The American and Russian delegations at the United Nations, along with six others, recently voted against the new Political Declaration on AIDS . The United States complained about the inclusion of "divisive" political topics "not related to the fight against AIDS."
Russia opposed the previous Political Declaration in 2021 on similar grounds , but this represented a seismic change in the American approach to the issue.
As a political scientist studying the diplomacy of HIV/AIDS, I am not surprised by the U.S. but it does alarm me. Even as it reduced foreign assistance and dismantled USAID , the U.S. had maintained a veneer of support for the global AIDS response.
Breaking consensus on the AIDS declaration clearly signals that American political priorities now completely override their participation. This decision can only further politicize debates around the HIV-AIDS response and weaken its reach.
An ongoing battle
Organizing a global response to the epidemic of HIV/AIDS has been a complex endeavour. When the disease was first detected in the 1980s, it was immediately associated with certain groups , like gay men and intravenous drug users. Their marginalization made it a politically controversial disease to tackle.
Activists succeeded in raising the profile of HIV/AIDS in the 1990s, but it often required focusing on more "palatable" victims, such as children . By the early 2000s, the world was paying attention, and international organizations like the Global Fund and the Joint United Nations Programme on HIV/AIDS (UNAIDS) had been created to co-ordinate efforts. Billions in funding were allocated by countries around the world to face the threat.
Nevertheless, many obstacles remain, including the politics of naming vulnerable groups. Russia's position stems from its long-standing promotion of a moral conservative agenda , which views human rights as secondary to traditional cultural and religious values .
Its opposition to the declaration's rights-based language and policies - specifically those targeting populations termed key by UNAIDS (including men who have sex with men, sex workers, people who inject drugs, transgender individuals and prisoners) - must be viewed through this ideological lens.
This development pulls the global AIDS response directly into international culture wars - a dynamic that has unfortunately become standard in these debates.
New hurdles
The U.S. stance worsens this situation, coming at a time of crisis for the international response to HIV-AIDS. Global funding has decreased since 2025. Major historical donors like France have cut their contributions.
The U.S. used to provide 70 per cent of global funding through the President's Emergency Program for AIDS Relief, known as PEPFAR, but the funds were channelled through USAID and have been strongly affected by its dismantling .
The current situation is the biggest challenge in decades, with key populations often on the front lines of battling HIV/AIDS now in jeopardy.
Amid all of this, the U.S. vote at the UN might appear comparatively trivial. But, in fact, it marks a significant shift in American priorities in the global fight against HIV/AIDS, which have evolved significantly since the early 2000s.
Republican administrations have enacted conservative policies , including the "global gag rule," which substantially curtailed the support provided to key populations in the fight against HIV-AIDS. Recent Democratic administrations have tended to put the focus back on those communities to align with their overall agenda.
Despite these shifts in priorities, successive American administrations always maintained their support to the overall response. Even in 2019, when Trump was threatening to eliminate it, U.S. Congress maintained the American contribution to the Global Fund . The country has supported every political declaration at the UN until last month .
The U.S. political agenda
The U.S. delegate to the UN said the country could not support the 2026 declaration because of trade and intellectual property (IP) rights issues, comments on sanctions and the inclusion of divisive social issues .
IP has always been a sore spot for the U.S. It was one of the fiercest opponents of the access-to-treatment movement because of the IP rights of pharmaceutical companies and was only convinced to drop its opposition in the face of intense public pressure.
This issue has likely gained prominence recently due to the ongoing pandemic treaty negotiations and U.S. concerns that a new precedent could weaken IP protections. Furthermore, the Trump administration's focus on divisive social issues reflects its broader conservatism.
Taken together, these developments demonstrate that U.S. support for the global AIDS response as a whole - not just specific programs - is now entirely conditional on its political agenda. Not only is funding being diverted, but the U.S. is no longer expending political capital to ensure a common diplomatic standard is reached.
The risks
The current reorganization of the global HIV/AIDS response, which includes a shift to bilateral agreements and an emphasis on country control, is sometimes presented as an opportunity to address long-standing imbalances of power .
Those issues are undeniable. But the fragmentation of the global HIV/AIDS response, along with the absence of strongly supported global standards, will deprive key populations of an important tool in their arsenal to advocate for prevention and for the treatment programs they need.
If political agendas hijack these debates, the global HIV/AIDS response risks becoming a battleground with scant real-world impact. This outcome would devastate the 40 million people living with HIV/AIDS, especially the most marginalized, whose voices are already at risk of being silenced.
Yolaine Frossard de Saugy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
