Research in palliative and supportive care has played an important role in responding to these challenges. Evidence now shows that integrating palliative care into HIV services, particularly for key populations disproportionately affected by HIV, can improve symptom control, enhance quality of life, reduce stigma and support more person-centred models of care. This growing body of research informs international guidance, which now recommends palliative care provision for people living with HIV.
To reflect on these developments, we spoke with Professor Richard Harding about how research is shaping improved HIV care worldwide and supporting people living with HIV to achieve a better quality of life.
What originally drew you to work on HIV-related palliative care?
In the 1990s, while working in the voluntary sector at a time when no effective treatment for HIV existed, palliative care was all there was for people living with HIV. Through King’s, I later moved to Columbia and then to Washington, D.C., where I worked with the National AIDS Office at the White House. During this time, I became part of the team that built and implemented PEPFAR which was an initiative to the global HIV/AIDS response and supported by a major global funding programme.
Could you tell us a bit about the current landscape of palliative care for people living with HIV?
According to data from the UNAIDS programme, around 600,000 people died from HIV-related illnesses last year. Many people living with HIV are now ageing in different ways to how they used to and developing complex health needs, meaning we need to find new ways to support them.
Within the Faculty, we are running a big programme of research in Uganda focused on improving palliative care for children living with HIV. This is called the GHAP Project and is a four-year global health initiative funded by the NIHR.
What are some of the main barriers that people living with HIV still face in accessing palliative care?
A major issue is that people often receive palliative care too late, frequently only at the very end of life. Our research aims to integrate palliative care earlier, when it can make the biggest difference. We are currently doing some research in Kenya through the TOPCare trial to find how we can improve palliative care outcomes.
Why is it still important to highlight this issue around World AIDS Day in 2025?
Almost 41 million people are living with HIV around the world and last year, 630,000 people died as a result of their HIV. Over 44 million people have died from AIDS-related illnesses since the start of the epidemic, with problems in access to treatment and funding shifts in global health.
It is also important to remember children, as an estimated 1.5 million children under 15 are living with HIV worldwide, so we must remember their needs also.
We also need to remember that stigma remains one of the most powerful and harmful challenges facing people living with HIV.
Could you share some of the current or recent research within NMPC related to HIV and palliative care?
In addition to our work in Uganda for children living with HIV palliative care research in Uganda, we are leading a major programme funded by Gilead, working with three clinics in the UK and two in the US. This project is implementing the POSITIVE OUTCOMES measure into routine community care to ensure services are person-centred to help people living with HIV report their primary symptoms and concerns more easily.
What gaps in research or policy still need urgent attention?
From your experience, what does high-quality palliative care for people living with HIV look like in practice?
It requires a holistic, person-centred approach that addresses the physical, psychological and spiritual needs of each individual.
Is there one message you’d like people to take away this World AIDS Day about care for people living with HIV?
To remember that people living with HIV who are on treatment cannot pass on HIV to anyone else, and that HIV stigma remains an enormous challenge for people living with HIV.