HIV was an inevitable death sentence and launched a hard-hitting campaign demanding research into treatments. Over the years, there was a spread of the alphabet soup anti-HIV medicationswhich ultimately ensured that most of the infected could live almost normal lifespan.
Success produced a paradox: Increased years of potential infectiousness meant an expanding epidemic. In 2010, I worked for the CDC on HIV prevention in Kenya, with a small role in an ongoing giant multinational study investigating whether it was possible to use anti-HIV treatment to stop HIV transmission. In a meeting room at the local public hospital, I spoke to a group of health workers who were to carry out this study and others.
Almost all were women. They were paid the standard princely salary of around 300 dollars a month. They were our study workers because they came from the most vulnerable society. One in four women in their age group was HIV infected. Access to anti-HIV drugs was fiscally and logistically limited. Only a third of those who needed treatment actually received it. That meant that an unknown number of the women I spoke to would eventually die the same death as those in the San Francisco AIDS ward. But they went out to the villages and did the hard work of enrolling subjects and bringing the data home.
Because of these women and others around the world, 2016 was the result scientific publication became one of them most cited and influential studies in medicine. For the first time, it showed that HIV transmission was not inevitable. It can be stopped cold through anti-HIV treatment. Zero transfer — IF appropriate treatment is received.
Fast forward a decade, and RFK Jr., is one HIV skepticsuggesting that a conspiracy of individuals with personal ambitions had diverted attention away from other potential causes of AIDS, such as a “toxin”. He has also claimed, without evidence, that anti-HIV drugs were based on “false, crooked“studies that killed people.
The new cases will infect others. Inevitably, HIV will escape from the at-risk groups to create a generalized pandemic in the United States
In 2025, five of the 11 branches of the CDC’s Division of HIV Prevention was abolished and the staff laid off. All CDC HIV websites were removed. After being restored by court order, website about treatment now includes the heading “This page does not reflect biological reality and therefore the administration and this department reject it.” A similar headline appeared on HIV Prevalence Pagebut some brave CDC soul managed to intervene an explanation of why the data was frozen in 2023: “the branches that produced HIV incidence estimates… were eliminated.” RFK Jr. canceled $759 million in HIV research grantsand suggested that responsibility for HIV is transferred from the CDC and all other agencies to a new administration for a healthy America under his direct control, with a funding reduction of 80%. Pending the reorganization, half a billion dollars in budget cuts from HIV treatment was presented to Congress.
All this came at a moment when the tools to end the HIV epidemic seemed to be in our hands. New cases had been cut by more than 90%, and transmission from mother to child had been completely eliminated.
Now, instead of having the resources to complete the job, states are implementing or considering a variety expenditure-reducing measures: waiting lists for treatment, reduced form options, work requirements, low income requirements, end of reimbursement for the laboratory tests needed to know if the drugs worked.
Similar cutbacks are happening globally, such as The US withdrew aid from international HIV prevention. With our domestic defenses removed and an increased threat of foreign exposure, virus spread will obviously accelerate and infect far more than currently 1 in 300 Americans. The new cases will infect others. Inevitably, HIV will escape from the at-risk groups to create a generalized pandemic in the United States
1983 redux?
Thanks to nearly 50 years of hard work by AIDS activists in San Francisco, village health workers in Kenya, laboratories around the world, along with so many others, the choices now seem clear: With appropriate treatment, we can stop the HIV epidemic before it becomes a pandemic, allow those infected to live close to normal lives, and provide good cost savings for society. Or, with a lack of treatment, we can have uncontrolled infection, a spreading epidemic that becomes a pandemic, distressing deaths for individuals and huge costs for society.
In this election, perhaps the term “1983” should have the same resonance for health that George Orwell once gave the term “1984” for politics. For HIV, do we really want to go back to the hopelessness of 1983? Or do we defy inevitability, use strong advocacy backed by strong science to rebuild our defenses, stop the HIV resurgence before it starts, and stop the epidemic before it becomes a pandemic?
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