Holding the Line: Peter Staley on Resistance, PrEP Access, and the Fight to Preserve HIV Progress

The Lancet's characterization of 2025 as an annus horribilis for American public health may prove, in retrospect, to have been optimistic. With the current administration's systematic dismantling of federal science infrastructure, HIV prevention advocates find themselves defending gains that took 4 decades to build, while simultaneously trying to sustain clinical programs, protect researchers, and imagine what durable access to prevention might look like on the other side of this political moment.

Few voices carry more weight in that effort than Peter Staley. A co-founder and board member of PrEP4All, Staley has been a central figure in HIV activism since the ACT UP era, and he delivered an opening plenary at CROI 2026 that framed the current crisis in explicitly political terms. In the interview that follows, he reflects on what resistance means when hope is in short supply, how clinicians and managed care professionals should navigate the tension between political uncertainty and clinical duty, and what structural reforms would make pre-exposure prophylaxis (PrEP) access genuinely durable over the coming decade.

Staley's message to clinicians is pointed: keeping programs running quietly is legitimate, even necessary, but keeping your head down entirely is no longer acceptable. He argues that individual researchers and clinicians have an obligation to work through their professional societies and medical academies, pushing those institutions toward faster, bolder, and more coordinated responses to each new assault on science. The momentum of resistance is real, he notes—the FDA's recent retreat on a flu vaccine decision being one example—and history will record who participated and who did not.

On the structural side, Staley makes the case for a nationally funded PrEP access program modeled on the COVID-19 vaccine rollout: free at the point of contact, available through pharmacies, community health organizations, and LGBT clinics, with federal funding covering both testing and drug supply. He is direct about the failure of the current patchwork model; co-pay assistance programs and patient navigators have made only a small dent, and he calls on Gilead (the maker of the PrEP drug lenacapavir), which has shown more willingness internationally than domestically, to partner with the federal government in something that actually works. The standard, as he frames it, is simple: when someone walks in, they get what they need, without paperwork, without delay.

For managed care professionals, his ask is equally direct. There are ways to participate in the resistance—publicly or quietly—that do not require putting a target on one's back. What is not an option, he argues, is doing nothing while the infrastructure built over 45 years of HIV/AIDS advocacy is rolled back. The goal now is to hold on as much as possible and to be ready to rebuild when the political conditions allow.