It’s all in the headline: “Erosion of progress against AIDS puts millions of lives at risk”. It is the one chosen for the latest UNAIDS report on the state of the fight against AIDS in the world. He is not good. “Advances in prevention and treatment are slowing around the world, putting millions of people at great risk,” the UN agency said. Several side effects explain this. For several years, “Eastern Europe and Central Asia, Latin America, the Middle East and North Africa have recorded an increase in annual HIV infections”. “Asia-Pacific data update [de l’agence] show an increase in new HIV infections where they had been declining. As cases increase, so do the “inequalities that are fueling the AIDS epidemic.” They are not being contained, although their end “would avoid millions of new HIV infections [durant] this decade” and would bring about the end of this pandemic.
As has been pointed out – this is not the first report to make this finding – the weak progress of recent years has been undermined by a “slowing down of progress in the fight against the HIV pandemic” and “cutting of resources”. This has accelerated over the past two years with the outbreak of Covid-19 and then other global crises (e.g. Russia’s invasion of Ukraine), putting millions of lives at risk.
The new UNAIDS report ‘In Danger’ (as it is officially titled) was launched ahead of the start of the AIDS Conference 2022 in Montreal, as a warm-up to the issues that needed to be discussed for participants, but also as a warning. Globally, the number of new HIV infections fell by just 3.6% between 2020 and 2021, the lowest annual decline since 2016, the UNAIDS document explains. In various regions (Eastern Europe, Central Asia, Middle East, North Africa, Latin America, etc.), cases are no longer decreasing or are even increasing. The resurgence of infections in these regions is alarming. “In eastern and southern Africa, momentum has slowed significantly in 2021 after years of steady progress,” UNAIDS said. Of course, the agency wants to show that there is some encouraging data: New HIV infections in West and Central Africa and the Caribbean are falling dramatically.
However, all regions of the world, whether they are seeing a decrease or an increase in cases, see their HIV response threatened by reduced resources. “These data show that the global fight against AIDS is in serious jeopardy. Unless we make rapid progress, we will lose ground as the pandemic thrives in the context of Covid-19, mass displacement and other crises. Let’s not forget the millions of preventable deaths we’re trying to prevent,” said UNAIDS Executive Director Winnie Byanyima, but it seems we’re hearing little.
Stagnation = infections
This stagnation has resulted in around 1.5 million new infections in 2021, more than 1 million above global targets. These goals must be met if we are to reach the end of the epidemic in 2030.
New infections have disproportionately affected young women and adolescent girls – this has been the case in previous years – with one new infection every two minutes in this demographic in 2021. Sex, particularly among young African women and girls, has taken place against a background of disruption of essential HIV prevention and treatment services, pandemic-related school truancy of millions of girls and spikes in teenage pregnancy and gender-based violence,” the report analyzes. In sub-Saharan Africa, adolescent girls and young women are three times more likely to get HIV than adolescents and young men.
Exposed key populations
In recent years, key populations have been particularly affected in many communities, with prevalence rising again in many places, the report points out. In addition, ethnic inequalities exacerbate the risk of HIV. In the United Kingdom and United States, new HIV diagnoses have declined more among white populations than among black people. In countries such as Australia, Canada and the United States, HIV incidence rates are higher in Aboriginal communities than in non-Aboriginal communities. The report also points to a “declining” effort to ensure access to life-saving antiretroviral treatment for all HIV-positive people. In 2021, the increase in the number of people on treatment for HIV was the lowest in more than a decade. Although three-quarters of all HIV-positive people have access to antiretroviral treatment, about 10 million others do not have access, and only half (52%) of HIV-positive children have access to life-saving medicines. Here, the gap between anti-HIV treatment coverage in children and adults is widening rather than narrowing, UNAIDS points out.
One death per minute
“In 2021, the AIDS pandemic was responsible for an average of one death per minute, or 650,000 AIDS-related deaths, despite the existence of effective HIV treatment and tools to prevent, detect and treat opportunistic infections,” the report said. “These figures are entirely dependent on political will. Do we care about empowering and protecting our daughters? Do we want to end AIDS deaths among children? Would we rather save lives than criminalize? asked Winnie Byanyima. “If we want to, then we have a duty to close the gap in the fight against AIDS. » There are significant differences between countries. The Philippines, Madagascar, the Democratic Republic of the Congo and South Sudan are among the countries that have seen the sharpest increases in the number of new HIV infections since 2015. In contrast, South Africa, Nigeria, India and the United Republic of Tanzania have seen some of the sharpest declines in the number of HIV infections, including in the context of Covid-19 and other crises. There is therefore a lot of room for maneuver if states agree on real efforts to fight AIDS.
The UN report describes the “devastating consequences of not taking urgent action to address the inequalities fueling the pandemic”. “It shows that at the current rate, the number of new infections per year would exceed 1.2 million in 2025. This year coincides with the deadline set by United Nations member states to reduce the number of new HIV infections to less than 370,000, meaning that humanity has not fulfilled its promise in terms of new infections, but that the latter have exceeded would be three times higher than this target”. It’s easy to understand that millions of preventable HIV infections each year complicate action and increase costs to ensure people living with HIV have access to life-saving treatments and that goals of ending the AIDS pandemic are met here by 2030.
Added to this is the international context (Covid-19 pandemic, war in Ukraine) which fuels the risks for the response to HIV and systemic problems: for example debt repayments. “Debt repayments for the world’s poorest countries have reached 171% of all spending on health, education and social protection combined, stifling their ability to respond to AIDS, says UNAIDS. Domestic funding for HIV control in low- and middle-income countries has been falling for two years.” And the report points out: “One of the consequences of the war in Ukraine is the significant increase in food prices worldwide. This exacerbates food insecurity for HIV-positive people around the world and makes HIV treatment disruptions much more likely.”
We need more solidarity
“At a time when we need international solidarity and more funding more than ever, too many high-income countries are cutting aid and financing for global health is at serious risk. In 2021, the international funding available for HIV was 6% lower than in 2010. Foreign development assistance for HIV provided by bilateral donors other than the United States of America has fallen by 57% over the past decade” , concerns UNAIDS. “HIV response in low- and middle-income countries is $8 billion below what is needed by 2025 and promising long-acting HIV treatments. They also keep prices too high for these countries to buy in bulk.” Today, global solidarity is stagnating as international support is needed more than ever. Nevertheless, Winnie Byanyima wants to believe that those responsible are always able to steer the reaction back on the right track. This requires both national action and international solidarity; but we are still a long way from that.
In June 2021, leaders agreed on a roadmap to end AIDS by 2030 if fully adhered to. The goal is achievable and affordable. In other words, “Eradicating AIDS will cost much less than continuing to live with AIDS.” It is important to note that the actions needed to end AIDS will also allow humanity to be better protected from the threats of future pandemics. The argument could also bear fruit in the current context. Firm in his convictions, Winnie Byanyima recalled when the report was released In danger “We can end AIDS by 2030 as promised (…) but it takes a bit of courage. Who hears him?
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