Epidemics of Significance and Global Health Politics: From the End of AIDS to the End of Scaling Up the Global AIDS Response

Over the last four and a half decades, the history of the HIV pandemic has gone through several phases that can be thought of as distinct waves in terms of the social and political response that the pandemic has generated. Throughout this history, there have been important battles over the meanings and interpretations that the response to the pandemic has produced. But, especially in the last decade, there seems to be a growing disconnect between the claims of success made by many global health agencies and policymakers and the empirical reality that these claims mask. This commentary argues that the 'scale-up' of the response to the pandemic has essentially come to an end and emphasizes the importance of a more honest political debate about the current state of the global response to HIV. It argues that in order to better define the directions this response should take in the future, it requires us to think critically about the ways in which this response has developed historically, to recognize the significant advances made in recent decades, but also to acknowledge the crossroads it has reached in the mid-2020s.