I was working on HIV in India in 1996 when ground-breaking news came out of the Vancouver International AIDS Conference: AIDS would no longer have to be a death sentence, thanks to the discovery of highly effective combination antiretroviral therapy.

I remember the sudden, overwhelming hope of that moment. And then frustration and anger as the treatment, which cost back then some US$10,000 per patient a year, only became available in wealthy countries. While people in Australia, the United States, Canada and western Europe began living longer almost immediately, millions in low- and middle-income countries waited years for the same medicines. Access was determined by profits and politics. In the decade that followed, millions of people died from a disease that was already treatable. 

Nearly 30 years later, the world faces another ‘Vancouver’ moment. The question facing governments in 2026 is whether the deadly health inequities that defined the post-1996 years will be allowed to define this one too. 

This month, governments will gather at the United Nations to negotiate a new Political Declaration on HIV and AIDS. What they agree will shape how the response is funded, designed and delivered for years to come.

A new drug called lenacapavir, a twice-yearly delivered as an injection, reduced HIV by 96 percent in clinical trials. For a mother who cannot safely store daily medication at home, for a young person who faces judgement every time he walks into a clinic, for a gay man whose only option is a service where healthcare workers stigmatize or deny service, that figure represents something profound. Yet this medicine currently remains inaccessible to nearly all of them. 

The backdrop to this moment is not a disease in retreat. HIV remains a serious public health threat. In 2024, 1.3 million people acquired the virus and 630,000 died from AIDS-related illnesses. UNAIDS has warned that the severe funding contraction could drive daily new infections from 3,500 to 5,800, adding 6.6 million infections between now and 2029. The epidemic continues to grow wherever stigma, discrimination, criminalization and underfunded health and community systems keep people from care. 

The UN meeting and its ensuing declaration matter more than ever. With courage and political commitment in the form of bold goals and targets, it drives funding and shapes national policy in ways that reach real people.

UNAIDS has called for 80 percent of at-risk people to be reached with antiretroviral-based HIV prevention like lenacapavir by 2030. Achieving that will require that governments commit in the Political Declaration to a similarly ambitious target. They must also enable affordable supply, sustainable financing, community-led delivery and legal environments where people can seek services without fear. 

Medicines alone are not enough. In Malawi, Sunati Wayiti, a young mother supported through a MANERELA+ community-led HIV programme, described how stigma once pushed women living with HIV away from community life and made it harder to stay connected to care. Through this programme, mentor mothers worked with health workers, educators and local leaders to help women to understand their health, take medication as directed and rebuild trust in their communities.

Sunati's experience shows how the HIV response has always worked best: through community-led systems that reach people on their own terms. This includes groups and networks led by or supporting adolescent girls and young women, gay and bisexual men, sex workers, people who inject drugs, transgender people and people in prisons. Such systems are best positioned to support the roll-out of lenacapavir and other long-lasting prevention tools.  

People living with and affected by HIV are already mobilizing for lenacapavir’s rollout. An outreach worker for the Zimbabwe Civil Liberties and Drug Network, which links people who use injection drugs to health services, recently told me that the supply of lenacapavir on the ground was not keeping up with the demand. 

The 2026 Political Declaration must match the urgency of this moment. The world has the tools, and the financing capacity to end AIDS as a public health threat. Communities continue to lead. What governments choose to do with the 2026 declaration will reveal whether they also have the courage, humanity and political will.

In 1996, a breakthrough arrived, but for millions of people, access took a decade longer. Now, 30 years later, there is the chance to write a different story, one of hope where science and access arrive together, and millions of lives are saved as a result.

This article was originally published in Le Monde.