Entrenched inequalities hamper efforts to end HIV/Aids epidemic by 2030
Rise in global HIV infections and Aids-related deaths is unacceptable as there are effective medicines available
Like the HIV/Aids epidemic before it, Covid-19 is exploiting the extreme inequalities between countries, and within them, to take root among disadvantaged and vulnerable communities.
I am proud that decades of experience in responding to HIV/Aids are being used in the fight against the coronavirus and that activists all over the world are working hard to make sure that the disruption to HIV/Aids services is minimised. But I am also deeply concerned. Even before the onset of Covid-19 the world was failing in its commitment to end the HIV epidemic by 2030.
The UNAids new global report “Seizing The Moment: tackling entrenched inequalities to tackle epidemics” shows that there were 690,000 Aids-related deaths in 2019 and 1.7-million new infections — far from the global targets set for 2020 of fewer than 500,000 deaths and 500,000 new infections a year.
The collective failure to implement and sufficiently invest in comprehensive, rights-based HIV/Aids responses has come at a dreadful price. There were 3.5-million more HIV infections and 820,000 more Aids-related deaths from 2015 to 2020 than the world had aimed to achieve.
This is unacceptable when we have medicines to keep people living with HIV alive and well, and an array of prevention tools to stop new infections. We are being held back by entrenched inequalities that put vulnerable and marginalised groups of people at higher risk of becoming infected with HIV and dying of Aids-related illnesses.
Of course, there are bright spots. SA has massively expanded the numbers of people on treatment in the past decade, from 1.4-million people in 2010 to 5.2-million people in 2019. Countries such as Eswatini and Lesotho are showing that new infections can be driven down by rolling out combination prevention options.
But in too many countries the epidemic is worsening. Infections have risen by 72% in Eastern Europe and Central Asia since 2010, with rises of 22% recorded in the Middle East and North Africa and 21% in Latin America.
As ever, it is the most vulnerable who pay the price. Every day, marginalised groups such as gay men, sex workers, transgender people, people who use drugs, prisoners and migrants are prevented from receiving proper health care and are criminalised and marginalised. Denied their right to health, these groups and their sexual partners comprised 62% of all new adult infections in 2019.
Meanwhile, women and girls are too often denied their sexual and reproductive health and rights, while gender-based violence and gender inequalities continue to drive the epidemic forward among young women and girls. In 2019 young women and adolescent girls accounted for one in four new infections in Sub-Saharan Africa, despite making up about 10% of the total population.
It is estimated that globally 243-million women and girls aged 15 to 49 have been subjected to sexual and/or physical violence perpetrated by an intimate partner in the past 12 months. Meanwhile, we know that women who experience such violence are 1.5 times more likely to acquire HIV than women who have not experienced violence. Among marginalised groups, a high prevalence of violence is also linked with higher rates of HIV infection. Female sex workers have a 30 times greater risk of acquiring HIV than the general population.
All this must change, and we have to act on multiple fronts. A multisectoral approach that respects the rights and dignity of women and of all marginalised groups is urgently needed to reduce HIV infections and guarantee their right to health and other essential services.
In SA there has been a significant decline in the number of new HIV infections, a reduction of 52% between 2010 and 2019. The number of new HIV infections among adolescent girls and young women between 15 and 24 has dropped by 54%. These numbers are second only to Eswatini, which reported a 65% and 63% decline respectively.
This achievement is in part owing to the implementation of programmes such as DREAMS/She Conquers, which provides multisectoral interventions, including youth-friendly sexual and reproductive health services, education subsidies, social protection services and parenting programmes, together with HIV services.
Just like HIV, Covid-19 holds up a mirror to the stark inequalities and injustices that run through our societies. The pandemic will also be worsened unless we address the human rights impact on vulnerable people and their lack of access to health services, education, protection from violence and social, economic and psychological support.
We need a global commitment that diagnostics, medicines and an eventual vaccine against the coronavirus will be available free at the point of use to everyone, everywhere. When a vaccine becomes available it must be a People’s Vaccine. Successful pandemic responses are grounded in human rights, implement evidence-based programming and should be fully funded to achieve their targets.
Unfortunately, the funding gap for HIV/Aids responses is widening. Increases in resources for HIV/Aids responses in low- and middle-income countries stalled in 2017, and funding decreased by 7% between 2017 and 2019 after adjusting for inflation. The total HIV/Aids funding available in these countries in 2019 amounted to about 70% of the 2020 target set by the UN General Assembly.
HIV has been slipping down the international agenda for some years. I am now calling on leaders to convene a new UN high-level meeting on ending Aids next year to address with urgency the outstanding issues that are holding us back from ending Aids as a public health threat by 2030.
We cannot drop the HIV/Aids ball. The futures of millions of people are at stake. The UNAids 2020 global report is a call to action. It highlights the terrible scale of the HIV/Aids epidemic and how it runs along the fault lines of inequalities. We can and must close the gaps.
• Byanyima is executive director of UNAids.