In an era of uncertainty, a renewed call to activism

.AIDS 2026 | Rio de Janeiro.

As MPact Global, which advocates for the health and rights of gay and bisexual men affected by HIV around the world, observes its 20th anniversary, executive director Andrew Spieldenner, PhD, sees progress, but he also sees challenges.

“One of the big challenges is instability,” with loss of funds for the fight against HIV, he says.

Spieldenner attributes much of the funding loss as a consequence of the Trump administration. The U.S. Agency for International Development (USAID), dismantled last year by Elon Musk’s Department of Government Efficiency (DOGE), handled many foreign aid projects, including global HIV assistance. The administration has also placed restrictions on the President’s Emergency Plan for AIDS Relief (PEPFAR), founded under another Republican president, George W. Bush, in 2003 to provide HIV prevention and treatment primarily in poor countries.

Also concerning is the possibility that the Joint United Nations Programme on HIV/AIDS (UNAIDS) could shut down at the end of 2027 due to funding cuts, especially from the U.S. The UN has said the response to HIV/AIDS can be coordinated through other agencies, Spieldenner says, but UNAIDS started because those agencies weren’t doing enough. The most recent statement from UNAIDS says no decision has yet been made on ending the program, but it “must evolve” in the “changing financial and global health landscape.” UNAIDS and KFF, the public health news and policy organization, will release reports on the devastating cuts Monday, July 27, at the International AIDS Conference in Rio de Janeiro, Brazil. 

The U.S. isn’t the only country cutting HIV-related funding. Sweden, France, the UK and others are reducing it as well, Spieldenner says But U.S. actions have had “far-reaching impacts,” he says. 

USAID not only funded services but assured that they went to gay and bisexual men, transgender people, sex workers and other groups who face hostility from conservative governments around the world, he points out. If USAID still existed, he says, it would never have stood for the Trump administration’s restrictions of PrEP under PEPFAR—limiting it to cisgender women who are pregnant or breastfeeding, leaving most LGBTQ+ people out of the equation.

When PEPFAR funding was frozen early in Trump’s second term, many organizations were no longer able to pay their employees or the rent on their offices or clinics, resulting in cuts to staff and services. Now the money is flowing again, but PEPFAR can freely ignore LGBTQ+ people, sex workers and other marginalized people. 

What can—and should—Americans do about the situation? For one, recognize that foreign aid is part of global citizenship, he says, and get in touch with their legislators. “If people cared about [the HIV crisis overseas], legislators would pay attention to it,” he says, adding, “The idea that there’s no money for this is a fallacy.”

While people living with HIV know the virus hasn’t gone away, either in the U.S. or around the world, others may not recognize that fact. “We’re at a point now where people don’t have to die of HIV-related causes,” Spieldenner says, but even in the U.S., 10,000 die every year. “An individual can manage HIV, but the disease is not managed,” he observes.

Visibility is important, he says. Spieldenner is also a professor of health communication at California State University–San Marcos. “I tell my students at the beginning of every semester that I’m a person living with HIV,” he says. And while more people need to get involved in the fight, he’s seen that people who tell their stories of living with HIV have made a difference.

“We have to get our allies together,” he says. “We have to build coalitions with other groups, representing other health conditions.”

He adds that MPact is working to address the global funding crisis, such as urging philanthropists to make up for the money that governments have taken away. It is upping its social media use to raise awareness, he says, and it will have a large presence at the International AIDS Conference.

“We’ve done a lot to raise awareness of gay and bisexual men’s issues around the world—that’s a clear success,” he notes. “We were key in pushing PrEP in the PEPFAR portfolio.” HIV service groups around the world have found MPact to be a trusted partner, he adds.

MPact also works for the rights of people living with HIV, including the right to a sex life. Over the past few years, MPact has held popular “kiss-ins” at the U.S.-Mexico border for men living with HIV, as well as in Brazil. There will be a kiss-in during the AIDS 2026 conferencein Rio. Kiss-ins not only make the point that men living with HIV are still sexy and sexual, but they have inspired participants to become activists, Spieldenner says. “Suddenly they are doing protests; they are demanding mpox vaccines.”

“MPact works with partners in the most hostile contexts to look ahead and build a world where our lives and our rights are celebrated,” he concludes. “Something as simple as a kiss in public can change the story.”