New global AIDS report shows uneven progress

  • by Liz Highleyman, BAR Contributor
  • Tuesday July 18, 2023
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UNAIDS Executive Director Winnie Byanyima. Photo: Courtesy UNAIDS
UNAIDS Executive Director Winnie Byanyima. Photo: Courtesy UNAIDS

There is a clear path to ending AIDS, and some countries have made great strides, according to the latest UNAIDS update released July 13 ahead of the International AIDS Society Conference on HIV Science in Brisbane, Australia. But inadequate funding and discrimination against key affected populations — including LGBTQ people — are impeding progress.

"The message [of the new report] is hopeful, but it is not the relaxed optimism that might come if all was heading as it should be. It is, instead, a hope rooted in seeing the opportunity for success, an opportunity that is dependent on action," stated UNAIDS Executive Director Winnie Byanyima. "The end of AIDS is an opportunity for a uniquely powerful legacy for today's leaders. They could be remembered by future generations as those who put a stop to the world's deadliest pandemic. They could save millions of lives and protect the health of everyone."

Further progress depends on following the evidence, tackling inequalities, enabling community organizations to play their vital role, and ensuring sufficient and sustainable funding, Byanyima said at a UNAIDS briefing to unveil the report, entitled "The Path that Ends AIDS."

Some 39 million people worldwide were living with HIV in 2022, according to the report. Nearly 30 million of them were on antiretroviral treatment, up from just 7.7 million in 2010. An estimated 1.3 million people were newly infected and 630,000 died from AIDS-related illnesses in 2022, bringing the total number of HIV cases to 86.6 million and total AIDS deaths to 40.4 million since the start of the pandemic. New infections have fallen by 59% from a peak of 3.2 million in 1995, while AIDS deaths have dropped by 69% from their peak of 2 million in 2004.

But progress is uneven. New HIV infections are rising in Eastern Europe and Central Asia, the Middle East and North Africa, and some countries in Asia and the Pacific, primarily due to a lack of prevention services for marginalized populations and barriers imposed by punitive laws and social discrimination, the report states.

Botswana, Eswatini, Rwanda, Tanzania, and Zimbabwe have already achieved the UNAIDS 95-95-95 targets, meaning 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of treated people have achieved viral suppression. Sixteen other countries — half of them in hard-hit sub-Saharan Africa — are close to reaching these goals.

But other countries are lagging behind, bringing down global percentages. Worldwide, an estimated 86% of HIV-positive people knew their status in 2022, leaving 5.5 million unaware that they have the virus. For the second target, 89% of people who knew their status, but just 76% of all people living with HIV were on antiretrovirals at the end of last year, leaving more than 9 million untreated. Finally, 93% of people on treatment, but only 71% of HIV-positive people overall, had achieved viral suppression.

The United States has not yet reached the UNAIDS 95-95-95 targets, though progress varies widely across cities, states, and regions. According to a recent report from the Centers for Disease Control and Prevention, 66% of people diagnosed with HIV were on treatment with an undetectable viral load in 2021.

Comparing San Francisco's progress is not straightforward because the Department of Public Health uses different metrics than UNAIDS. Based on the city's latest HIV epidemiology annual report, 97% of all residents living with HIV knew their status, 77% had received care, and 70% had an undetectable viral load in 2021. Citing DPH data, the Fast Track Cities website reports that 94% of people who were on treatment achieved viral suppression.

Discrimination impedes progress

Key populations, including adolescent girls and young women, gay and bisexual men, transgender people, people who use drugs, and sex workers continue to face stigma, discrimination and, in some cases, criminalization that keeps them from accessing the tools they need to prevent and treat HIV, the report states.

Worldwide, just over half of people living with HIV are women and girls, driven by high incidence (new cases) and prevalence (total cases) in Africa. UNAIDS estimates that some 4,000 adolescent girls and young women acquire HIV every week, three quarters of them in sub-Saharan Africa.

While less than 1% of the global adult population is living with HIV, prevalence is much higher among key populations. Some 10% of transgender people, 8% of gay and other men who have sex with men, 5% of people who inject drugs, and nearly 3% of sex workers are HIV-positive, according to the UNAIDS report.

A new law in Uganda that includes long prison sentences for same-sex relations and even for "promoting" homosexuality threatens to reverse the country's progress against HIV, the International AIDS Society recently warned.

"Uganda is not [a] special case. Anti-gay sentiment is deeply woven to the fabric of a lot of African societies," Keith Zenga King, a queer activist and writer in Uganda, said at the UNAIDS briefing. "In regard to HIV response, these laws deeply affect trans and gender-nonconforming people who have already been marginalized and minoritized."

Yana Panfilova of Ukraine, founder of the Eastern European and Central Asian youth advocacy group Teenergizer, added, "In some countries, it can feel safer to live in the shadows as a person living with HIV, as a refugee, or as a gay person than accessing the health services you need."

Inequalities that undermine the health and well-being of marginalized communities also threaten the HIV response in the United States, where new diagnoses among Black people are four times higher than those among people from other racial and ethnic groups, according to the report.

The good news is that several countries have recently rescinded harmful laws, including five that decriminalized same-sex relations in 2022 or 2023 (Antigua and Barbuda, the Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore).

Funding for HIV declined last year, falling back to the same level as 2013, the report notes. UNAIDS estimates that approximately $29.3 billion will be needed by 2025 to get the response back on track in low- and middle-income countries, but only $20.8 billion was available at the end of 2022.

"The new data released today by UNAIDS makes it clear that with strong political leadership and adequate funding, we can end AIDS as a public health threat," said Peter Sands, executive director of the Global Fund. "To achieve that goal, we must also be smart in how we invest, building more inclusive, resilient, and sustainable systems for health that can ensure everyone, everywhere, has access to the services they need for good health and well-being."

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