I approach World AIDS Day in 2025 with an ache that feels older than my body, as if my bones remember the faces, the laughter, and the final breaths of those taken long before their time. This year’s theme, “Rethink, Rebuild, Rise,” lands in my chest with a weight that feels both familiar and unwelcome. I know what it means to live through eras when the response to HIV required courage that institutions refused to display. I know the sound of grief settling into a room after another funeral. I know the silence that followed the loss of yet another friend who deserved a lifetime. If I close my eyes, I can still see their smiles, their energy, their fire, and their fear. I am HIV negative, but the disease carved out space in my life through the people it took from me. The epidemic shaped my identity, my advocacy, my sense of responsibility, and my belief in community. This year’s theme demands more than reflection. It demands honesty. This moment calls for a reckoning with what has been lost and what has been neglected by political leaders who refuse to treat this fight as the urgent public health matter it is.
The HIV response has always depended on a strange blend of heartbreak and defiance. Activists, artists, caregivers, researchers, and everyday people saved one another while governments ignored medical evidence, moral responsibility, and basic human dignity. Today, the landscape of HIV work faces shifting geopolitics, renewed stigma, and funding threats that echo the very failures that cost lives in earlier decades. The political environment in the United States, especially over the past several years, reflects an erosion of commitment to science and a disturbing willingness to undermine essential programs. As I write this, the federal government continues to roll back investments in public health infrastructure while promoting rhetoric that dismisses the lived realities of LGBTQIA+ communities, people who use drugs, Black and Brown communities, and immigrants. These communities remain at the center of the epidemic in the United States, yet they continue to face disparities that could have been addressed with political courage.
Rethinking the response is not an academic exercise. It is a plea for survival. It is a demand that we refuse to repeat the failures of the past. We must question policies that trade public health outcomes for political points. We must challenge leaders who downplay the seriousness of a disease that has taken millions of lives around the world. We must confront the decisions that weaken global partnerships, threaten PEPFAR’s stability, and reduce access to medication and prevention tools. Every time a political figure chooses ideology over science, people suffer. I have watched this pattern for decades, and every year it returns in a new form.
In Iowa, I have seen hope grow through the dedication of organizations like The Project, ICARE, and other community-based programs that continue to provide care even when federal action falters. Iowa’s own history with HIV criminalization laws, once among the harshest in the country, shows that change is possible when advocates refuse to accept harmful policies as permanent. Community members, legal experts, and people living with HIV worked together to build a better framework. That success reflects what happens when we rethink, rebuild, and rise through persistence rather than resignation. At the same time, Iowa has felt the consequences of budget cuts, political hostility toward LGBTQIA+ health, and the ongoing struggle to secure stable funding for prevention and treatment services. The gap between community commitment and government commitment creates a burden that frontline workers and people living with HIV should not have to carry.
Rebuilding momentum is not optional. It is urgent. Across the country, HIV testing rates dropped during the pandemic and never fully recovered. Many community clinics are fighting for survival as federal and state health budgets shrink. When politicians defund public health systems, they weaken far more than HIV programs. They weaken the infrastructure that supports hepatitis testing, STI treatment, access to PrEP and PEP, harm reduction programs, mental health services, and community health navigation. Political leaders have repeatedly chosen to weaken these systems, often while claiming that fiscal responsibility justifies the harm. The truth is simpler and far less noble. Funding public health is not politically convenient, and some leaders believe that communities most impacted by HIV are expendable.
Some states pursue policies that silence, censor, or erase HIV education by restricting what schools can teach about LGBTQIA+ identities, sexual health, or harm reduction. These decisions ignore decades of evidence showing that shame, silence, and disinformation fuel infection rates. The HIV response rises only when scientific freedom is protected, when evidence-based strategies are funded, and when people who live with HIV are invited into decision-making spaces. I have lived through cycles where science was dismissed as inconvenient, and I know exactly who pays the price. People pay with their lives.
Rising above misinformation and political cruelty is a collective task, and it begins with the stories we carry. I cannot talk about rising without thinking about the men and women I loved who never had the chance. They were young, brilliant, hilarious, stubborn, scared, bold, and human. I remember sitting at bedsides. I remember watching breath fade into stillness. I remember the rage that filled my throat because the world seemed comfortable letting certain people die unnoticed. The grief did not end when they passed. It settled into my bloodstream and became part of my identity, shaping how I approach this work.
