The view from Geneva 2026
Too many crises at this year's World Health Assembly
It was easy to get distracted at this year’s World Health Assembly. Even as leaders gathered in Geneva to discuss global health architecture and other high-level issues, they were called to address the Ebola outbreak in East Africa or how the Strait of Hormuz blockade is exacerbating humanitarian catastrophes.
In that mix of crisis and unpredictability, the global HIV response didn’t much feature at this year’s gathering. When it came up, it was often with a sense of relief that the emergency that was predicted when President Trump started slashing U.S. support to global HIV programs had not materialized. That things weren’t as bad as had been feared.
Dr. K.J. Seung offered a corrective at one of the few side events dedicated to the epidemic. He described a “psychological denial of what is going on. For HIV, it is going to be a massive problem and it hasn’t completely happened, yet.”
We’re just starting to see the implications.
For nearly a year, the Trump administration withheld data about the President’s Emergency Plan for AIDS Relief – the flagship U.S. HIV program. When officials finally released a tranche of data earlier this year, it revealed that the number of people PEPFAR has tested for and diagnosed with HIV has fallen off a cliff. The longer those people stay outside of care, the higher the risk they’ll transmit the virus.
At the same time, the number of people receiving prevention services through PEPFAR dropped from 659,000 in the fourth quarter of 2024 to 388,000 in the same quarter last year.
As Seung points out, the situation appears set to get even worse. The Trump administration is withholding funds from the U.S. Centers for Disease Control and Prevention, which was one of the primary implementers of PEFPAR programs.
Seung and others have described this as a “functional end” to PEPFAR, even if the program lives on in name.
That worse has not come to pass despite the dismantling of PEPFAR is a credit to the efforts of community-based organizations, says Camille Spire. The head of the French HIV organization AIDES, she spoke alongside Seung. She highlighted partner organizations that continue to provide services despite facing their own funding cuts or are lobbying governments for care even as politicians villify some of the communities most in need of support – including sex workers and gay men.
After more than a year of trying to keep services afloat, Spire says she is not sure how much longer these groups can keep going.
“There is a finance crisis and the attacks on civil society,” she says. “People are fighting for their rights.”
Her message: Act now to shore up what remains of the response or risk a bigger emergency in the future. One that could swamp some of the crises at this year’s WHA.
At last year’s WHA, there was an attempt to position the nascent crisis in the HIV response as an opportunity. To increase domestic spending on HIV. To integrate programs. To accelerate breakthrough prevention methods that could help reduce the pressure on HIV services.
That framing did persist on the margins of this year’s WHA, though somewhat tempered by the reality of the past year. Government budgets are stretched and geopolitics – especially the ongoing closure of the Strait of Hormuz – are only straining them further. Program integration is going to take time. And to actually be gamechanging, someone will have to pay for these prevention methods to reach everyone who would benefit from them.
Community leaders and civil society groups did call a session at World Health Organization’s headquarters to highlight integration efforts that are working without alienating marginalized groups. But it’s not clear how many decisionmakers were listening to them.
There were too many other emergencies.