Peter Staley’s talk at the opening session of the Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver was a grim post-mortem of one of the most challenging years in recent HIV history – an ‘annus horribilis’ – a phrase Queen Elizabeth II used to describe 1992 and The Lancet applied to 2025.
Staley is a co-founder and president of the board of PrEP4All. He is most famously associated with the activism of ACT UP and was one of the founders of the Treatment Action Group (TAG). Staley was diagnosed with AIDS-related complex in 1985, while working as a bond trader on Wall Street.
Staley noted that there wasn’t always a strong focus on community involvement in HIV science. In the early days, scientists were “freaked out” by the activists’ anger and demands. However, a symbiotic relationship slowly developed between scientists and activists.
“We learned from you [the HIV medical experts] and adjusted our demands accordingly,” he said. “You learned from us and adjusted clinical trials and access programmes. We became more like you – science became our shared religion. And some of you became more like us, joining us in coalitions, working towards various goals.”
But 2025 would test that hard-won alliance more severely than anything in decades.
Trump’s “war on science”
“We all knew Trump’s second term would be worse than his first,” Staley said. “But few of us were prepared for the level of destruction – and the speed of it – that started immediately after his inauguration.”
He described Dr Anthony Fauci, a former director of the National Institute for Allergy and Infectious Diseases (NIAID) and famous “bridge builder” between scientists, government officials and community members, calling him in January 2025: “Have you heard anything about PEPFAR shutting down?” Fauci asked. “No, that can’t be right,” Staley answered in utter disbelief.
Soon the worst fears of scientists and community members were realised: the dismantling of USAID, PEPFAR funding placed on hold, multiple National Institutes of Health (NIH) grants cancelled, the spread of misinformation and hatred towards transgender communities, and the Senate’s approval of AIDS denialist and anti-vaxxer, Robert F. Kennedy Jr. as Secretary of Health.
“USAID is a criminal organization,” Elon Musk posted on X. “Time for it to die.” Musk’s Department of Government Efficiency (DOGE) eviscerated the $10 billion dollar budget that provided some of the world’s poorest with HIV interventions while Musk’s personal wealth grew by $300 billion in 2025.
When PEPFAR funding was placed on hold, partner organisations received stop work orders, immediately halting HIV prevention and treatment services. Staley recalled the night sweats he had when his body fought against uncontrolled HIV before effective HIV treatment was available and imagined the same now happening to people across Africa – “suddenly robbed of the hopeful futures they were looking forward to, just weeks earlier.”
US science has not been spared
The upheaval was not just felt outside of the US. In February 2025, DOGE dismissed thousands of civil servants from healthcare agencies – the largest cut to the US government workforce in history. The NIH workforce was reduced by 18% in 2025.
“These cuts had nothing to do with cost-cutting; they were political: targeting women and people of colour in leadership roles, including the institute directors, and any job tinged with concern about health equity,” Staley said.
Dr Jeanne Marazzo, Fauci’s successor at NIAID, was ousted, her career-long focus on health equity in underserved communities apparently counting against her. Marazzo has recently been named chief executive officer of the Infectious Diseases Society of America (IDSA).
Regarding how the research community has responded to the war on science, Staley said that “the grades are mixed”. He was particularly critical of the decision by some researchers to scrub their grant applications of words such as ‘diversity’ and ‘equity’, after one of Trump’s executive orders targeted diversity, equity and inclusion (DEI) programmes. The order triggered the cancellation of $780 million in NIH grants, many of them focused on health equity and the social determinants of health. “One can appreciate the harm reduction nature of this approach, but it looked like acquiescence,” Staley said.
However, there has been resistance. The American Public Health Association (APHA) took the NIH to court over the cancelled grants, and despite losing at the Supreme Court, many grants have been reinstated and others are being re-reviewed. Almost 500 NIH employees have signed the Bethesda Declaration, committing to academic freedom and the use of evidence-based health policy. Several prominent officials have resigned. “This kind of standing up has been one of our community’s finest hours,” Staley said.
He argued that activism is thriving: the resistance to RFK Jr.’s vaccine policies reminded him of ACT UP’s early days. Activist groups such as Stand Up for Science, Defend Public Health and the Science and Freedom Alliance have been organising and mobilising.
However, other scientists believe they can remain apolitical and wait this out on the sidelines. “The old, entrenched view – holding that scientists should avoid politics – and the newer view – that they should just keep their heads down until this is all over – are both sadly prevalent.”
The pendulum will eventually swing back
Staley highlighted the small victories that resistance has achieved in recent months. There’s been bipartisan pushback on funding cuts to science in the US, and the NIH and NIAID have received increased funding as a result. “PEPFAR, while battered and bruised, is still standing.”
More broadly, he highlighted the exceptional organising of cities such as Minneapolis in response to Immigration and Customs Enforcement (ICE) violence and the growth of movements such as the No Kings marches around the country.
“If each of us takes even the smallest step towards defending science, we’ll add to the current momentum.” He emphasised the need for both large-scale, dramatic activism akin to ACT UP’s early days, and quieter, everyday forms of activism – especially by those still employed in the public health workforce. As a first step, people can sign up for updates from groups such as Stand Up for Science: being well informed by reliable sources is its own form of activism in these times.
Activists should demand that Democrat presidential candidates for 2028 commit to resurrecting USAID and rebuilding PEPFAR.
Staley ended by comparing the current moment to one of the bleakest periods in HIV history: the 1993 Berlin conference that presented yet another unsuccessful HIV medication trial. But only three years later, the HIV response was revolutionised by new scientific findings of the effectiveness of combination antiretroviral therapy. These medications would go on to save millions of lives, Staley’s among them.
“I have to believe that the pendulum that has been swinging against us this past year will – if we fight for it – eventually swing back.”
He ended on a rousing note, to a standing ovation from a room full of HIV scientists, medical professionals, community members and journalists – whom he reminded to take care of themselves, as they prepare for what’s to come: “Let’s start strategising for the fight ahead. ACT UP.”
