The global response to AIDS is in danger. Inequalities are a threat to us all.
Every minute, a life is lost to the disease. The world is not on track to end AIDS. Millions of lives are at stake.
In 2021, we witnessed the .1 Indeed, new HIV infections are now on the rise in 38 countries around the world. Last year, 1.5 million people became newly infected with HIV, 1 million more than global targets.
The colliding crises of the COVID-19 pandemic, the war in Ukraine and the related economic fallout from both have impacted services and increased risks.
The deeper challenge is that the world has not sufficiently addressed the inequalities that drive the AIDS pandemic. We can end AIDS, but only if leaders are courageous in tackling the inequalities that are blocking progress.
One of the starkest inequalities is in access to treatment for children and adults. Globally, only 52 per cent of children living with HIV are on life-saving treatment, far behind adults, of whom 76 per cent are receiving antiretrovirals. This disparity has had deadly consequences. In 2021, children accounted for only 4 per cent of all people living with HIV but 15 per cent of all AIDS-related deaths. Closing the treatment gap for children will save lives.
A second dangerous inequality is in access to education. Right now, around the world, an adolescent girl or young woman acquires HIV every two minutes. The COVID-19 crisis disrupted key HIV prevention services and education, resulting in the possibility that millions of girls will never return to school, and a spike in teenage pregnancies and gender-based violence put many girls at increased risk for HIV.?Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among girls. The driving factor is power. Enabling girls to stay in school until they complete secondary education . Greater gains have been made in reducing new HIV infections among adolescent girls and young women . When this is reinforced with a package of empowerment support, their risks are reduced even further. We need to interrupt the power dynamics that are making girls more vulnerable to HIV.
The underfunding of the AIDS response is exacerbating inequalities and undermining our ability to get the response on track.
It’s key that all children, including those who have dropped out of school since the onset of the COVID-19 pandemic and those who were out of school even before the crisis, have the opportunity to complete a full secondary education, one that includes comprehensive sexuality education and girls’ empowerment. Yet as countries struggle with current fiscal challenges, education and health are among the sectors that are suffering the biggest budget cuts. That is why the was co-convened by the United Nations Children’s Fund (UNICEF), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Population Fund (UNFPA), the United Nations Entity for Gender Equality and the Empowerment of Women (UN-Women) and the Joint United Nations Programme on HIV and AIDS (UNAIDS), along with governments, civil society and international partners. The initiative is pressing leaders to accelerate the actions and investments needed to ensure that every African girl is in school, safe and strong.
A third inequality standing in the way of the end of AIDS is in the realization of human rights. , making people afraid of visiting facilities where they could receive prevention, testing and treatment services that could save their lives and break the cycle of infection.
Punitive and discriminatory laws undermine the AIDS response. Gay men and other men who have sex with men have 28 times greater risk of acquiring HIV than adult men 15 to 49 years of age in the general population. People who inject drugs have a 35 times greater risk of acquiring HIV than adults who do not. Female sex workers are at 30 times greater risk than adult women in the general population. Transgender women have 14 times the risk of other adult women. Too often, political decisions are worsening inequalities: Countries that criminalize key populations have made less progress on ensuring that people know their status and are on effective antiretroviral therapy than those that avoid criminalizing approaches.
To beat AIDS, governments need to value the rights and dignity of every person. Decriminalization saves and changes lives.
A fourth dangerous inequality is in access to medicines. We need to get the new, long-acting antiretroviral medicines that will make it easier to treat and prevent HIV to people in low- and middle-income countries at the same time as they are made available in rich countries. We need to ensure that all medicines that can prevent deaths of people living with HIV are manufactured by multiple producers affordably, especially in the global South, where the disease is concentrated. This requires funding as well as reform of failing rules on intellectual property and support for globally distributed production, so that access to life-saving science is no longer dependent on the passport you hold.
Inequalities are obstructing the end of AIDS.?With courage and cooperation, political leaders can overcome them.
The fifth dangerous inequality is in access to resources. When international support has been most needed, global solidarity has stalled. Overseas development assistance for HIV from bilateral donors other than the United States has plummeted by 57 per cent over the last decade. The domestic and international resources needed to end AIDS by 2030 are increasingly under threat. In 2021, of the amounts needed. Domestic funding for the HIV response in low- and middle-income countries has now fallen for two consecutive years. The war in Ukraine has dramatically increased global food prices, worsening food insecurity for people living with HIV across the world, making them much more likely to experience interruptions in HIV treatment. The underfunding of the AIDS response is exacerbating inequalities and undermining our ability to get the response on track.
Communities across the world are calling on leaders to equalize access to HIV treatment, prevention and care services by tackling gender inequalities and toxic masculinity;? by?closing?the treatment gap between children and adults; by removing discriminatory and punitive laws; and by ensuring that all people have access to the best science and medicine, and that the AIDS response is fully resourced.
Inequalities are obstructing the end of AIDS. But they are not fate. We know what works. With courage and cooperation, political leaders can overcome them.
We can end AIDS, by 2030, if we EQUALIZE.?
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Note
1Unless otherwise indicated, all data presented in this article can be found in the UNAIDS report, IN DANGER: UNAIDS Global AIDS Update 2022 (Geneva: Joint United Nations Programme on HIV/AIDS), 2022. License: CC BY-NC-SA 3.0 IGO. Available at:
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