The HIV Response Is in Danger and the Promise of Ending Aids Is Under Threat

The promise of ending HIV is under threat.

The HIV response is in danger and the promise of ending AIDS is under threat, writes Patricia Ongpin, UNAIDS Country Director for Laos, Cambodia, and Malaysia, in an Op-ed.

Last year, world leaders came together at the United Nations in New York and agreed to a groundbreaking Political Declaration on HIV and AIDS. That plan takes on the inequalities that drive the pandemic by setting ambitious strategies and targets to dramatically reduce new HIV infections, reduce AIDS-related deaths by 2025, and end the AIDS pandemic as a global health threat by 2030 – if world leaders fulfill it.

But the world, including Laos, is not on track to meet its targets.

Data just released in the new UNAIDS report, In Danger, reveals that the world is not on course to end AIDS by 2030. The 3.6% reduction in global HIV infections in 2021 is the smallest annual fall since 2016. On the current trajectory, there will be a projected 1.2 million new HIV infections worldwide in 2025, more than three times higher than the target of 370 000.

Eastern Europe and Central Asia, the Middle East and North Africa, and Latin America have all seen increases in annual HIV infections over several years. In Asia and the Pacific—the world’s most populous region—UNAIDS data now shows new HIV infections are rising where they had been falling. Climbing infections in these regions are alarming

The human cost of a stalled HIV response is chilling. Globally, more than 1.5 million people became infected with HIV last year. That’s 4,000 people every day, more than a quarter of them young people aged 15-24. Women and girls accounted for 49% of all new infections in 2021. Worldwide, an adolescent girl or young woman acquires HIV every two minutes. Although affordable treatments are available to prevent most AIDS-related deaths, 650 000 people died of AIDS-related illnesses in 2021.

In Laos, although the estimated number of new HIV infections are falling and more people are receiving treatment annually, we must go further faster to better protect those most vulnerable to HIV transmission and empower people living with HIV with treatment and other life-saving support. The concern for overall wellbeing is further underlined by the number of AIDS-related deaths and a considerable number of clients lost to treatment follow-up. Concerted, holistic, multi-sectoral, and sustainable approaches are needed from all stakeholders in the Lao PDR national HIV response, including leveraging on the valuable and unique support from PLHIV and key population communities and networks

The COVID-19 pandemic, the war in Ukraine, and the global economic crisis have created extraordinary headwinds that threaten national AIDS responses. Global solidarity is fraying, richer countries are cutting or redeploying humanitarian budgets, low- and middle-income countries are saddled with debt repayment and being forced to cut back spending on essential services like health and education, and, in many countries, there is a lack of political will to challenge inequalities, gender-based violence and the criminalization and marginalization of vulnerable groups of people that continue to drive HIV infection levels.

In Laos, the COVID-19 pandemic caused disruptions to HIV prevention, treatment, and care services. However, innovations developed to cope with these disruptions, such as scaling up the community-based ART delivery model, multi-month dispensing policies, and telehealth services, will serve to bolster inclusive and quality HIV service delivery to those most in need. However, inequalities, stigma, and discrimination remain which result in the most marginalized not accessing HIV-related services.

The human and financial cost of not ending AIDS by 2030 would far outweigh the cost of the immediate and necessary action to turn the ship around.

The good news is that success is possible, and we know how to do it. Examples of these achievements can be found in the Asia and Pacific region, such as the use of digital technologies and community-led services to reach more key populations, especially young people, in the Philippines and Thailand; scale-up of HIV testing and reduction of new infections in Vietnam; and scale-up of PrEP in Cambodia.

Here are five ways that countries can defend and expand their HIV response.

  • Address the inequalities that stop people from receiving HIV prevention, testing, and treatment services. In diverse settings, countries and communities are taking action to end inequalities and close gaps. Building on this momentum, policymakers need to strengthen their understanding of localized epidemics to focus on eliminating the inequalities that slow progress against the pandemic.
  • Realize human rights and gender equality. Punitive, discriminatory, counterproductive laws and policies must be removed. The human rights of women and girls, including their sexual and reproductive rights, must be upheld. Countries must prioritize and integrate focused, well-resourced efforts to end gender-based violence into national HIV responses.
  • Make a new push for HIV prevention. Countries urgently need to elevate the political and financial prioritization of HIV prevention, including providing comprehensive sexuality education in and out of school, and move to large-scale implementation of prevention projects so that innovations such as PrEP and long-acting injectables become much more widely accessible, especially to vulnerable groups of people like young women and adolescent girls, gay men and other men who have sex with men, sex workers, people who use drugs and transgender people.
  • Support and effectively resource community-led responses. Countries must recognize the essential role of community-led responses and integrate them into national HIV planning, implementation, and monitoring. Communities should be effectively resourced and laws that impede community-led responses should be removed.
  • Ensure sufficient and sustainable funding. Major new investment and innovative programmatic and financial mechanisms are needed to ensure a fully funded global AIDS response, both from international donors and governments in low- and middle-income countries. Coordinated international action is also required to alleviate the debt crisis facing too many countries and to counteract the need for short-sighted and counterproductive national austerity measures.

In Laos, two key priorities for urgent action are to increase efforts and allocations to prevention and treatment interventions (especially for key population groups) and to increase investments and allocative efficiencies of the HIV response to deliver high-impact interventions. These are critical to building greater momentum in the national HIV response and ensuring that nobody is left behind.

Ending AIDS is a promise that can and must be kept.

Patricia Ongpin
Patricia Ongpin, UNAIDS Country Director for Laos, Cambodia, and Malaysia.

The views expressed in this article are those of its authors and do not necessarily reflect the views of the Laotian Times.