UNAIDS: COVID-19 and Plummeting Donor Funds Slow Progress Against HIV HIV and AIDS 28/07/2022 • Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) UNAIDS director Winnie Byanyima (centre), with Dr Adeeba Kamarulzaman, co-chair of the International AIDS Society, and PEPFAR’s head, Dr John Nkengasong MONTREAL – Progress against HIV has slowed down during the COVID-19 pandemic as donors pull back, countries test and treat fewer people and miss key targets, UNAIDS revealed on Wednesday. “Progress in prevention and treatment is faltering around the world, putting millions of people in grave danger. Eastern Europe and central Asia, Latin America, and the Middle East and North Africa have all seen increases in annual HIV infections,” UNAIDS director Winnie Byanyima revealed at the release of the global body’s annual report, aptly named In Danger. “In Asia and the Pacific, UNAIDS data now shows new HIV infections are rising where they had been falling. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic.” Countries with the biggest increases in new HIV infections include Philippines, Madagascar, Congo and South Sudan, according to the report, issued just ahead of Friday’s opening of the 24th Annual AIDS conference, which opens Friday in Montreal, Canada. ‘Key populations’ account for 70% of new infections Some 70% of new infections are in groups designated by UNAIDS as “key populations” for their particular vulnerability to infection: men who have sex with men (MSM), sex workers, transgender people, people who inject drugs, and prisoners. In El Salvador between 2019 and 2021 HIV prevalence among MSM attending HIV testing clinics almost doubled, and increased eight-fold among transgender people. UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity. People who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk. “UNAIDS data showed insufficient progress on removing punitive laws that increase the risk of HIV infection and death for marginalized people including LGBTI people, people who inject drugs, and sex workers,” according to the report. “Closing the inequalities by removing punitive laws, promoting human rights and expanding community-led services is working in countries like Thailand,” said Byanyima. Gender inequality is also pushing infection, with an adolescent girl being infected with HIV every two minutes. In sub-Saharan Africa, girls and young women are three times more likely to acquire HIV than boys and young men their age. “Effective pandemic response means addressing gender inequalities. Botswana, for example, extended universal secondary education and found that for each additional year of schooling, there was a 12% reduction in girls’ risk of acquiring HIV,” said Byanyima. Racial inequalities also exacerbate HIV risk. In the UK and US, HIV declines have been greater amongst whites than blacks. In Australia, Canada and the US, indigenous communities are disproportionately affected by HIV. Caribbean, central and west Africa make progress “We have to sound the alarm. But let me be clear: this is not a council of despair. It is a call to action because even amidst these crises, we see remarkable resilience in some cases,” noted Byanyima. The bright spots include robust declines in annual HIV infections in the Caribbean, western and central Africa. South Africa, Nigeria, India and Tanzania had some of the most significant reductions in the numbers of HIV infections even amidst COVID-19. In eastern and southern Africa, cases decreased too – but fewer people started antiretroviral (ARV) treatment, fewer HIV tests were conducted, and voluntary medical male circumcision dropped by a third. A person dies of AIDS every minute “Every minute of 2021, the AIDS pandemic took someone’s life,” Byanyima revealed. Globally, 4000 people a day are still being infected with HIV and if current trends continue, 1.2 million people will be newly infected with HIV in 2025, which is three times more than the 2025 target of 370 000 new infections. UNAIDS is particularly concerned about treatment for children living with HIV, revealing that only half (52%) have access to life-saving medicine. While new HIV infections are still falling globally, last year the drop was only 3.6%, the smallest annual reduction since 2016. “These figures are about political will. Do we care about empowering and protecting our girls? Do we want to stop AIDS deaths among children? Do we put saving lives ahead of criminalization?” asked Byanyima. Donor funds plummet by 57% A key concern for UNAIDS is that HIV funds from bilateral donors other than the US has plummeted by 57% over the last decade. The 2022 replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) in September is a focal point for HIV activists at the International AIDS Conference due to start on Friday. Domestic HIV investments have not replaced lost international funding, mainly due to worsening economic conditions. “The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026,” according to the UNAIDS report. Dr Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases, described the report as a “wake-up call”. “There has been backsliding in the HIV response amid the COVID 19 pandemic,” said Fauci, who joined the media briefing virtually. “HIV diagnoses decreased in many countries, including in my own country. Harm reduction services to people who use drugs, and other vulnerable people have been widely disrupted. Reduced access to TB diagnosis and treatment resulted in an increase in TB deaths among persons with HIV in 2020.” Fauci added that US President Joe Biden was seeking $7.4 billion for the US President’s Emergency Plan for AIDS Relief (PEPFAR) in 2023, noting that PEPFAR has saved 21 million lives so far. “Over the past two and a half years, I have seen many similarities between COVID-19 and HIV. It saddened me how hard some patient groups need to fight for recognition, how stigma, misinformation, and denialism can promote illness and death, and how slowly interventions reach vulnerable populations,” said Fauci. Dr John Nkengasong, speaking for the first time as head of PEPFAR, said that the HIV response was “at a crossroads”. “If we have to bring back HIV to the fore, we have to think about political commitment, political will and political boldness to make sure that HIV AIDS is again not considered as the pandemic of the past,” said Nkengasong. Nkengasong committed to working with UNAIDS to address the “structural determinants” of HIV, particularly “on rights and issues of discrimination and stigmatisation of key populations”. 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