The Conference on Retroviruses and Opportunistic Infections (CROI), a major annual HIV conference, opened in San Francisco Sunday, March 9, under a cloud of uncertainty in the face of the Trump administration's attacks on government health and science efforts.
While speakers at Sunday's opening session acknowledged the threat, they also offered words of encouragement and issued calls to action. The San Francisco Gay Men's Chorus added a note of inspiration with a song about being survivors of the worst years of the epidemic.
"We are facing a cataclysmic and cruel precipitous disruption of HIV services," said Dr. Diane Havlir, chief of the HIV, Infectious Diseases, and Global Medicine Division at Zuckerberg San Francisco General Hospital and Trauma Center. "We condemn the censoring of science, the targeting of scientists, their institutions, and the communities they serve, the withdrawal of funding for research, and the abrupt withdrawal of programs based on evidence-based advances that we have made in science for both [HIV] treatment and prevention."
The CROI Foundation and program committee concurred in a media statement.
"We recognize that this year's meeting is taking place in a time of tremendous apprehension and uncertainty as a result of recent actions by the U.S. government. We stand united with our colleagues and partners in this country and around the world as together we navigate these difficult times," it stated. "Indeed, in times like this, it is more crucial than ever for the scientific and advocacy communities to come together to support research and forge a path that enhances the lives of people around the world."
More than 3,700 participants, including 40% from outside the United States, are expected to attend CROI, which runs through Wednesday. Several presentations - especially those addressing the diversity of people living with HIV - were withdrawn from the program, but more than 90% of selected abstracts will be presented.
Havlir said the conference would allow virtual presentation for delegates from the Centers for Disease Control and Prevention, the National Institutes of Health, and other federal agencies who are unable to attend due to funding cuts and travel restrictions. This year's meeting is not expected to feature major breakthroughs, such as twice-yearly PrEP or doxyPEP, but many sessions will focus on implementation of recent advances and efforts to make them available to those who need them most worldwide.
Introducing CROI's Martin Delaney Presentation, long-time advocate Dawn Averitt paid homage to Delaney, the founder of Project Inform, who died of liver cancer in 2009. The San Francisco-based nonprofit closed in 2019.
"Marty was an ally," she said. "He was not HIV positive himself, and I think that's important right now, because this is a moment in time when we're realizing how critically important being an ally really is."
The annual lecture was given by Rebecca Denison, who was diagnosed with HIV days before the 1990 International AIDS Conference in San Francisco. Inspired by the week of protests surrounding the conference, she joined ACT UP and went on to found WORLD (Women Organized to Respond to Life-threatening Diseases), an education and support group for women with HIV, that initially operated out of her living room in Oakland.
"By the time I joined ACT UP, they had split into two groups. ACT UP/Golden Gate was focused on research, because without better drugs, we were all going to die. ACT UP/San Francisco focused on social justice, because even if better drugs were discovered, those who couldn't access them would still die," recalled Denison. "And you know what? They were both right."
Denison, who was a long-term non-progressor before the advent of effective combination antiretroviral therapy (ART) in the mid-1990s, decided to pursue her long-time dream of starting a family. She had twin girls, one of whom was at the talk days ahead of her 29th birthday, along with Denison's HIV-negative husband of 40 years.
"The HIV-positive people you interact with need to know that they can have - and deserve to have - healthy, long, loving relationships, and that their partners can remain HIV negative and that they can have families," Denison said.
She noted that "a lot has happened since my diagnosis 35 years ago. HIV has gone from a death sentence to what should be a chronic, manageable disease. Today, we have so many drugs that work, I can no longer name them all. But it's easy and dangerous to take all the progress for granted."
As for the Trump administration's moves to end funding for global AIDS programs and HIV service providers in the U.S., Denison warned they will lead to dire consequences.
"The work our president now threatens to cut as waste and abuse is work that has saved millions of lives," she said. "The recklessness we're seeing is like dropping an egg on the floor. You can't just pick it up and put it back the way it was.
"Many of us believe they started the assault on democracy by cutting programs that serve Africans, undocumented immigrants, and transgender kids because they thought that Americans would let them," she continued. "Pick on the most vulnerable, and they would get away with it even if they broke the law, which they have many times. This is a coup. We have to fight back, and we have to call it what it is."
Denison acknowledged that many people "are scared, and I get it. We have a president so punitive, even the congressional Republicans are afraid to speak up. And I understand that there are times when silence by individuals and organizations may protect people, but this stunning collective silence ensures that the abuses of power and assault on our humanity will continue. So now is the time for moral courage. I beg of you. Do not bend the knee in advance. Do not crumble in despair. That is exactly what they want you to do."
In their comments during the opening session, Havlir and others stressed that investments in HIV research have laid the foundation for advances in other fields, including vaccines, gene therapy, cancer immunotherapy, and hepatitis B and C.
"HIV science has advanced our understanding and treatment of myriad other conditions," said Dr. Katharine Bar of the University of Pennsylvania. "As we gather together to celebrate science, we must acknowledge that science and humane medical care are under attack. One component of our collective response must be to protect, to advocate for, and to redouble our efforts to communicate to the general public the immense benefits of HIV science to people with HIV, to people with other conditions, and to society in general."
UPDATED 3/10/25 to correct the spelling of Rebecca Denison's last name.
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