Sink, Swim, Go Down with the Ship: The Global HIV/AIDS Response and the Changing World Order

Whither the global HIV/AIDS response? Over the past 25 years the notion of a unified and globally funded fight against HIV/AIDS had reached near political consensus. This normative status had come with major caveats, including the recurrent sidelining of the most vulnerable populations (men who have sex with men, injected drug users, sex workers, trans women, and prisoners) in international treaties in order to maximize uptake and support from states with widely varying political contexts and foreign policy agendas. In addition, the global HIV/AIDS response is a direct product of the dynamics of the early 2000s and has long been criticized as deeply intertwined with asymmetric North-South relations. However, even those calling for its reform as part of a reimagining of the paradigm of development had not envisioned the brutal attacks it has faced since the second inauguration of US President Donald Trump. The dismantling of USAID has endangered 70% of global funding, and Washington’s clear move away from multilateralism and return to bilateral agreements, in some cases followed by other leading actors in the field, is posing an existential threat to the current model. This paper therefore examines the likely future of the global response at this critical moment: can it survive the apparent crumbling of the post-World War II international structure in which it had become so enmeshed? Is this an opportunity to reshape and rebalance the global approach while preserving the progress made, or will most of it be undone? I argue that much will depend on the political leadership of the key actors that have supported the global response to date: the US Congress, which allocates funding and in the past managed to circumscribe hostile administrations, major donors such as the members of the G7/8, especially France and the United Kingdom who have historically played a central role, and the European Commission. By examining their public declarations, global health strategies, and foreign aid patterns in 2025-2026 and placing them within a larger historical trajectory traced through deep study of the secondary literature as well as two years of archival research and interviews, this paper will outline the current standing of the political principle governing the global response and provide insights regarding its likely future. This is a significant endeavour on two counts. First, according to UNAIDS there are around 40 million people living with the disease in the world, 23% of which do not have access to treatment. Understanding what may come of the global response is crucial if we hope to keep the progress made and ensure that prevention and treatment are made available to all of those who need it. Second, because it had reached that normative status the global response is a bellwether for other international norms and global initiatives. Better understanding how leading European actors will respond to the Trump administration’s brutal reshaping of US policy helps us outline what may happen to other sectors of global governance, and thus tease out the key aspects of the coming international landscape.