Every time I speak about HIV, I speak for the ones who should still be here. They deserved more years, more joy, more mornings with sunlight through their windows, more celebrations, and more dreams. They deserved a government that valued their survival. They deserved communities free from judgment. They deserved medical systems that did not ignore their pain. Their memory pushes me to demand that we rethink what leadership looks like. Leadership requires empathy, courage, and action, not political theater that treats human lives as bargaining chips.
As I consider the global picture, I see gains threatened by instability. International funding streams that once moved with urgency have slowed. Global partnerships designed to reach communities with limited infrastructure face political obstacles. Some leaders question whether programs like PEPFAR should continue, even with irrefutable evidence that these initiatives have prevented millions of infections. When lawmakers toy with funding for global HIV efforts, they play with the futures of children, parents, entire regions, and the medical gains that took decades to build. The choice to weaken global health funding is not a budget decision. It is a moral failure.
Yet even with these challenges, I continue to witness resilience. Community health workers, especially in under-resourced areas, do astonishing work with limited supplies. Researchers develop innovative treatments and prevention tools. Activists and educators push back against stigma, disinformation, and political pressure. People who live with HIV continue to lead the fight with a strength that inspires me. The heart of the HIV response has always been the people who wake up every day and refuse to give up.
Rethinking the future means acknowledging that resilience alone is not enough. Courage must be matched by investment. Innovation must be paired with political will. Collaboration must be funded, not merely praised. We need policies that protect scientific freedom, defend the rights of LGBTQIA+ people, expand harm reduction programs, and support nationwide access to testing, PrEP, PEP, and antiretroviral therapy. We need leaders who see public health as an ethical duty, not a partisan inconvenience.
Rebuilding momentum requires that we restore trust. Communities harmed by stigma and neglect deserve assurance that the systems failing them will be repaired. Rebuilding requires financial commitments that match the scale of the problem. It requires stable funding for local programs like The Project, whose work in Iowa reflects what community-centered health looks like when compassion and skill align. The Project has sustained services since 1986 with a focus on dignity, justice, and comprehensive care. Their resilience mirrors the broader movement’s resilience, but community organizations should not have to perform miracles to keep people alive.
Rising is the final demand of this year’s theme, and it is the demand that resonates most deeply with me. Rising does not mean leaving grief behind. Rising means carrying the losses and allowing them to fuel determination. Rising means honoring loved ones not only with memories, but with action. Rising means refusing to allow political actors to dismantle decades of work.
There is one more truth I need to name directly. The current political environment is hostile to queer lives, hostile to public health science, and hostile to human rights. Leaders in multiple states have pushed policies that make LGBTQIA+ youth unsafe, weaken HIV education, and reduce access to care. Some federal leaders have questioned the value of global HIV programs. Decisions like these place lives at risk. I am tired of watching elected officials treat public health as an afterthought. I am tired of watching LGBTQIA+ communities treated as disposable. This year’s theme is a reminder that our survival has never depended solely on institutions. It has always depended on each other.
I remember the early days of HIV work in Iowa, meeting people who survived periods when the state lacked both knowledge and compassion. I remember attending my first Red Ribbon Ball and feeling the depth of community commitment as people came together to support The Project. Those moments taught me that communities can rise even when politics fail. They taught me that the HIV response advances only when compassion outweighs fear.
This year, I feel the theme pushing me to speak more directly than I usually do. I feel anger at the cuts to essential programs. I feel grief when I consider how many lives would have been saved if leaders had listened sooner. I feel gratitude for the people who continue to fight. I feel urgency to keep speaking because silence has never saved us.
Rethinking requires truth telling. Rebuilding requires investment. Rising requires courage. World AIDS Day is not symbolic for me. It is personal. It is the day I sit with the faces of friends who never grew old. It is the day I remind myself that grief and love can coexist. It is the day I push myself to honor their memory by continuing the work.
The path forward demands action from every one of us. Testing saves lives. Treatment saves lives. PrEP and PEP save lives. Harm reduction saves lives. Community care saves lives. Advocacy saves lives. Political accountability saves lives.
And so I end this year’s reflection with a call that comes not from strategy, but from the rawest part of my heart.
Get tested. Know your status. Encourage those you care about to do the same. Support the organizations doing the work, whether through donations, volunteering, or amplifying their messages. Contact your elected officials and demand that they fund HIV programs, protect LGBTQIA+ rights, defend scientific freedom, and invest in prevention. Reject stigma wherever it appears, because stigma has always been the true accelerant of this epidemic. Stand with those who live with HIV, honor those we have lost, and commit to the future we deserve.
Rethink. Rebuild. Rise. We do it together, or we do not do it at all.
