“This is an urgent call to action. Progress against the AIDS pandemic, which was already off track, is now under even greater strain as the COVID-19 crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence-prevention programmes and more. We cannot be forced to choose between ending the AIDS pandemic today and preparing for the pandemics of tomorrow. The only successful approach will achieve both. As of now, we are not on track to achieve either.”UNAIDS Executive Director Winnie Byanyima
The warning comes in a new report by UNAIDS launched ahead of World AIDS Day (1 December) entitled Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics.
Some countries, including some with the highest rates of HIV, have made remarkable progress against AIDS, illustrating what is feasible. However, new HIV infections are not falling fast enough globally to stop the pandemic, with 1.5 million new HIV infections in 2020 and growing HIV infection rates in some countries. Infections are also following lines of inequality. Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among adolescent girls. Gay men and other men who have sex with men, sex workers and people who use drugs face a 25–35 times greater risk of acquiring HIV worldwide.
COVID-19 is undercutting the AIDS response in many places. The pace of HIV testing declined almost uniformly and fewer people living with HIV initiated treatment in 2020 in 40 of 50 countries reporting to UNAIDS. HIV prevention services have been impacted—in 2020, harm reduction services for people who use drugs were disrupted in 65% of 130 countries surveyed.
“It is still possible to end the epidemic by 2030. But that will require stepped up action and greater solidarity. To beat AIDS—and build resilience against the pandemics of tomorrow—we need collective action.”United Nations Secretary-General António Guterres in his World AIDS Day message.
This new report from UNAIDS examines five critical elements of the plan agreed by Member States at the United Nations General Assembly High-Level Meeting on AIDS that must be urgently implemented to halt the AIDS pandemic and which are critical but under-funded and under-prioritized for pandemic prevention, preparedness and response. These include:
- Community-led and community-based infrastructure.
- Equitable access to medicines, vaccines and health technologies.
- Supporting workers on the pandemic front lines.
- Human rights at the centre of pandemic responses.
- People-centred data systems that highlight inequalities.
The call for upscaled investments and shifts in laws and policies to end the inequalities that drive AIDS and other pandemics is backed by leaders in global health and pandemic response from across the world.
“If we do not take the steps needed to tackle the inequalities driving HIV today, not only will we fail to end the AIDS pandemic, we will also leave our world dangerously unprepared for future pandemics. Pandemics find space to grow in the fractures of divided societies. The amazing scientists, doctors, nurses and communities who work to end pandemics cannot succeed unless world leaders take the steps that will enable them to do so.”Helen Clark, Co-Chair of the Independent Panel for Pandemic Preparedness and Response, in a special foreword to the UNAIDS report.
UNAIDS and global health experts emphasize that while business as usual would kill millions and leave the world trapped with colliding pandemics going on for decades, leaders can, by acting boldly and together to tackle the inequalities in which pandemics thrive, end AIDS, overcome the COVID-19 crisis and be protected from the pandemic threats of the future.
“Pathogens ranging from HIV to the virus behind COVID-19 invade the cracks and fissures in our society with startling opportunism,” said Paul Farmer of Partners in Health, a nonprofit that for decades has effectively treated AIDS in settings of material poverty. “That the AIDS pandemic is shaped by deep structural inequalities need not resign us to inaction, however. Our teams, in rural Haiti and across the world, have routinely shown that with comprehensive care delivery, robust forms of accompaniment and social support and a larger dose of social justice, disparities in HIV outcomes can be rapidly narrowed, and health systems swiftly strengthened. We shouldn’t settle for anything less.”
This year marks 40 years since the first cases of AIDS were reported. Since that time, where investments have met ambition, there has been huge progress, particularly in expanding access to treatment. By June 2021, 28.2 million people had access to HIV treatment, up from 7.8 million in 2010, although progress has slowed considerably.
Countries with laws and policies aligned to evidence, strong community engagement and participation and robust and inclusive health systems have had the best outcomes, whereas the regions with the largest resource gaps and countries with punitive laws and that have not taken a rights-based approach to health have fared the worst.
“We know what works from seeing brilliant AIDS responses in some places,” said Ms Byanyima, “but we need to apply that everywhere for everyone. We have an effective strategy that leaders adopted this year, but it needs to be implemented in full. Ending inequalities to end AIDS is a political choice that requires bold policy reforms and requires money. We have reached a fork in the road. The choice for leaders to make is between bold action and half-measures.”
* The estimate of 7.7 million AIDS-related deaths between 2021 and 2030 is what UNAIDS models predict if HIV service coverage is held constant at 2019 levels. If the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS is executed and the 2025 targets are achieved, UNAIDS estimates that at least 4.6 million of those deaths can be averted over the decade.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with them on Facebook, Twitter, Instagram and YouTube.