This side and beyond the breaking point

On May 16, 2025, HIV community activists from Uganda and Russia met with the Deputy Executive Director of UNAIDS for a so-called fireside chat. The virtual discussion was hosted by Action against AIDS Germany and took place as part of the discussion series “Quo Vadis, Global Health?”

The goal of the series is to explore problems and questions related to the shifting priorities of the U.S. government under Trump’s “America First” agenda, its withdrawal from global cooperation and responsibility, and the abrupt cuts to health programs in the Global South. The discussions aim to examine the consequences of these cuts for people living with HIV, tuberculosis, and malaria, the programs created for and by them, and the care structures involved. What is the future of the U.S. if those in power permanently reject the knowledge and understanding of the value of international cooperation and solidarity? Will the country continue down a path toward becoming a full-fledged oligarchy—a political system in which billionaires and corporations hold power and buy or seize their privileges? What do these developments mean for the survival of already vulnerable groups, the communities they represent, and the future of civil society engagement?

The event was held in the context of the U.S. government’s recent imposition of terminological restrictions, including words like “gender,” “LGBTIQ,” and “equality.” These trends reflect authoritarian strategies and threaten core values of inclusion and human rights-based principles of public health. Global organizations like UNAIDS are increasingly struggling to fulfil their mandates and enforce agreements. Community representatives must prepare for the challenges of a progressively hostile environment.

Given that both Russia and Uganda have long histories of dealing with censorship, a discussion with activists from these regions was particularly relevant. We thank Alexei Lakhov from Russia, Shawn Mugisha from Uganda, and Christine Stegling from UNAIDS for a rich discussion of their perspectives, experiences, and strategies.

Red Lines in Dealing with Censorship and Repression

The discussion helped identify strategies and “red lines” when dealing with censorship. This marks our first exploration of the topic. The arguments presented are by no means exhaustive and must be supplemented with experiences from other countries governed by authoritarian regimes. It remains to be seen how the global HIV and LGBTIQ* community will respond to shrinking civic spaces and which solutions might be found. There is no universally successful strategy for dealing with repression. Political constellations and societal conditions change quickly. Loud protests by ACT UP in 1980s America cannot simply be transplanted into the present day—let alone into the contexts of other societies.

Impact on UNAIDS and Global HIV Work

During the discussion, Christine Stegling (UNAIDS) pointed out that more than 70% of global HIV program funding comes from the U.S. The abrupt withdrawal has led to shortages of antiretroviral medications, a reduction in testing capacity, and the forced closure of critical HIV services. UNAIDS is now advocating for diversified, sustainable financing mechanisms to maintain community engagement and rights.

Russia: First Comes Language, Then Survival

Alexei Lakhov, a longtime HIV activist from Russia, described the government’s harsh crackdown on civil society through the erasure of inclusive language and the criminalization of services for key populations. When asked whether the developments in the U.S. raised alarm bells, Alexei said:

“For those of us who have experienced censorship in Russia—especially in the fields of HIV and human rights—these developments feel like déjà vu, just happening faster. In Russia, the disappearance of certain terms was one of the first signs of systemic pressure on civil society. Words like ‘LGBT,’ ‘harm reduction,’ and even ‘gender’ gradually vanished from policy documents, funding calls, and public discourse. This semantic cleansing made it easier to dismantle protections for already marginalized groups.

So yes, alarm bells have been ringing—and they still are. When a government starts censoring terms like ‘gender’ or ‘equality,’ it’s not just about semantics. It’s a political signal. It legitimizes exclusion and lays the groundwork for discrimination, criminalization, and violence. We’ve seen this playbook before. First, the language disappears. Then, lives disappear.”

The consequences of such censorship laws are severe. Russia faces an ongoing HIV crisis with over 1.1 million registered HIV-positive individuals and tens of thousands of new cases annually. Yet censorship, stigma, and criminalization make it nearly impossible to respond effectively to the needs of key populations.

Laws like the 2012 ban on so-called “gay propaganda,” the Foreign Agents Law (2012) and the law on “undesirable organizations” (2015), and most recently the classification of the LGBT “movement” as extremist, have cut off crucial populations—such as gay men, people who use drugs, and sex workers—from life-saving services.”

Uganda – Legalized Persecution of LGBTIQ Communities

Shawn Mugisha reported that Uganda’s anti-homosexuality legislation fosters fear, stigma, and violence. Access to healthcare is obstructed, peer educators are arrested, and the provision of services to LGBTQ+ individuals is criminalized. This policy not only harms local communities but also influences neighboring countries to follow suit. In the past, we have repeatedly focused on the effects of this legislation in Uganda.

Appropriate and Inappropriate Strategies

When asked which strategies had proven effective in Russia and how he assessed developments in the U.S., Lakhov said:

“Censorship creates a climate of uncertainty and fear in which every word and funding source is scrutinized. Many organizations now plan only one year—or even less—ahead. Writing a funding proposal is no longer just a technical task; it’s a political risk. Using terms like ‘gender,’ ‘community-led,’ or even ‘peer approach’ can mark a proposal as suspicious.

In response, many organizations in Russia had to:

Sanitize their language and remove any references to LGBTQ+ people, people who use drugs, or sex work. For example, a project originally known as the ‘Forum of Transgender People’ under the Global Fund was renamed the ‘Forum of People with Gender Non-Conformity,’ and the MSM Forum (men who have sex with men) became the ‘Forum of People with Risky Sexual Behavior.’
Abandon advocacy work and focus instead on basic service delivery—such as HIV testing and treatment access—rather than harm reduction, legal reform, or the protection of marginalized groups’ rights.
Operate in legal gray zones, navigating opaque bureaucratic obstacles just to stay alive.

And yet, despite these restrictions, community-led organizations persist. They serve, adapt, and continue to advocate—often with less visibility, but still with impact.”

Whatever Strategy Is Chosen: Some Red Lines Must Not Be Crossed

• Commitment to communities: We are accountable to the communities we represent and will not abandon them. This is true even—and especially—when we must adapt language in project proposals or descriptions of our work to politically permissible formulations, which may outwardly appear as if we conform to the government or aren’t doing enough to resist it.
• No internalization of censorship: Not being able to say something officially does not mean we are not allowed to think it! To avoid internalizing censorship, teamwork and cooperation with like-minded individuals are vital.
• Rejecting the criminalization of our solidarity: All criminalization aims to silence us. To counter this, maintaining connections is crucial. We have a voice. Our vision of a better society is—and remains—the driving force behind our work, not fear of annihilation.
• Diversifying funding: This is essential to reduce dependence on funders’ priorities (or whims, attempts at coercion, etc.). Programs must be placed on broader financial footing, and alternative funding models must be developed.
• Building alliances: Censorship and language bans are not issues that affect only LGBTIQ+ communities. Advocacy efforts must build alliances and reach beyond the LGBTIQ+ sector.

“Quo Vadis, Global Health?” is a call to action. Communities around the world—from Russia to Uganda—are resisting repression and funding cuts with determination and clarity. That takes courage! “Taking responsibility means refusing to settle for invisibility as a form of supposed safety. We can adapt our tactics, but not our values,” says Lakhov.

The public health of the future must prioritize community engagement, inclusive language, and structural support.

Peter Wiessner, Alexei Lakhov