From Then to Now: A Call to Remember, a Call to ACT

The photo above was taken in 2003—before PEPFAR, before the massive global delivery of life-saving HIV medications to sub-Saharan Africa. At the time, I was part of a team connected through the University of Alabama at Birmingham Center for AIDS Research. In Lusaka, Zambia, we joined efforts studying HIV-discordant married couples—one partner living with HIV, the other not. This deeply human and scientific work aimed to understand how to prevent new infections in developing nations, and it was part of the groundwork that would soon transform the world.

Shortly after, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was launched, reshaping global health as we knew it. What began as a localized, academic, and community-led effort evolved into a multibillion-dollar global health strategy. It changed everything. Millions of lives—millions—have been saved through the consistent delivery of antiretroviral medications, health system strengthening, and human rights-centered public health policy.

As I look at that photo now, 22 years later, the contrast is stark. While the past was marked by urgency and global solidarity, today we face a troubling regression. The current Administration’s “America First” approach is rapidly hardening into “America Only”—leaving vulnerable populations behind, defunding global initiatives, and, in effect, sentencing countless people to death. Innocent lives are being lost—not by lack of knowledge or means, but by political choice.

But advocacy works. It always has. And the wisdom was never solely in the science—it was in the communities. Back in 2003, we held a conference in Lusaka. Several hundred people attended—many walking for days to be there. Our team, made up of Philip, Gina, Lynne, Priscilla, Christine, Maria, and me, didn’t come to teach—we came to make space. We handed over the microphone, listened, and helped organize what became community-led action toward readiness for PEPFAR’s eventual arrival. That work didn’t just support the rollout of treatment—it changed the trajectory of entire regions.

The debrief from that conference—attached here—is still staggering in its clarity. Today, as global progress is being systematically undone, I find myself returning to that decades-old document, not out of nostalgia, but necessity. Because the work of the past is now the work of the present.

According to the World Health Organization, global HIV infections have declined by over 50% since their peak in 1997. AIDS-related deaths are down by 69% since 2004. HIV is no longer a life sentence—it’s a manageable condition, thanks to the relentless advocacy, science, and humanity of tens of thousands of people. But this progress is fragile.

In honor of two of our colleagues, Lynne M. Cooper and Gina Quattrocchi—both of whom have passed—I share this post not in mourning, but in action. They carried the spirit of purpose, compassion, and fierce determination. That same spirit is needed now more than ever.

If we use our privilege not to speak over others, but to make space—true space—for the voices of people to be heard, felt, and uplifted, then progress can continue. Humanity can be restored.

Now is not the time for hand-wringing. Now is the time to deliver.