NEW YORK —The United Nations Secretary-General, António Guterres, has warned that despite intensive action and progress made against HIV in some places and population groups, HIV epidemics continue to expand in others and issued a set of 10 key recommendations. If followed by all countries, this will end the AIDS pandemic as a public health threat by 2030 as part of the Sustainable Development Goals.
In a new report, Addressing inequalities and getting back on track to end AIDS by 2030, the United Nations Secretary-General urges the world to address the inequalities that are slowing progress.
“It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” said Mr Guterres in the report.
“Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved for people living with HIV, communities and countries.”
The global targets set out in the General Assembly’s 2016 Political Declaration on Ending AIDS were missed by a long way, allowing the AIDS pandemic to grow in many regions and countries.
The staggering 1.7 million new HIV infections that occurred in 2019 are more than three times higher than the 2020 target of less than 500 000 new infections. In addition, the 690 000 AIDS-related deaths in 2019 far exceed the 2020 target of reducing deaths to fewer than 500 000 a year.
“Ending AIDS as a public health threat by 2030 is still within reach—many countries are showing that rapid progress against HIV is possible when evidence-informed strategies and human rights-based approaches are adopted,” said UNAIDS Executive Director Winnie Byanyima.
“But it requires bold political leadership to challenge and address the social injustices and inequalities that continue to make certain groups of people and entire communities highly vulnerable to HIV infection.”
The report notes that COVID-19 has caused additional setbacks. The United Nations Secretary-General warned that COVID-19 is not an excuse for missing AIDS targets, but rather a stark warning to the countries that they can no longer afford to underinvest in pandemic preparedness and responses.
At the same time, the COVID-19 pandemic has underscored the many spill-over benefits of HIV investments in health and development.
Community-led service delivery pioneered by the HIV response is helping to overcome the extraordinary impediments created by COVID-19.
The set of 10 recommendations to get the world back on track include: addressing inequalities and reaching all people living with or at risk of HIV infection to reduce the annual new HIV infections to under 370 000 and annual AIDS-related deaths to under 250 000 by 2025; prioritizing HIV prevention to ensure that 95% of people at risk of HIV infection have access to effective HIV prevention options by 2025; and eliminating new HIV infections among children.
The report underscores that addressing social and structural factors that perpetuate inequalities is key. It highlights, for example, how gender inequality, underpinned by harmful gender norms, restricts women’s use of HIV and sexual and reproductive health services by perpetuating gender-based violence and limiting decision-making power, including the ability of women and girls to refuse unwanted sex, negotiate safer sex and mitigate HIV risk.
It also shows how vulnerable, marginalized and criminalized communities, such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners and migrants, also remain at higher risk of HIV infection than the general population because they are not receiving essential information and HIV treatment, prevention and care services.
The United Nations Secretary-General describes how communities of people living with, at risk of and affected by HIV are the backbone of the HIV response. Initiatives led by people living with HIV, women, key populations, young people and other affected communities have identified and addressed key inequalities and service gaps, advocated for the rights of their constituents and expanded the reach, scale and quality of health services.
In the report, Mr Guterres applauds UNAIDS’ recently adopted Global AIDS Strategy 2021–2026: End Inequalities, End AIDS.
“The lessons from the countries, cities and communities that successfully fast-tracked their HIV responses over the last five years are at the heart of the UNAIDS Global AIDS Strategy 2021–2026,” said Mr Guterres.
“The global AIDS community and UNAIDS have used an inequalities lens to develop the strategy, with new targets that are ambitious, granular and tailored to reach the furthest behind first.”
The report comes 25 years after the creation of UNAIDS and describes how COVID-19 has exposed social inequalities and health system weaknesses.
The United Nations Secretary-General says that the world should leverage the experience from responding to the AIDS pandemic to strengthen health systems across the world and improve pandemic preparedness.
He also calls for enhanced global solidarity to close the HIV resource gap and increase annual HIV investments in low- and middle-income countries to US$ 29 billion by 2025.