Despite the giant strides the world has made in combating the HIV epidemic, the high rate of infections among women and girls in sub-Saharan Africa, as well as childhood HIV infections, continue to hamper progress.  

“Four thousand adolescent girls and young women acquired HIV every single week. That’s a crisis every single week. 3,100 of those are from Sub-Saharan Africa. So it’s a sub-Saharan crisis,” Winnie Byanyima, the executive director of UNAIDS, said at the launch of the 2023-UNAIDS Global AIDS Update report in Geneva, on Thursday.  

However, she asserted that ending AIDS by 2030 is an achievable goal. 

“The data and evidence in the report we are releasing today shows that there is a path that ends AIDS by 2030,” Byanyima added. “The path that ends AIDS is the same path that will help societies to be prepared for future pandemics and that will also help countries to achieve the sustainable development goals.” 

Adolescent girls and women bear higher burden of infections

In 2022 alone, women and girls accounted for 63% of all new HIV infections in sub-Saharan Africa. Less than half of the districts with very high HIV incidence in the region currently have HIV prevention programmes dedicated exclusively to adolescent girls and young women. 

Targeted prevention programmes for women and young girls, among other interventions, will cause a ripple effect in the population by directly reducing the number of new HIV infections among children, the report contends. 

Between 1996 and 2022, HIV treatments have averted almost 21 million AIDS-related deaths around the world. The number of AIDS-related deaths has also dropped by 69% since 2004 when it peaked, the report added. However, the disease killed one person per minute in 2022. 

Concerted efforts targeted at women and young girls have halved the number of new infections since 2010, but young girls and women remain among those most vulnerable to contracting HIV. 

“Fewer new HIV infections in women [globally]  and higher coverage of treatment among people living with HIV have led to a 58% drop in the annual number of new infections in children globally between 2010 and 2022, to 130 000, the lowest since the 1980s,” the report states.

Political action crucial to boost progress

A common thread among the various success stories of countries that have recorded reduction in HIV/AIDS transmission and death rates is the presence of strong political commitment to draft policies that place the people and communities at its core. 

“HIV programmes succeed when public health priorities prevail, as experiences in multiple countries attest,” the report added. 

Countries like Botswana, Cameroon, Nepal, Zimbabwe, and Cambodia have all achieved tremendous reductions in the number of new HIV cases, and AIDS-related deaths due to scaling up evidence-based policies and implementing focused prevention programmes, the report said. 

In 2020, UNAIDS announced an ambitious set of goals for countries to work towards by 2025. The so-called the ’95-95-95′ plan aims for 95% of all people living with HIV to know their HIV status; 95% of those who have HIV infection to receive sustained antiretroviral therapies; and 95% of those who receive antiretroviral therapies to have their viral loads suppressed, which will help people live longer, prevents further progression of the infection and sexual transmission of the virus. 

According to the 2023 UNAIDS report, Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe, have already achieved the targets set by the 95-95-95 program. At least 16 other countries, including eight in sub-Saharan Africa, and Thailand, are close to achieving their targets set by the program. 

The gains in combating HIV-AIDS, however, have been limited outside of sub-Saharan Africa. 

Around 23% of the new HIV infections were in Asia and the Pacific region, and the number of new infections in eastern Europe and central Asia has increased by 49% since 2010. The number of new HIV infections in the Middle East and North Africa region has increased by 61% since 2010, the report revealed. 

“These trends are due primarily to a lack of prevention services for people from marginalized and key populations and to the barriers posed by punitive laws, violence and social stigma and discrimination.”

Byanyima condemns Uganda’s criminalization of same-sex relationships

While acknowledging the positive steps some countries have taken to prioritize community-specific HIV preventive measures, Byanyima spared no words in condemning Uganda’s recent action to criminalize same-sex relationships. 

“In 2022 and 2023, Antigua and Barbuda, Cook Islands, Barbados, St. Kitts & Nevis, and Singapore decriminalized same sex sexual relations. Unfortunately Uganda, my country, took the opposite direction and that’s not positive,” she said.  

Consensual same-sex intercourse is a criminal act in 67 countries across the world. Over 160 countries criminalise some aspects of sex work and 20 countries criminalise transgender persons. All of these actions have direct impacts on the status of the HIV epidemic in a region. 

“In 2022, compared with adults in the general population (aged 15-49 years), HIV prevalence was 11 times higher among gay men and other men who have sex with men, four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people,” the report pointed out. 

Barriers hold back more rapid progress 

Lack of access to, and continuity of treatment is one of the key barriers holding back more progress, the report finds, in addition to delay in diagnosing the infection in regions like Latin America, European Union, and European Economic Area. 

In 2022, around 9.2 million people living with HIV were still not receiving treatment and around 2.1 million who were receiving treatment were not virally suppressed. 

Only around 50% of those living with HIV in eastern Europe, central Asia, the Middle East, and North Africa, were receiving treatments in 2022, according to the report. 

When it comes to children and adolescents living with HIV globally in 2022, only 57% receive treatment. While the number of AIDS-related deaths among children reduced by 64% between 2010 and 2022, HIV still claimed the lives of 84000 children in 2022. 

“Early infant diagnosis coverage has risen in eastern and southern Africa (to 83%) but remains very low in western and central Africa (23%),” it said.  

Another barrier preventing poor countries from implementing HIV prevention and treatment programmes is the lack of funds. From the substantial increase in HIV funding recorded in early 2010s, funds have now declined to 2013 levels, the report finds.  

In 2022, US$20.8 billion was available for HIV programmes in low and middle income countries. This is 2.6% less than the amount that was available in 2021. By 2025, the world requires US$29.3 billion to combat HIV. 

“So there is a gap of eight and a half billion [USD]. What this shows is that we are in a world where we are not yet on the path that ends AIDS, but we also show that we can choose to get on that path. It’s a choice,” Byanyima remarked. 

Decline in HIV incidence is directly related to an increase in HIV funding. 

“Some countries where HIV incidence is declining, including the Dominican Republic, India, Kyrgyzstan and Togo, are putting between 3% and 16% of HIV spending towards prevention programmes for people from key populations,” the report said. 

In 2022, around 90 countries together signed a voluntary licensing agreement to purchase generic versions of a pre-exposure prophylaxis (PrEP) drug for HIV. Several upper middle-income countries with significant HIV burden were not included in this purchase deal, thus placing those populations in a more vulnerable position. 

“It could take years before generic manufacturing of the medicine is in full swing… Removing these hurdles would give HIV prevention a major boost,” the report stated.

Image Credits: UNAIDS, UNAIDS.