Despite the disruptions of the COVID pandemic, dozens of countries have met or exceeded the ambitious targets set by the UN General Assembly towards a goal of ending AIDS by 2030, with evidence indicating that targets were not just aspirational but achievable, according to a new report by UNAIDS.

The report, released today, shows that countries with progressive laws and policies and strong and inclusive health systems have had the best outcomes against HIV. 

In these countries, people living with and affected by HIV are more likely to have access to effective HIV services, which include HIV testing, pre-exposure prophylaxis (medicine to prevent HIV), harm reduction, and multi month supplies of HIV treatment.

“High-performing countries have provided paths for others to follow,” said UNAIDS Executive Director Winnie Byanyima.

“Their adequate funding, genuine community engagement, rights-based and multisectoral approaches and the use of scientific evidence to guide focused strategies have reversed their epidemics and saved lives. These elements are invaluable for pandemic preparedness and responses against HIV, COVID-19, and many other diseases.” 

Globally, the report shows that the number of people on treatment has more than tripled since 2010, with 27.4 million of the 37.6 million people, 75% of those living with HIV were on treatment. This roll-out of quality, affordable treatment is estimated to have averted 16.2 million deaths since 2000. 

COVID-19 Still Sets Back Progress In Some Countries  

However, despite those bright spots, some countries and regions are off-track, with previous gains in eliminating AIDS being reversed due to COVID-19, conflicts, and humanitarian emergencies.  Particular problem areas that need more focus exist in eastern Europe, central Asia and parts of Sub-Saharan Africa, she said. 

“Our progress towards ending AIDS is further threatened by COVID-19,” said Byanyima during a launch of the report.

“In the last year, the trend is in the wrong direction. Countries with punitive laws that do not take a rights-based approach to health punish, ignore, stigmatize, and leave key populations on the margins and out of reach of HIV services.” 

“Our gains over the last year are something that we might lose because of COVID-19,” said Maximina Jokonya, Y+ Global HER Voice Fund Coordinator. 

To get sub-Saharan Africa back on track to meet the 2030 targets for HIV/AIDS will require expanding high impact treatment and prevent for key populations – adolescent girls and young women, and young men, said Quarraisha Abdool Karim, Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA).

“We need to ensure the sustainability of an HIV response [that breaks down] social and structural barriers.”

“We have seen how community services and leadership enable us to reach affected communities with essential services under the most difficult circumstances.”

Young People as Decision-Makers and Experts in HIV/AIDS

In the fight against HIV/AIDS, Jokonya emphasized the need for countries and decision-makers to not forget the voices and rights of young people, a group often left behind in these important discussions.

“Are we making sure their voices are being heard, their priorities are being put in place, and they’re also involved in key decision making processes to make sure they have access to services?” 

Though ideas are sought out from young people, they are often not involved in program design or implementation.

However, Jokonya pointed out that since young people are the ones experiencing HIV/AIDS, they are the experts when it comes to their health. 

“We need policies that speak to young people themselves in their diversity.” 

These policies give an opportunity not only to integrate HIV services into health more broadly, but also to integrate other aspects of health that are also neglected, such as sexual and reproductive health, and mental health.  

“We are saying no to tokenism, we are saying no to manipulation. We want meaningful and ethical engagement with people being able to participate and have a voice.” 

Gender Inequality in HIV/AIDS Policy

Women are continually left behind in HIV/AIDS policy, especially in sub-Saharan Africa, with six out of seven new HIV infections from adolescent girls 15 – 19 years of age and 4500 adolescent girls and young women newly infected every week in the region. 

AIDS is also the leading cause of death in adult women aged 15 to 49 years old. 

According to Karim, the root cause of this lies in gender inequality.

“[Gender inequality] underpins harmful gender norms that restrict women’s access to HIV and sexual reproductive health services. It’s exacerbated by a parallel pandemic of gender-based violence and limited agency and decision making power.”

Globally, only 55% of adult women have the agency and autonomy to say no to sex, decide on the use of contraception, and decide on their own healthcare.

Girls are least likely to complete second education, leading to missed opportunities for the provision of comprehensive sexual health education that can shift toxic gender norms for both young boys and young girls. 

Law and Policy – Determines Access to HIV Treatment 

The growing gap between and within countries on HIV/AIDS elimination is driven very significantly by law and policy, said Matthew Kavanagh, Director of Global Health Policy and Politics Initiative at Georgetown University’s O’Neill Institute. 

“Law is a determinant of health. Law structures inequality; policy drives success and failure in the pandemic response.” 

Countries that criminalized gay men and other men who have sex with men, sex workers, and people who inject drugs saw significantly less sucess in the 90-90-90 targets. 

The 90-90-90 targets, agreed by the United Nations General Assembly in 2016, call for the vast majority of people living with HIV to be tested, start treatment and reduce HIV within their bodies to undetectable levels by 2020. 

HIV Policy Lab data shows that only 21 countries in the world have fully adopted national policies aligned with WHO recommendations for treating, preventing, and managing HIV/AIDS. 82 countries have policies that restrict access to PrEP and are not aligned with the WHO. 

Policy alignment remains uneven and contradictory, with only some people eligible in certain countries – for example, gay men, but not young women or sex workers, may have access to PrEP.  

Kavanagh called the differences in law and policy ‘substantial’, that criminalization is associated with factors that drive HIV infections across the whole population. 

He also added that alongside criminal laws and rights laws, laws on access to science are also impact access to treating HIV.

“It’s critical that in the next five years there’s a sharp focus on building law and policy environments that enable us to get back on track to defeat HIV.” 

UNAIDS Urges Action in Upcoming UN General Assembly Meeting on AIDS 

With the upcoming UN General Assembly holding its fifth high-level session on HIV and AIDS on 8-10 June, Byanyima called on governments to commit to taking a people-centered, rights-based approach to HIV, and to work with policy reform, to engage and support communities and to end inequalities.

“We need to build on this momentum to drive forward political will and commitment to end AIDS. We need commitment for better technologies and treatments for a vaccine, and for a cure to get the world back on track.”

Image Credits: ©PSI-Dogsontherunphotography, UNAIDS, Cecille Joan Avila / Partners In Health, Patrick Gruban.