What could possibly explain why, despite having more tools than ever before to prevent, diagnose, and treat HIV — the human immunodeficiency virus — so many people in the Americas, which includes Jamaica, are still not being reached?

Health authorities generally accept that expanding access to innovations such as oral pre-exposure prophylaxis (PrEP), long-acting injectable PrEP, rapid testing, and HIV self-testing, will be essential to the elimination of HIV as a public health problem in the region.

The issue was robustly ventilated at the recent 26th International AIDS Conference in Rio de Janeiro, Brazil, where Pan American Health Organization (PAHO) Director Dr Jarbas Barbosa took the floor during the opening session.

Dr Barbosa emphasised that the Americas have repeatedly demonstrated that ambitious public health goals can be achieved through cooperation, scientific evidence, and strong health systems.

As examples, the region has eliminated polio and rubella, and several countries have eliminated mother-to-child transmission of HIV, achievements that provide a strong foundation for accelerating progress toward HIV elimination.

But there is no doubt that achieving this goal would require combining innovations in prevention, diagnosis, and treatment with political leadership, equity, and close collaboration with communities. We are not in the least surprised by this.

It was, of course, heart-warming to note that countries in Latin America and the Caribbean now finance 92 per cent of HIV investments through domestic resources, representing one of the highest levels of domestic funding for HIV programmes globally and demonstrating the region’s sustained commitment to HIV response. So that is not the problem.

The real question, Dr Barbosa argued, is “whether we can ensure that those tools reach everyone who needs them, regardless of where they live, who they are, or the circumstances they face”. Indeed, innovation only changes lives when people can access it.

For those who might be tiring in the long and sustained battle against AIDS, the conference bore positive and encouraging news. AIDS-related deaths in Latin America and the Caribbean declined by 46 per cent between 2010 and 2025.

Further, in 2024 alone, access to antiretroviral treatment prevented an estimated 117,000 AIDS-related deaths; and access to PrEP also increased substantially, from 35,000 people in 2020 to more than 326,000 in 2025.

Yet, and this is the mystery, despite this progress, approximately one in three new HIV diagnoses is still made at a late stage of infection, and nearly 900,000 people living with HIV in Latin America and the Caribbean are not receiving treatment.

Late diagnosis, delays in treatment initiation, and challenges in retaining people in care continue to contribute to preventable deaths and to the burden of co-infections such as tuberculosis, which remains the leading cause of death among people with advanced HIV disease, PAHO disclosed.

In response, PAHO has launched the Alliance for HIV Elimination in the Americas, a new regional platform designed to advance progress towards HIV elimination by 2030, through stronger collaboration among governments, communities, international organisations, academia, development partners, and the private sector.

We wish them every success.