HIV targets set for 2020 will not be reached, owing in part to deeply unequal access to antiretroviral therapy and service disruptions caused by the COVID-19 pandemic, according to a new UNAIDS report released on Monday.
The report – Seizing the Moment – warns that the remarkable achievements made in the fight to end AIDS have not been shared equally within and between countries.
Moreover, decades of hard-won gains could be lost if the world fails to act.
Missed targets have resulted in more than 3.5 million HIV infections and 820,000 AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. And the global AIDS response could be set back by 10 years or more if COVID-19 disrupts HIV services.
“Every day in the next decade, decisive action is needed to get the world back on track to end the AIDS epidemic by 2030,” said Winnie Byanyima, Executive Director of UNAIDS. “The progress made by many needs to be shared by all communities in all countries.”
Prevention efforts lagging
The world is far behind in preventing new HIV infections, the report finds. Some 1.7 million people were newly infected, reflecting more than three times the global target.
While progress has been made in eastern and southern Africa, where new infections have fallen by 38 per cent since 2010, eastern Europe and central Asia have seen a staggering 72 per cent rise in new HIV infections since 2010. New infections also rose by 22 per cent in the Middle East and North Africa, and by 21 per cent in Latin America.
“The HIV epidemic remains enormous, unfinished business,” Secretary-General António Guterres says in the report’s preface. “Gender inequalities, gender-based violence and the criminalization and marginalization of vulnerable groups continue to drive HIV forward.”
Indeed, the report finds that marginalized populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services - especially those related to contraception and HIV prevention. And stigma against people living with HIV is still commonplace, with 82 countries criminalizing some form of HIV transmission, exposure or non-disclosure.
Women, girls most affected
Women and girls in sub-Saharan Africa continue to be the most affected, accounting for 59 per cent of all new HIV infections in the region in 2019, with 4,500 adolescent girls and young women between 15 and 24 years old becoming infected every week.
Despite making up only 10 per cent of the population there, young women accounted for 24 per cent of new HIV infections.
However, transmission levels are reduced significantly in areas where HIV services are comprehensively provided, and high combination prevention options coverage have also narrowed inequality gaps and driven down incidences.
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A clarion call
The COVID-19 pandemic has already seriously impacted the AIDS response and threatens further interruption.
A six-month HIV treatment disruption could cause more than 500,000 additional deaths in sub-Saharan Africa between 2020 and 2021, bringing the region back to 2008 AIDS mortality levels, according to the report. And even a 20 per cent disruption could trigger an additional 110,000 deaths.
To fight the two colliding epidemics, UNAIDS and its partners are leading a global call for a “people’s vaccine for COVID-19, demanding that all vaccines, treatments and tests be patent-free, mass produced and distributed fairly and free for all”.
UNAIDS is also urging countries to bump-up investments in both diseases.