It is still “possible” to end AIDS as a public health threat by 2030, but a growing funding gap is holding back accelerating progress, the United Nations said on Thursday. The roadmap presented in the new UNAIDS report “shows that success is possible during this decade”, underlines the executive director of the organization, Winnie Byanyima.
The role of financial investment
Ending AIDS is first and foremost a political and financial choice, according to UNAIDS, which is leading global action to end the AIDS epidemic as a public health threat by 2030, as part of of the Sustainable Development Goals adopted in 2015. The organization calls for fighting inequalities, supporting communities and civil society organizations in the response and ensuring adequate and sustainable funding.
Winnie Byanyima notes in this regard that progress has been greatest in the countries and regions that have invested the most financially, citing Eastern and Southern Africa where new infections have decreased by 57% since 2010. Botswana, Eswatini, Rwanda, Tanzania and Zimbabwe have already achieved the so-called “95-95-95” targets: 95% of people living with HIV know their HIV status, 95% of these people are on treatment life-saving antiretroviral and 95% of people on treatment have a suppressed viral load (and therefore no longer transmit the virus).
Sixteen other countries, including eight in sub-Saharan Africa – the region where 65% of HIV-positive people live – are on track to achieve this target. Thailand, Kuwait, Saudi Arabia and Denmark are also on this list.
Another death every minute
The number of people on antiretroviral treatment worldwide has increased from 7.7 million in 2010 to 29.8 million in 2022, while new infections have fallen by 59% since their peak in 1995. In addition, 82% of pregnant and breastfeeding women living with HIV globally had access to antiretroviral therapy in 2022, up from 46% in 2010. These efforts have resulted in a 58% drop in new infections among children between 2010 and 2022, the highest level low since the 1980s.
“The end of AIDS is an opportunity for today’s leaders to leave a legacy of exceptional power,” notes Winnie Byanyima, in the roadmap. “Future generations will remember them as those who put in place the policies, programs and investments that brought about the end of the world’s deadliest pandemic,” she continues. In 2022, one person would still die every minute from AIDS, and around 9.2 million people are still not on treatment, including 660,000 HIV-positive children. Several obstacles are holding back the acceleration of progress.
Funding down
In 2022 and 2023, five (Antigua and Barbuda, Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore) decriminalized same-sex sexual relations. But laws that criminalize most-at-risk populations or their behaviors are still in effect across much of the world, UNAIDS said. The vast majority of countries (145) criminalize the use or possession of small amounts of drugs, 67 countries criminalize consensual same-sex sexual activity, and 20 countries criminalize transgender people.
In addition, 143 countries criminalize or prosecute HIV exposure, non-disclosure or transmission of the virus. When “leaders ignore, isolate and criminalize people living with HIV or at risk of infection, progress in the AIDS response is hampered and more and more people contract the virus,” points out UNAIDS. Another daunting challenge is financing the global response. After increasing considerably in the early 2010s, it fell back last year to the same level as in 2013.
In 2022, a total of $20.8 billion was available for HIV programs in low- and middle-income countries, down 2.6% from 2021 and well below the 29.3 billions of dollars deemed necessary by 2025.