My primary role at IAS was as a poster presenter. My poster, The TGD Scorecard: Addressing Trans Erasure in HIV Clinical Trials, summarizes a project that Cindra Feuer (AVAC) and I recently completed to promote better representation of trans people and priorities in HIV research. We found that trans people represent only about 1% of participants in 41 of the most influential HIV clinical trials conducted since 1991, and that HIV trials are seldom designed to actionably respond to the disproportionate burden of HIV within trans communities. Clacking around the Kigali Convention Center in my heels with a poster designed as a giant trans flag, I figured that my work (and I) would stick out like a sore thumb. Put plainly, trans communities are facing erasure, and many people and institutions are complicit in seeing this erasure through. To some, the removal of the word “trans” may seem a benign gesture to be compliant and hang onto funding. Many of us in community understand that this erasure of language is an act of violence that is part of a larger effort to eradicate our very existence. Evidence we gathered through the Scorecard analysis demonstrates that when trans people are excluded, we continue to suffer, and that our inclusion is not only a moral imperative but a scientific necessity—if we speak the truth when we say that we intend to end the HIV epidemic for everyone. So, I was prepared to stand out at IAS…but imagine my delight to see trans communities named in almost every session I attended. Examples included a presentation on the Tangerine Clinic in Bangkok, the World Health Organization releasing guidelines on the health of trans adults, and one of my favorite moments of the week, the community protest during the IAS opening ceremony in which the refrain “We will not be erased!” echoed through the auditorium. This is what integrity looks like—doing the right thing even when it’s hard. HIV community, I am proud of you.

Ntando Yola (Desmond Tutu Health Foundation) and I also moderated a session, titled, “Rethinking Approaches to Clinical Studies.”  We heard from five presenters touching on various aspects of updating clinical trials to better translate efficacy into effectiveness and deliver the rewards of scientific inquiry to the communities who need them most. One speaker, Garo Kiledjian (SGM Alliance), asked the audience to sign onto The Kigali Manifesto, a petition demanding the greater inclusion of people living with HIV in health-related research.

One of the more widely reported presentations from IAS was the Phase 2 data on MK-8527, the drug being tested as a PrEP pill taken only once monthly. With the stellar safety data and pharmacodynamic data suggesting that MK-8527 could be protective within an hour of taking it (wow), the audience was thrilled to see this compound moving forward into Phase 3 studies. Most folks, however, have not had the chance to hear about the company’s commitment to community engagement. I had the chance to talk to several of the folks behind the upcoming Phase 3 trials, and they have already been meeting with the community and assembling community advisory boards. The world has yet to realize the full potential of PrEP, and it will remain that way until true partnership with the community is forged—with access at the forefront. The folks behind MK-8527 asked the community to hold them accountable. Let’s honor that request in full.

There were scores of sobering sessions at IAS 2025, many of them focused on the HIV funding crisis. There were estimates that US government funding cuts could result in 1-3 million excess deaths in the coming years. Others showed data on what has already occurred as a result of funding cuts and stop-work orders: lower viral suppression, fewer PrEP prescriptions, and less HIV testing. One of the most sobering sessions in my experience at IAS was a special session, titled, “The Double Burden: HIV Incidence and Prevalence in Conflict Zones.” Featured speakers had come from Ethiopia, Ukraine, and Gaza to report on their experience responding to HIV in times of war and human rights violations. My mind is emblazoned with recorded images of hospitals being destroyed and reports of healthcare workers being attacked. But I was also inspired by the resilience, dedication, and creativity of responders in these areas: tent hospitals serving immediate needs, cabotegravir being administered in subway stations, medication for opioid use disorder being distributed in long-term rather than short-term supply. The session moderator closed by reminding us that when we place differential value on human life, we end up with health crises like HIV…we end up with genocide, like that which occurred in Rwanda. I think it was a plea to all of us to tirelessly nurture our own humanity, which requires us to see ourselves in all others.  

Not far from the hustle and bustle of IAS, the Kigali Genocide Memorial offered a quieter, more reflective (though heavy) space. One theme of the museum is heroism. Dire times call for it. Some acts of heroism are remembered and enshrined in places like museums. Many are forgotten or perhaps never even registered despite their consequential legacies. As I looked around the halls at IAS, or the makeshift dancefloor after the day’s final plenary, or the hot and crowded airport shuttle on the way back home, I often found myself shoulder-to-shoulder with heroes. Keep up your acts of heroism, conspicuous and quiet alike. Murakoze (thank you).