United Nations warns of rapidly growing disparity in HIV treatment

UNAIDS have warned a growing disparity between how HIV infections are tackled in wealthy countries and the rest of the world, and the COVID-19 situation has compounded the problem pushing back global progress in tackling the virus.

A new report from the world’s global leader on tackling HIV has been released at the start of AIDS 2020, the 23rd annual Global AIDS Conference which is being held for the first time in a virtual environment.

The Seizing The Moment report shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. Because the achievements have not been shared equally within and between countries, the global HIV targets set for 2020 will not be reached.

In December 2013 UN AIDS set the ambitious 90-90-90 targets for 2020. The goal was that by this year 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression.

While some countries have surpassed the ambitious targets, others have seen increases in the rates of new infections, creating an uneven playing field when looking at the challenge from a global perspective. There is also concern that COVID-19 will have a major impact on the treatment of HIV, and could push progress back by almost a decade.

The report warns that even the gains made could be lost and progress further stalled if we fail to act. It highlights just how urgent it is for countries to double down and act with greater urgency to reach the millions still left behind.

Experts still hope AIDS will not be a health concern by 2030

Winnie Byanyima (pictured), the Executive Director of UNAIDS, said it was important to recognise the areas where great progress had been made, and apply those lesson to other nations that are still struggling. The next goal is to make sure HIV/AIDS is no longer a health concern anywhere in the world by 2030.

“Every day in the next decade decisive action is needed to get the world back on track to end the AIDS epidemic by 2030,” Byanyima said. “Millions of lives have been saved, particularly the lives of women in Africa. The progress made by many needs to be shared by all communities in all countries. Stigma and discrimination and widespread inequalities are major barriers to ending AIDS. Countries need to listen to the evidence and step up to their human rights responsibilities.”

Fourteen countries have achieved the 90–90–90 HIV treatment targets by the end of 2019, they include Australia, Botswana, Cambodia, Eswatini, Ireland, Namibia, the Netherlands, Rwanda, Spain, Switzerland, Thailand, Uganda, Zambia and Zimbabwe.

Eswatini shows that major change is possible

One of the success stories is Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. Experts say the African nation, previously known as Swaziland, shows that major change is possible.

Millions of lives and new infections have been saved by the scale-up of antiretroviral therapy. However, 690 000 people died of AIDS-related illnesses last year and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment.

The country’s Prime Minister Abrose Dlamini, said he hoped eventually everyone in his country would be able to access treatment.

“We cannot rest on our successes, nor be discouraged by setbacks. We must ensure that no one is left behind. We must close the gaps. We are aiming for 100–100–100,” Dlamini said.

Around the world the effectiveness is reducing the number of new infections of the virus is a success story in some regions, while other parts of the world have seen a rapid increase in diagnoses. There has been progress in eastern and southern Africa, where new HIV infections have reduced by 38% since 2010. This is in stark contrast to eastern Europe and central Asia, which has seen a staggering 72% rise in new HIV infections since 2010. New HIV infections have also risen in the Middle East and North Africa, by 22%, and by 21% in Latin America.

Stigma and discrimination leave vulnerable people at risk

The report also shows unequal progress, with many vulnerable people and populations left behind. Around 62% of new HIV infections occurred among key populations and their sexual partners, including gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison, despite them constituting a very small proportion of the general population.

Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Marginalized populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention. The report warns that stigma against people living with HIV is still commonplace. At least 82 countries criminalize some form of HIV transmission, exposure or non-disclosure, sex work is criminalized in at least 103 countries and at least 108 countries criminalize the consumption or possession of drugs for personal use.

Women and girls in sub-Saharan Africa continue to be the most affected and accounted for 59% of all new HIV infections in the region in 2019, with 4500 adolescent girls and young women between 15 and 24 years old becoming infected with HIV every week. Young women accounted for 24% of new HIV infections in 2019, despite making up only 10% of the population in sub-Saharan Africa.

COVID-19 may have a major impact on addressing HIV

Experts have expressed concern in the report that the COVID-19 pandemic has seriously impacted the AIDS response and could disrupt it more. A six-month complete disruption in HIV treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths.

For Gracia Violeta Ross, President of the Bolivian Network of People Living with HIV, there is great concern that resources that were used to tackle HIV are being reassigned to the COVID-19 pandemic, and important lessons leaned over decades of fighting HIV are being ignored.

“Those of us who survived HIV and fought for life and access to treatment and care cannot afford losing the gains that took so much effort to win. In some Latin American countries we are seeing how HIV resources, medicines, medical staff and equipment are being moved to the fight against COVID-19,” Ross said in a press release annoncig the new report. “Some good lessons and practices of the HIV response, such as meaningful participation and accountability, are being ignored. We will not allow HIV to be left behind.”

Calls to maintain funding for HIV research and treatment

UNAIDS is also urging countries to increase investments in both diseases. In 2019, funding for HIV fell by 7% from 2017, to US$ 18.6 billion. This setback means that funding is 30% short of the US$ 26.2 billion needed to effectively respond to HIV in 2020. Winnie Byanyima says support for funding HIV initiatives has slowly been slipping down the global agenda for several years.

“We cannot have poor countries at the back of the queue. It should not depend on the money in your pocket or the colour of your skin to be protected against these deadly viruses,” Byanyima said. “We cannot take money from one disease to treat another. Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”

António Guterres, the United Nations Secretary General said like HIV before it, the COVID-19 pandemic needed significant funding to be tackled effectively, and addressing inequality around the globe was central to the success in battling both health concerns.

“Like the HIV epidemic before it, the COVID-19 pandemic is exposing our world’s fragilities—including persistent economic and social inequalities and woefully inadequate investments in public health. In many parts of the world, COVID-19 is colliding with the ongoing HIV epidemic.” Guterres said.

“As the latest UNAIDS report shows, the HIV epidemic remains enormous, unfinished business. Gender inequalities, gender-based violence and the criminalization and marginalization of vulnerable groups continue to drive HIV forward. This crisis is a wake-up call to do things differently. We need a recovery based on economic and social justice since response gaps in pandemics, whether HIV or COVID-19, lie along the fault lines of inequality.”

Graeme Watson

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