science silenced
HIV services for key populations halted by funding cuts
Project ACCELERATE, a successful HIV care model, was slated to be handed over to the Indian Government in December of 2025. It was shuttered due to termination of funding.
Dr. Sunil Solomon
Image courtesy of Sunil Solomon
Published in
IDeas Magazine -
Fall 2025
In 2019, Dr. Sunil Solomon began an impressively large, 7-year program to provide evidence-based, life-saving care to people living with HIV/AIDS across 6 states in India, and to keep them engaged in care. Funded under a PEPFAR grant administered by USAID, he employed a team of nearly 700 people in both the U.S and India to develop, implement, and evaluate community outreach, testing, treatment, education, and care retention services to mitigate the epidemic among children, adolescents, and adults. The need is there: with an estimated 2.4 million people with HIV, India has the second highest burden of HIV globally.
As of December 31, 2024, Project ACCELERATE had tested nearly 112,000 people for HIV, diagnosing nearly 20,000 new cases almost all of who were linked to life-saving ART. Through a network of 38 antiretroviral therapy clinics across 2 Indian states, the program supported more than 170,000 people with HIV, including nearly 8,000 children and adolescents. The services were intended to be turned over to the Indian government at its conclusion in 2026, ensuring sustainability going forward.
On January 24, 2025, Solomon received a stop work order from USAID. Three weeks later, he received a waiver to resume the life-saving activities in his program. Then on February 26, the award was fully terminated, including the live-saving care that Solomon’s team was providing.
Findings from his program received national attention, and were used to inform India’s strategies for PrEP, transgender healthcare, and approaches to reach vulnerable populations in virtual spaces like Grindr and Tinder. With the burden of HIV among India’s transgender community 20 times higher than the national average, ACCELERATE established the first clinics to serve transgender persons India. Three clinics, serving approximately 6,000 transgender men and women in Pune, Hyderabad, and Thane, provided HIV services integrated with primary care, government and social service navigation, legal assistance, and served as places where people felt safe to come.
“We provided convenient, quick care tailored to people’s needs. People can sometimes spend a whole day to complete a visit at an ART center. Our approaches demonstrated that there are more efficient and effective ways to provide care.”
Because people are increasingly finding partners online, ACCELERATE created a virtual model of health care delivery that offered anonymity in seeking HIV services. The program offered options for people to visit the clinic for testing, PrEP, and ART, or to self-test and have medications delivered, and more than 3,000 people were started on PrEP through this virtual platform, which is now terminated.
“I can start someone on PrEP in an hour or two, but keeping them on for years takes a lot of engagement. We put signs up on the doors of the clinics/website landing page with a phone number as we left, but that’s just a barrier to seeking care. If it’s inconvenient, people don’t go. They won’t get their tests, they won’t refer partners and friends into care. People will just stop, and lives will be lost. This is completely preventable.”
Additional casualties of the termination are children and adolescents living with HIV. Solomon’s program provided home delivery of medication so that children would not have to miss school for clinic visits. And the program’s 4 Adolescent Friendly Health Centers—gathering places for teens living with HIV—offered social programs for kids who are often isolated due to stigma of the disease. The Centers offered drama, martial arts, music activities that are all terminated.
“Kids need to take ART to survive, but to really live and thrive, they need to have fun. We were in the process of evaluating the impact of these initiatives—when we first started the activities, viral suppression among teens at one of our centers was 67%. At our last evaluation, it was 95%.”
The grant termination undermines the impact this program could have at the national level. Translating research findings, from programs to policy, going from implementing and evaluating strategies at the clinic level, to changing policies at the national level to improve outcomes at the population level, is why research is conducted.
“It’s difficult to come to terms with ending the program before we turned it over to the Indian government. We made a promise to the community we served, and they relied on us. A trust is broken that I’m not sure we can regain. We were seeing encouraging, tangible results, and just abandoning people and the program before we could show the return on investment in healthcare engagement and retention, demonstrate strategies that reduce India’s HIV burden, and make it part of India’s nation program is deflating. Also, these findings could have impact on outcomes beyond India including in the US.”
