Policies will determine the end of AIDS by 2030, reveals UN report
The policy decisions taken by governments this year will determine whether the global commitment to end AIDS as a public health threat by 2030 will be met or not, said a new UNAIDS report released Monday.
The policy decisions taken by governments this year will determine whether the global commitment to end AIDS as a public health threat by 2030 will be met or not, said a new UNAIDS report released Monday.
The report, the Urgency of Now: AIDS at a Crossroads, shows that globally, of the 39.9 million people living with HIV, 9.3 million, or nearly a quarter, are not receiving life-saving treatment. Outside sub-Saharan Africa, which is the hardest hit, countries with the highest numbers of people living with HIV but not on treatment in 2023 were Brazil, India, Indonesia, Mexico, Pakistan and Thailand.
Leaders pledged to reduce annual new infections to below 370, 000 by 2025, but new HIV infections are still more than three times higher than that at 1.3 million in 2023, the report revealed.
“World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” UNAIDS executive director Winnie Byanyima said in a statement. “Leaders can save millions of lives, prevent millions of new HIV infections and ensure that everyone living with HIV can live healthy, full lives.”
If leaders take the bold actions to ensure sufficient and sustainable resourcing and protect everyone’s human rights, the number of people living with HIV, requiring lifelong treatment, will settle at around 29 million by 2050, the report estimated, but if they take the wrong path, the number of people who will need lifelong support will rise to 46 million, compared to 39.9 million in 2023.
There has been continued progress in rolling out medicines to people living with HIV, with 30.7 million people now on treatment, more than three in four people living with HIV. As recently as 2010, treatment coverage stood at just 47%. The expansion is a landmark public health achievement that has seen AIDS-related deaths halved since 2010, from 1.3 million to 630,000 in 2023.
However, the world is off track to meet the 2025 target of reducing AIDS-related deaths to below 250,000, the report said.
Although progress has been made in preventing new HIV infections, which have fallen by 39% since 2010, and by 59% in eastern and southern Africa, the report showed new HIV infections are rising in three regions -- the Middle East and North Africa, Eastern Europe and central Asia and Latin America.
“Countries are making enormous progress to end the AIDS epidemic by 2030. However, there have been many challenges that could slow our efforts,” said Anthony Fauci, former scientific advisor to the US President. “We must do everything we can to be continually vocal and proactive. Failure is not an option here. In fact, it is unthinkable. If we all work together, we shall meet our common goal.”
Gender inequality is exacerbating the risks faced by girls and women and driving the pandemic. HIV incidence among adolescent girls and young women is still extraordinarily high in parts of eastern and southern Africa and western and central Africa, said experts in the report.
Because stigma and discrimination against marginalized communities create barriers to vital prevention and treatment services, key populations, including sex workers, men who have sex with men and people who inject drugs, represent an increased proportion at 55% of new infections compared to 2010, which was 45%.
UNAIDS calculations showed that while 20% of HIV resources should be dedicated towards prevention for populations most affected by HIV, just 2.6% of HIV spending went towards interventions in 2023.
Around the world, funding is shrinking, holding back progress and even leading to rising epidemics in certain regions. In 2023, total resources available for HIV ($19.8 billion) dropped by 5% from 2022 and were $9.5 billion short of the amount needed by 2025 ($29.3 billion). Domestic funding in low- and middle-income countries, which make up 59% of total resources for HIV, is being constrained by the debt crisis and fell for the fourth consecutive year, with a 6% decline from 2022 to 2023.
Increased resource mobilization is needed, especially in Asia and the Pacific, where the numbers of people living with HIV are projected to almost double by 2050, and in Eastern Europe and Central Asia, Latin America and the Middle East and North Africa, regions with growing epidemics, but where funding for HIV has decreased significantly. Around half of the total resources needed by 2025, and 93% of the current HIV funding gap, are outside of sub-Saharan Africa.
“The fraying of solidarity between and within countries is putting progress in danger, but the path that ends AIDS is a path that has been proven, and is a path that leaders have promised to take,” said executive director Byanyima. “Whether leaders fulfil their pledge to end AIDS is a political and financial choice. The time to choose the right path is now.”