UNAIDS reports that global 2020 targets will not be met, and COVID-19 could make things even worse

The latest report from UNAIDS shows that whilst remarkable progress has been made that progress has been highly unequal especially when it comes to access to HIV treatment. As a result of this the global targets set for 2020 will not be reached.

The report, Seizing the moment, also warns that gains we’ve already made could be lost and progress stalled if we continue to fail to act, and that the current COVID-19 epidemic could see much of that progress undone.

Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally supressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95. However, missed targets have resulted in 3.5 million more HIV infections and 820,000 more AIDS-related deaths since 2015 compared to if the world was on track to meet the 2020 targets.

“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, the Executive Director of UNAIDS. “Millions of lives have been saved, particularly the lives of women in Africa. The progress made by many needs to be shared by all communities in all countries. Stigma and discrimination and widespread inequalities are major barriers to ending AIDS. Countries need to listen to the evidence and step up to their human rights responsibilities.”

Whilst millions of lives have bee saved by the scaling up of access to antiretroviral HIV therapy last year alone 690,000 people died of AIDS-related illnesses and out of the 38 million people living with HIV 12.6 million (33%) had no access to the life-saving treatments.

Last year 1.7 million people were newly infected with HIV, more than three times the 2020 global target. Progress on tackling new infections has varied wildly by country and region. Eastern and Southern Africa have reduced new HIV infections by 38% snice 2010, where are in Eastern and Central Asia new infections have seen an eyewatering 72% increase in the same period. Rises in infections were also seen I the Middle East (22%) and Latin America (21%).

New HIV infections also continue to disproportionately impact vulnerable and marginalised people with 62% of new infections occurring in key populations such as gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison.

Stigma and discrimination, along with the social inequalities they perpetuate, continue to be barriers to testing and treatment of these marginalised populations. Fear of judgement, arrest, violence and even death hinder access to sexual and reproductive healthcare – especially contraception and HIV prevention/care.

At least 82 countries around the world still criminalise some sort of HIV transmission, exposure, or non-disclosure. Sex work is criminalised in at least 103 countries and at least 108 criminalise the personal use and possession of drugs.

Women and girls in Sub-Saharan Africa continue to be one of the most affected population in the world and last year accounted for 59% of all new HIV infections in the region.

This new report also states that the COVID-19 pandemic has seriously harmed the ongoing HIV & AIDS response and threatens to disrupt it even further. It is estimated that a six-month interruption in HIV treatment could cause more than half a million deaths in Sub-Saharan Africa in 2020/21 alone which would throw the region back to their 2008 mortality levels.

“Those of us who survived HIV and fought for life and access to treatment and care cannot afford losing the gains that took so much effort to win. In some Latin American countries we are seeing how HIV resources, medicines, medical staff and equipment are being moved to the fight against COVID-19,” said Gracia Violeta Ross, President of the Bolivian Network of People Living with HIV. “Some good lessons and practices of the HIV response, such as meaningful participation and accountability, are being ignored. We will not allow HIV to be left behind.”

UNAIDS is also urging countries to increase investments in both diseases. In 2019, funding for HIV fell by 7% from 2017, to $18.6 billion. This setback means that funding is 30% short of the $26.2 billion needed to effectively respond to HIV in 2020.

“We cannot have poor countries at the back of the queue. It should not depend on the money in your pocket or the colour of your skin to be protected against these deadly viruses,” said Ms Byanyima. “We cannot take money from one disease to treat another. Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”