One year after the policy break that reshaped the US President's Emergency Plan for AIDS Relief (PEPFAR), the global HIV response has entered its second year of structural transformation. In early 2025, the program faced the most uncertain period in its history, characterized by the absence of reauthorization, the suspension of foreign aid spending by the US government, and the beginning of major shifts in the implementation of the PEPFAR program. These conditions have not been fully resolved. The continued lack of long-term reauthorization by the US Congress allowed further programmatic and structural changes to proceed. These changes radically changed the way PEPFAR works. The changes also affected the coordination of the global response to HIV.