I was at ground zero for the AIDS epidemic. RFK's cuts could fuel a new pandemic, just when elimination seemed within reach.

In a single year, the secretary of Health and Human Services (HHS), Robert F. Kennedy Jr. (RFK Jr.), has done such comprehensive damage to the extraordinarily successful HIV prevention program as to leave the country almost defenseless against a brewing HIV pandemic, right when elimination seemed possible.

These unprecedented actions have stunned and frightened many who work in the field. But I know from past personal experience that strong science promoted by strong advocacy can return us to the path of HIV elimination.

I saw the AIDS epidemic play out firsthand. In my final year of medical school in 1983, I did a month-long practice internship at the San Francisco General Hospital AIDS ward, the first in the country. The cause of acquired immunodeficiency syndrome (AIDS) was unknown. No test or treatment existed, and the modes of transmission were controversial.

Gay men were the primary risk group. The number diagnosed with AIDS was exploding exponentially, and everyone died slow, lingering, excruciating deaths. Patients were blinded and emaciated, vomiting and asphyxiating and covered with sores, often abandoned by neighbors, family and friends out of the terror of contagion.

Stonewall had come and gone, Harvey Milk had been assassinated, and now fundamentalist preachers thundered from the pulpit that AIDS was God's justified vengeance on sinners.

Then there was the soft-spoken, low-expenditure, laissez-faire approach, with the implication that AIDS was nature's way of culling out undesirables.

Soon after my time on the AIDS ward, the cause of AIDS was identified: human immunodeficiency virus (HIV).

Charles LeBaron

For more than 28 years, Charles LeBaron worked as a medical epidemiologist at the Centers for Disease Control and Prevention (CDC).

Supported by science, AIDS activists refused to accept that HIV was an inevitable death sentence and launched a hard-hitting campaign demanding research on treatments. Within years, there was a proliferating alphabet soup of anti-HIV medications, which ultimately ensured that most of those infected could live near-normal life spans.

Success produced a paradox: Increased years of potential infectivity meant an expanding epidemic. In 2010, I was working for the CDC on HIV prevention in Kenya, with a tiny role in an ongoing giant multi-national study examining whether it was possible to use anti-HIV treatment to stop HIV transmission. In a meeting room in the local public hospital, I was speaking to a group of health care workers who were going to carry out this study and others.

Almost all were women. They were being paid the standard princely salary of about $300 a month. They were our study workers because they came from the community most at risk. One-in-four women in their age group were HIV infected. Access to anti-HIV medication was fiscally and logistically limited. Only a third of those who needed treatment actually received it. That meant an unknown number of the women to whom I was speaking were ultimately going to die the same death as those in the San Francisco AIDS ward. But they went out to the villages and did the hard work to enroll study subjects and bring home the data.

Because of these women and others across the globe, the resulting 2016 scientific publication became one of the most cited and influential studies in medicine. For the first time, it demonstrated that HIV transmission was not inevitable. It could be stopped cold through anti-HIV treatment. Zero transmission — IF appropriate treatment is received.

Fast forward a decade, and RFK Jr., is an HIV skeptic, suggesting that a conspiracy of persons with personal ambitions had diverted attention away from other potential causes of AIDS, such as a "toxin." He's also claimed, without evidence, that anti-HIV medications were based on "phony, crooked" studies that killed people.

In 2025, five of the 11 branches of the CDC's Division of HIV Prevention were abolished and the employees laid off. All the CDC's HIV websites were taken down. After being restored by court order, the web page on treatment now contains the header, "This page does not reflect biological reality and therefore the Administration and this Department rejects it." A similar header appeared on the HIV prevalence page, but some brave CDC soul managed to insert an explanation why the data was frozen in 2023: "the branches that produced HIV incidence estimates... were eliminated." RFK Jr. cancelled $759 million in HIV research grants, and proposed that responsibility for HIV be transferred from the CDC and all other agencies to a new Administration for a Healthy America under his direct control, with a funding reduction of 80%. Pending that reorganization, a half-billion dollars in budget cuts from HIV treatment were put before Congress.

All this came at the moment when the tools to end the HIV epidemic seemed to be in our hands. New cases had been cut by more than 90%, and maternal-to-child transmission had been eliminated completely.

Now, instead of having resources to finish the job, states are implementing or considering a host of expenditure reduction measures: treatment waiting lists, reduced formulary options, work requirements, low income requirements, an end to reimbursement for the lab assays needed to know if the medications were working.

Similar cutbacks are happening globally, as the U.S. withdrew assistance from international HIV prevention. With our domestic defenses being stripped away and an increased threat of foreign exposures, viral spread will obviously accelerate to infect far more than the current 1-in-300 Americans. Those new cases will infect others. Inevitably, HIV will escape from its risk groups to create a generalized pandemic in the U.S.

1983 redux?

Thanks to almost 50 years of hard work by AIDS activists in San Francisco, village health workers in Kenya, laboratorians across the world, along with so many others, the choices now seem clear: With appropriate treatment, we can bring the HIV epidemic to a halt before it becomes a pandemic, allow the infected to live near normal lives, and provide great cost-savings for society. Or, with lack of treatment, we can have uncontrolled transmission, a spreading epidemic that becomes a pandemic, tormented deaths for individuals, and great costs for society.

In this choice, perhaps the term "1983" should take on the same resonance for health that George Orwell once gave the term "1984" for politics. For HIV, do we really want to return to the hopelessness of 1983? Or do we defy inevitability, use strong advocacy backed by strong science to restore our defenses, stop the HIV resurgence before it starts, and put an end to the epidemic before it becomes a pandemic?

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