Students and junior investigators at Hopkins have also been affected. They were relying on Solomon’s project network for their own studies, which in turn, have been terminated, including the dissertation of a doctoral student.
“The termination of the program, and others across the university, is having a real impact on budding careers. Where do students and early career investigators go from here?”
As of December 31, 2024, Project ACCELERATE had tested nearly 112,000 people for HIV, diagnosing nearly 20,000 new cases almost all of who were linked to life-saving ART. Through a network of 38 antiretroviral therapy clinics across 2 Indian states, the program supported more than 170,000 people with HIV, including nearly 8,000 children and adolescents. The services were intended to be turned over to the Indian government at its conclusion in 2026, ensuring sustainability going forward.
On January 24, 2025, Solomon received a stop work order from USAID. Three weeks later, he received a waiver to resume the life-saving activities in his program. Then on February 26, the award was fully terminated, including the live-saving care that Solomon’s team was providing.
Findings from his program received national attention, and were used to inform India’s strategies for PrEP, transgender healthcare, and approaches to reach vulnerable populations in virtual spaces like Grindr and Tinder. With the burden of HIV among India’s transgender community 20 times higher than the national average, ACCELERATE established the first clinics to serve transgender persons India. Three clinics, serving approximately 6,000 transgender men and women in Pune, Hyderabad, and Thane, provided HIV services integrated with primary care, government and social service navigation, legal assistance, and served as places where people felt safe to come.
“We provided convenient, quick care tailored to people’s needs. People can sometimes spend a whole day to complete a visit at an ART center. Our approaches demonstrated that there are more efficient and effective ways to provide care.”
Because people are increasingly finding partners online, ACCELERATE created a virtual model of health care delivery that offered anonymity in seeking HIV services. The program offered options for people to visit the clinic for testing, PrEP, and ART, or to self-test and have medications delivered, and more than 3,000 people were started on PrEP through this virtual platform, which is now terminated.
“I can start someone on PrEP in an hour or two, but keeping them on for years takes a lot of engagement. We put signs up on the doors of the clinics/website landing page with a phone number as we left, but that’s just a barrier to seeking care. If it’s inconvenient, people don’t go. They won’t get their tests, they won’t refer partners and friends into care. People will just stop, and lives will be lost. This is completely preventable.”
Additional casualties of the termination are children and adolescents living with HIV. Solomon’s program provided home delivery of medication so that children would not have to miss school for clinic visits. And the program’s 4 Adolescent Friendly Health Centers—gathering places for teens living with HIV—offered social programs for kids who are often isolated due to stigma of the disease. The Centers offered drama, martial arts, music activities that are all terminated.
“Kids need to take ART to survive, but to really live and thrive, they need to have fun. We were in the process of evaluating the impact of these initiatives—when we first started the activities, viral suppression among teens at one of our centers was 67%. At our last evaluation, it was 95%.”
The grant termination undermines the impact this program could have at the national level. Translating research findings, from programs to policy, going from implementing and evaluating strategies at the clinic level, to changing policies at the national level to improve outcomes at the population level, is why research is conducted.
“It’s difficult to come to terms with ending the program before we turned it over to the Indian government. We made a promise to the community we served, and they relied on us. A trust is broken that I’m not sure we can regain. We were seeing encouraging, tangible results, and just abandoning people and the program before we could show the return on investment in healthcare engagement and retention, demonstrate strategies that reduce India’s HIV burden, and make it part of India’s nation program is deflating. Also, these findings could have impact on outcomes beyond India including in the US.”
Students and junior investigators at Hopkins have also been affected. They were relying on Solomon’s project network for their own studies, which in turn, have been terminated, including the dissertation of a doctoral student.
“The termination of the program, and others across the university, is having a real impact on budding careers. Where do students and early career investigators go from here?”