To End AIDS by 2030, We Must Tackle Health Inequities
By Mandeep Dhaliwal, Director of HIV, Health and Development, UNDP; Ludo Bok, Manager, SDGs and UNAIDS, HIV, Health and Development Group, UNDP
This has been a historic year for scientific innovation, but even the most advanced science only realises its full potential if it can be delivered to those in need — a dynamic we are watching play out not only with COVID-19 diagnostics, therapeutics, and vaccines, but also with innovations for HIV.
Last month, results from a new clinical trial revealed the injectable drug cabotegravir to be remarkably effective at preventing HIV in women, giving the world a powerful new tool in the fight to end AIDS by 2030. This newer regimen works with just six shots a year, marking a significant leap forward in preventing acquisition of HIV worldwide, particularly where gender inequality, stigma, discrimination and HIV prevention remain major challenges.
Cabotegravir and other new technologies present exciting opportunities for the HIV response and reaching our 2030 target of ending AIDS, but they must be accessible to vulnerable and marginalized communities. This World AIDS Day, it’s time we step up our shared responsibility and put an end to discriminatory laws, dangerous stigma and other structural barriers impeding universal access.
The world has made some important strides, but these have come much too slowly, and marginalized communities continue to be disproportionately affected. It took 25 years to halve the number of new HIV infections among adolescent girls, who despite this progress, still account for 3 in 4 new cases among all adolescents. In 2019, 62% of new adult HIV infections occurred among key populations — including sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, prisoners — and their sexual partners. Persistent barriers, like stigma, discrimination and social exclusion, place these and other communities at a much higher risk of acquiring HIV than the general population, and it often takes much longer for them to gain access to the latest innovations.
Amid COVID-19, these inequities have only deepened. LGBTIQ+ populations and sex workers have been subject to further violence and human rights abuses, and in some countries, have been left out of COVID-19 responses. People who are incarcerated continue to face a heightened risk of sickness and death in prisons around the world, even as some risk their lives to support pandemic response. Since the start of the coronavirus crisis, women and girls have also been disproportionately affected by lockdown measures, exacerbating the challenges they face with growing care burdens, fewer working hours and alarming increases in gender-based violence. School closures have also interrupted girls’ education, in some cases leading to higher rates of early pregnancies and child marriage. Many countries have not achieved universal health coverage, forcing the most vulnerable to pay for their own care out-of-pocket and compounding existing inequities.
The data points us to a stronger focus on those left furthest behind, but resources are alarmingly low where they are needed most. A recent report from Aidsfonds found that only 2% of funding for HIV programs goes to key populations in low- and middle- income countries, despite their higher burden of HIV. The situation isn’t poised to improve, as the economic fallout from COVID-19, decreases in funding, and a changing financial landscape for health and development leaves the global AIDS response at a relative standstill even as scientists continue to deliver promising innovations like cabotegravir.
To help the most vulnerable and marginalized people, governments must work together and find innovative ways to scale up targeted investments in prevention, diagnosis and treatment programs, especially those that are community-led. Community organizations, including those led by key populations, have played a pivotal role in getting communities the care they need before and during the COVID-19 pandemic, using innovative approaches and long-standing relationships to deliver services safely, effectively and without stigma or discrimination. Amid lockdowns, community health workers have been essential to ensuring HIV care continues despite service disruptions.
While these kinds of community-based approaches are highly effective, they are still underfunded, particularly in resource-limited settings. Governments, donors, and civil society need to work together to build a healthier world where universal health coverage is a reality for all, innovations are readily accessible and laws and policies are enabling and empowering. Decision-making bodies and processes must include women and marginalized communities, which will help further gender equality, understanding and acceptance at all levels of society and support those living on the margins to survive and thrive.
We have the tools needed to end AIDS. We must translate our solidarity into the bold action needed to end discriminatory laws, stigma and other structural barriers which are fuelling inequities and driving infections and deaths. Together we can protect the rights of all and achieve the healthier societies we need to heal from this crisis.
