The global AIDS response is faltering, putting millions of lives in danger

The 24th International AIDS Conference, taking place this week in Montreal and bringing together thousands of activists, scientists and policymakers, could not have come at a more vital time. For over two decades, this conference has been a moment to celebrate life-saving advances against the AIDS pandemic. This year, however, the Joint United Nations Programme on HIV/AIDS (UNAIDS) is releasing new data that will sound an alarm: we are not on track to end AIDS, and millions of lives are at risk. We can turn this around, but in this particular emergency, the only safe response is to be bold.

Our report, In Danger, reveals that progress against the HIV pandemic has faltered, inequalities have widened, and resources have shrunk. Globally the number of new infections dropped only 3.6 per cent between 2020 and 2021, the smallest annual decline since 2016. Faltering progress meant 1.5 million new HIV infections occurred last year – over 1 million more than global targets.

Stalled progress against AIDS is a consequence, and a cause, of inequalities. Every two minutes in 2021, an adolescent girl or young woman was newly infected with HIV. In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men. The COVID-19 crisis has disrupted key HIV prevention services and education, prevented millions of girls from a potential return to school, and caused a spike in teenage pregnancies and gender-based violence – all of which puts many girls at increased risk for HIV.

The AIDS pandemic took a life every minute in 2021, causing 650,000 deaths worldwide. If this trend continues, we will miss the UN target of ending AIDS as a public health threat by 2030, resulting in 7.7 million additional AIDS-related deaths.

The number of people receiving HIV treatment grew more slowly in 2021 than it has in over a decade: while three-quarters of all people living with HIV have access to antiretroviral treatment, approximately 10 million people do not.

Only half of children living with HIV have access to life-saving medicine, and the inequality in HIV treatment coverage between children and adults is increasing rather than narrowing.

Amidst crisis, however, we have also seen resilience in a diverse range of countries, from Lesotho to Vietnam. These exemplars of effective pandemic response have achieved remarkable progress in reducing new HIV infections and in increasing access to treatment.

But we are also not moving fast enough to end the inequalities that drive pandemics. In some cases, we are also moving in the wrong direction, favouring tech monopolies instead of tech sharing, austerity instead of investment, clamping down on marginalized communities instead of repealing outdated laws and promoting and enabling inclusive, community-centred care.

The COVID-19 crisis and the war in Ukraine have impacted the global HIV response, putting a growing number of countries and communities at risk. Debt repayments for the world’s poorest countries reached 171 per cent of all their spending on health care, education and social protection combined, choking countries’ capacities to respond to AIDS. Domestic funding for the HIV response in low- and middle-income countries has fallen for two consecutive years.

The Ukraine war has dramatically increased global food prices, worsening food insecurity for people living with HIV across the world, making them much more likely to experience interruptions in HIV treatment.

When international support has been most needed, global solidarity has stalled. Overseas development assistance for HIV from bilateral donors other than the United States has plummeted by 57 per cent over the last decade.

Domestic and international resources needed to end AIDS by 2030 are increasingly under threat. Leaders must not mistake this huge red warning light for a simple stop sign.

Insufficient investment and action are putting all of us in danger. We need to be frank: our current path would lead us to millions of AIDS-related deaths and millions of new HIV infections. But this is not a counsel of despair, it is a call to action.

Ending AIDS would cost much less money than not ending AIDS. Importantly, the actions needed to end AIDS will also help us in combatting other illnesses and in protecting ourselves against the threat of future pandemics.

What we need to do is not a mystery. We’ve repeatedly seen the elements for success work across different contexts: we have to commit to shared science, strong services and social solidarity. This was the pledge made at the United Nations General Assembly High-Level Meeting on HIV/AIDS in June last year: end the AIDS pandemic by ending the inequalities that perpetuate it.

We can end AIDS by 2030. But the curve will not bend itself. We have to pull it down, together.

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Originally published by The Globe and Mail, adapted from the UNAIDS Global AIDS Update 2022: 'In Danger.'

Watch the launch of the Global AIDS Update 2022.

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