As Dr. Nancy Reynolds assumes the role of chair of the board for the Consortium of Universities for Global Health (CUGH), she reflects on the future of global HIV care at a time of mounting political and financial uncertainty.
Nancy Reynolds, PhD, RN, C-NP, FAAN, professor and associate dean for global affairs at the Johns Hopkins School of Nursing, shares what she’s watching closely, the critical role of nurses, and what it will take to sustain HIV care in a changing global landscape.
You’re stepping into this leadership role at a time when global health funding, especially support for HIV, faces major threats. What’s most urgent right now?
What’s most urgent is protecting vulnerable populations. Many recent funding cuts have come with little warning, leaving no time to prepare or ensure continuity of care. That creates serious risk—especially for those whose lives depend on stable access to life-saving medications such as antiretroviral treatment.
I remember attending the International AIDS Society conference in the early 2000s. There had always been a sense of solidarity at those meetings—clinicians, researchers, and advocates from around the world coming together in the face of immense suffering. But something had shifted. High-income countries were focused on refining the now available, effective (but costly and complex) combination therapies, while attendees from lower-income countries still lacked access to basic treatment. The realization that access to life-saving treatment hinged on geography, was, and remains, morally and ethically unacceptable. It catalyzed a pivotal global movement to make antiretroviral therapy accessible to everyone, everywhere. Programs like PEPFAR [President’s Emergency Fund for AIDS Relief] and the Global Fund helped close that gap and the disease shifted from almost certain death to a chronic, manageable condition.
That progress is now in jeopardy. If the United States and other high-income countries pull back support, the hope is that national governments will sustain the programs. But the reality is more complex. Domestic health priorities vary, and HIV may not be high on the list. It’s also uncertain who, if anyone, will step in to fill the void. These questions sit at the intersection of health, diplomacy, and global solidarity.
Nurses have always played a central role in HIV care. What unique contributions can they make in this moment of global uncertainty?
Nurses are indispensable to the future of HIV care. They’re the largest segment of the global health workforce. In many places, they’re the first—and often the only—point of contact, especially in community-based settings. That makes them essential to prevention, early detection, and long-term treatment engagement, particularly as health systems face increasing pressure.
When antiretrovirals first became available in many African countries, there weren’t enough physicians to meet demand. Nurses stepped into that space and became foundational to the rollout of treatment. They were trained to manage HIV care, monitor patients, and provide critical education—work that ultimately transformed outcomes. I saw that impact firsthand when the Clinton Foundation invited me to help train nurses in India as part of a similar effort. Today, nurses continue to fill essential gaps in care. But to lead at this moment, they must be supported, trusted, and empowered to practice at the full scope of their training. They must also be involved in system-level decision making.
What does it take to build truly sustainable HIV care today—especially as global priorities, power dynamics, and funding structures begin to shift?
Sustainable HIV care means consistent access to treatment and serious investment in prevention. The World Health Organization recently recommended twice-yearly injectable PrEP [pre-exposure prophylaxis], but putting that into practice takes political will and long-term financial commitment.
We came close to achieving a world without new HIV infections. With sustained treatment, people don’t transmit the virus. But we won’t reach that vision if prevention stalls and treatment becomes inconsistent. The risk of resurgence is real.
At the same time, global health itself is changing. There’s a growing recognition that power—not just funding—must shift to countries most affected. That means having local institutions set priorities, hiring and trusting in-country staff, and ensuring that external global partners don’t impose health agendas.
As chair of CUGH, I’m proud to bring nursing into these conversations. Nurses understand care at the community level. We bring a person-centered, equity-focused lens that global health needs now more than ever. If HIV care is to be sustainable, nurses can’t just be involved—they must help lead the way forward as clinicians, researchers, and advocates.
