Shifting priorities: U.S. health policy and the fragile future of global HIV/AIDS efforts.

ObjectiveThis narrative review examines the impact of the United States on the war against HIV/AIDS and thus the impact of political ideologies on the financing of the medical sector.DiscussionInitially marked by stigma, particularly in the early years of the epidemic, the US response was transformed with the launch of the Presidential Emergency Plan for AIDS Relief (PEPFAR) in 2003. PEPFAR has partnered with entities such as the Global Fund and the Joint United Nations Programme on HIV/AIDS (UNAIDS), retranslating global health governance. Despite this success, the global response remains dependent on the support of the United States. Political changes under the leadership of the conservatives have limited funding. Therefore, political polarization in the US is undermining long-term progress on HIV/AIDS prevention and treatment, particularly in low- and middle-income countries.ConclusionBy tracing historical developments and analysing current funding trends, the article highlights the urgent need for sustainable and depoliticized investments in global health systems. Without renewed bipartisan commitment and greater local ownership, the vision of eliminating AIDS as a public health threat by 2030 is seriously threatened.