Four decades after the first cases of AIDS were reported, new data from UNAIDS show that dozens of countries achieved or exceeded the 2020 targets set by the United Nations General Assembly in 2016 — evidence that the targets were not just aspirational but achievable.
The report, according to a release from UNAIDS, shows that countries with progressive laws, policies and strong and inclusive health systems have had the best outcomes against HIV. In those countries, people living with and affected by HIV are more likely to have access to effective HIV services, including HIV testing, pre-exposure prophylaxis (medicine to prevent HIV), harm reduction, multimonth supplies of HIV treatment, and consistent, quality follow-up and care.
“High-performing countries have provided paths for others to follow,” said Winnie Byanyima, the executive director of UNAIDS. “Their adequate funding, genuine community engagement, rights-based and multisectoral approaches and the use of scientific evidence to guide focused strategies have reversed their epidemics and saved lives. These elements are invaluable for pandemic preparedness and responses against HIV, COVID-19 and many other diseases.”
Globally, the report shows that the number of people on treatment has more than tripled since 2010. In 2020, 27.4 million of the 37.6 million people living with HIV were on treatment, up from just 7.8 million in 2010. The roll-out of affordable, quality treatment is estimated to have averted 16.2 million deaths since 2001, the release said.
Deaths have fallen in large part due to the roll-out of antiretroviral therapy. AIDS-related deaths have fallen by 43 per cent since 2010, to 690,000 in 2020. Progress in reducing new HIV infections has also been made, but has been markedly slower — a 30 per cent reduction since 2010, with 1.5 million people newly infected with the virus in 2020 compared to 2.1 million in 2010.
The report underscores that countries with punitive laws and that do not take a rights-based approach to health punish, ignore, stigmatise, and leave key populations — which make up 62 per cent of new HIV infections worldwide — on the margins and out of reach of HIV services. For example, almost 70 countries worldwide criminalise same-sex sexual relationships. Gay men and other men who have sex with men, sex workers, transgender people, people in prison, and people who inject drugs are left with little or no access to health or social services, allowing HIV to spread among the most vulnerable in society.
The Caribbean situation
According to the report, from 2010 to 2020 AIDS-related deaths in the Caribbean declined by half. During the same period, new HIV infections in the region decreased by 28 per cent. In 2020 members of key population communities and their sexual partners accounted for 60 per cent of new infections. Forty per cent of new infections occurred among the remaining population. As of the end of 2020, 82 per cent of people living with HIV in the Caribbean were aware of their status. Two-thirds of all people living with HIV were on treatment. Fifty-nine per cent of people living with HIV in the region were virally suppressed last year.
Dr James Guwani, director of the UNAIDS Caribbean Office, noted that most countries in the region stepped up around financing treatment and transitioned to providing HIV treatment to all diagnosed people. However, increased focus is needed on combination prevention and psychosocial support for people living with HIV.
COVID-19 has shown the fragility of the health and development gains made over the past decades and has exposed glaring inequalities. To get the world on track to end AIDS by 2030, the global AIDS community and UNAIDS have used an inequalities lens to develop an ambitious and achievable strategy with new targets to reach by 2025.
If reached, the targets will bring HIV services to 95 per cent of the people who need them, reduce annual HIV infections to fewer than 370,000 and AIDS-related deaths to fewer than 250,000 by 2025. This will require an investment of US$ 29 billion a year by 2025. Each additional US$1 of investment in implementing the global AIDS strategy will bring a return of more than US$7 in health benefits.