Covid-19 and other worldwide crises of the past two years have slowed down the fight against the HIV pandemic, reduced funding, and put millions of lives in danger, according to new data from UNAIDS on the global HIV response.
The smallest annual decline in new HIV infections since 2016 occurred between 2020 and 2021, when the number of infections decreased globally by only 3.6%.
Over the past few years, annual HIV infections have increased throughout Latin America, Eastern Europe, Central Asia, the Middle East, and North Africa.
According to UNAIDS data, where new HIV infections had been declining throughout Asia and the Pacific, the region with the largest population, they are now increasing.
Alarmingly, infection rates are rising in these areas. In 2021, the tremendous advancement from previous years in eastern and southern Africa dramatically stalled.
Positive news includes significant drops in new HIV infections in the Caribbean, central and western Africa, but even in these areas, the HIV response is threatened by a deepening resource shortage.
"The statistics indicate that there is a serious risk to the worldwide Aids response. Since the pandemic flourishes in crises like Covid-19, mass migration, and other crises, if we are not making headway quickly, we will be losing momentum. Let's not forget the millions of fatalities that may have been prevented", urges UNAIDS Executive Director Winnie Byanyima.
Over one million more infections than the global targets were reported last year due to stalling progress, at 1.5 million new infections. The HIV response is stalled by stark inequalities, both inside and between nations, and HIV is extending these inequalities even more.
Young women and adolescent girls were disproportionately affected by new infections, with one occurring every two minutes in this cohort in 2021.
The gendered HIV effect took place in the context of important HIV treatment and prevention programmes being disrupted, millions of girls missing school due to pandemics, spikes in teenage pregnancies, and gender-based violence.
This was especially true for young African women and girls. Teenage girls and young women in sub-Saharan Africa are three times more likely than adolescent boys and young men to contract HIV.
Key groups have been disproportionately impacted by the disturbances during the past few years in many localities, with increased prevalence in many places.
According to UNAIDS data, gay men and other men who have sex with men (MSM) suffer an increased risk of new infections globally.
According to data from UNAIDS' key populations, as of 2021, MSM have a 28-fold higher risk of contracting HIV than people of the same age and gender identity, while injecting drug users have a 35-fold higher risk, sex workers have a 30-fold higher risk, and transgender women have a 14-fold higher risk.
HIV risks are also exacerbated by racial disparities. The number of new HIV diagnoses has decreased more among white populations in the United Kingdom and the United States than it has among black communities.
Indigenous groups have greater rates of HIV acquisition than non-indigenous communities in nations like Australia, Canada, and the United States.
The research also demonstrates the failure of efforts to guarantee that all HIV-positive individuals have access to life-saving antiretroviral therapy.
More slowly than it had in more than a decade, the number of persons receiving HIV therapy increased in 2021.
Only half (52%) of children living with HIV have access to life-saving medication, and while antiretroviral treatment is available to 75% of all persons living with HIV, the gap between children and adults in terms of HIV treatment coverage is widening rather than reducing.
In spite of better HIV treatment and resources to prevent, identify, and treat opportunistic infections, the Aids epidemic claimed a life per minute on average in 2021, with 650 000 Aids deaths.
"These statistics speak to political will. Do we value the safety and empowerment of our girls? Do we want to stop child Aids deaths? Do we prioritise preventing homicide over criminalisation, questioned Byanyima. "If we do, we need to restart the Aids response."
The research outlines the terrible repercussions that will occur if prompt action is not taken to address the injustices that are fuelling the pandemic.
It demonstrates that if things continue as they are, there could be more than 1.2 million new HIV infections annually in 2025, while the United Nations member states have established a goal of less than 370 000 new HIV infections.
That would entail exceeding the pledge on new infections by more than three times, in addition to missing the pledge entirely. Every year, millions of preventable HIV infections make it more difficult and expensive to guarantee that individuals living with HIV have access to life-saving medication and that the goals to end the Aids pandemic by 2030 are met.
The Covid-19 epidemic and the crisis in Ukraine are only two examples of how global shocks have increased the risks for the HIV response.
The capacity of the world's poorest nations to combat Aids has been stifled by debt repayments, which have reached 171% of total expenditures on healthcare, education, and social protection put together.
For the past two years in a row, domestic financing for the HIV response in low- and middle-income countries has decreased. Food insecurity for persons living with HIV around the world has been worse due to the Ukraine war, increasing their likelihood of experiencing breaks in their HIV treatment.
Too many high-income nations are cutting back on aid, and resources for global health are in grave dange just when they most need international solidarity and a boom in investment. HIV-related foreign resources were 6% less available in 2021 than they were in 2010.
Over the past ten years, bilateral aid from countries other than the United States of America for HIV-related development has fallen by 57%.
By 2025, the HIV response in low- and middle-income nations will fall $8 billion short of what is required. Global trade regulations prevent low- and middle-income countries from producing pandemic-ending drugs, such as novel and emerging long-acting HIV medications, and they keep costs too high for these nations to afford to purchase at scale.
"Global solidarity has halted at a time when it was most needed. The massive red caution light should not be interpreted by leaders as a stop sign. The time has come for a surge of international assistance, according to Byanyima.
It is still feasible for the leaders to refocus the response. National action, as well as international cooperation are required in this. If leaders follow the strategy they agreed to last year, which was outlined in the Political Declaration on HIV and Aids, Aids might be eradicated by 2030.
It is both feasible and economical; in fact, putting an end to Aids will cost a lot less money than not doing so. Importantly, taking the necessary steps to eliminate Aids will also better position the globe to defend itself from the dangers of upcoming pandemics.
Community-led, people-centred services, the upholding of everyone's human rights, the repeal of punitive and discriminatory laws, the eradication of stigma, the empowerment of girls and women, equal access to treatment, including cutting-edge medical technology, and health services, education, and social protection for all are all part of the tried-and-true recipe for success.
As promised, we can eradicate Aids by 2030, claimed Byanyima. However, courage is necessary.
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