The fight against HIV needs new impetus. As we feared at the onset of COVID-19, the pandemic has had a devastating impact on progress made against HIV and AIDS. Even before COVID-19, however, we were far from our goals of reducing new infections and deaths from HIV. Now we are definitely off track.
Stark inequalities – both within and between countries – continue to fuel the spread of HIV and AIDS. Persistent human rights violations and gross gender inequalities prevent us from progressing towards our goal of ending the virus as a public health threat by 2030. In 2021, most of the 1.5 million new infections occurred among the most marginalized and vulnerable people. While the number of people on life-saving antiretroviral treatment in 2021 – 28.7 million – is a record, it is staggering that there are still nearly 10 million people worldwide living with HIV without any treatment.
On World AIDS Day, we must renew our commitment to extending the HIV response to all people at risk, especially the most neglected communities. For example, only half of children infected with HIV get the life-saving treatment they need. This is unacceptable but so is the fact that thousands of children continue to be born infected with HIV even though we know how to prevent it.
Equally unfair is the impact of HIV on adolescent girls and young women. Every two minutes, a young woman is infected with HIV. Four decades after the initial emergence of HIV, AIDS remains the leading cause of death for women of reproductive age. This is an extremely worrying indicator of gender inequality in global health.
We have the tools to deliver effective prevention and treatment services to those who need them most, but far too many people cannot access them or are receiving suboptimal services. Think of the many children who receive antiretroviral treatment but with older generation drugs, less effective and with more side effects. This, coupled with poor adherence support, results in less effective viral suppression. In addition to expanding treatment coverage, we need to accelerate the transition – in children – to the latest antiretroviral drug treatments, dolutegravir-based. This pharmacological formulation is more effective, cheaper and better tolerated by children.
In addition to ensuring access to the best tools and therapeutic approaches to all people at risk, we must be even more determined to break down barriers to human rights, gender inequalities and other injustices that increase their vulnerability to HIV.
It is because of this critical dimension of rights and equality that the fight against HIV and AIDS has always been about more than just an effort to defeat a particular virus. Since the spread of HIV is attributable to inequality, defeating it means making the world better and more inclusive.
In that sense, the fight against HIV serves as an inspiration and starting point for defeating all other infectious diseases – those we are dealing with now, including COVID-19, and those likely to arise in the future. As the COVID-19 pandemic evolves from an acute emergency to a long-term fight against a formidable pathogen, many lessons can be learned from our 40-year fight against HIV; not least the fact that pandemics such as these generally continue to cause death and disruption in poorer communities for many years after the perception of the threat diminishes in wealthier countries.
Not only does it cost millions of lives not to finish these fights, but it also contributes to the cycle of panic and carelessness that has repeatedly characterized our response to pandemics. As one pandemic rages on, preventing the next requires urgent policy action. However, as soon as the threat diminishes, the momentum to invest in a stronger response quickly subsides.
The solution is to finish the fight against existing pandemics while preparing for the next ones. Investing in scientific research against pathogens serves to combat both existing and potential pathogens, especially since most new infectious diseases are not completely new but arise from existing ones. An advance of the COVID-19 has, for example, manifested itself with SARS and MERS.
By adopting this kind of approach, we can protect everyone from the deadliest infectious diseases – those that are taking their lives now, such as HIV, tuberculosis, malaria and COVID-19 – and those that will inevitably emerge in the future.
In a world where conflicts and climate change are exacerbating the threat of infectious diseases, we cannot let our guard down. We must work harder and more effectively to defeat the deadliest infectious diseases, build resilient and sustainable health systems so that no one is left behind.
This is how we will contribute to the dream of truly universal health coverage and deliver on the promise of the Sustainable Development Goals. The fight against HIV and AIDS is at the heart of this effort.
Peter Sands is Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Winnie Byanyima is Executive Director of UNAIDS.