Are we actually on a path to ending AIDS?

Is the Joint United Nations Programme on HIV/AIDS alarmed enough? UNAIDS issued its global AIDS update last week, spelling out a path toward ending AIDS as a public health threat by 2030. That path includes strong political leadership, addressing inequities, enabling communities, and civil society organizations to lead the response, and providing sustainable funding to pay for the broader HIV response. The report celebrated significant steps in the decadeslong effort to combat the pandemic, including an annual global number of new infections that have dropped to the lowest level since the late 1980s. But even as the report champions gains in reduced infections and AIDS-related deaths, which are “bringing the AIDS response closer to achieving Sustainable Development Goal 3.3 of ending AIDS as a public health threat by 2030,” the world remains well short of that target. And activists are warning that the gains UNAIDS is celebrating are at serious risk, both amid threats to key sources of funding, such as the U.S. President’s Emergency Plan for AIDS Relief, and in global efforts to further criminalize communities that are already marginalized, including transgender people and men who have sex with men. “Governments and other duty-bearers are choosing not to be on the path [to end AIDS].” --— Asia Russell, executive director, Health GAP Against that backdrop, Asia Russell, the executive director of Health GAP, tells Devex in an interview that maybe UNAIDS should have adopted a less rosy framing for this year’s global AIDS update. This conversation has been edited for length and clarity. What was your initial reaction to the report? The global AIDS crisis is a public health emergency, and in order to be accurate, any authoritative report has to start from that place. It was surprising that the UNAIDS report was so positive and upbeat. Why do I say that? We are in a time when not only is the AIDS crisis persisting with a preventable AIDS-related death every minute. With preventable new infections across vulnerable and criminalized communities around the globe. And with a growing funding gap. I say that because the report was released at an unprecedented moment of rising threats to the most vulnerable communities — rising threats to whatever fragile gains have been made in response to HIV and rising threats to one of the most important functional aspects of the global AIDS architecture, which is [the U.S. President's Emergency Plan for AIDS Relief, or] PEPFAR. And that has implications beyond just the AIDS crisis? PEPFAR is also the backbone of effective pandemic prevention, preparedness, and response across [Africa]. So whatever existential threat PEPFAR is experiencing right now is by extension an existential threat to any global effort to expand PPPR beyond HIV and TB, across key countries on the continent. Instead of emphasizing those issues, the report focuses on a path toward ending AIDS. It is already well known that human rights and science show us a path to end AIDS. There is no news there. Rather than passively restating that there is a path, what’s extremely important is what communities have been saying, which is that governments and other duty-bearers are choosing not to be on the path. Why? Because of a choice to pursue criminalization; to pursue funding cuts; to pursue deprioritization of responding to preventable deaths from HIV, preventable new infections, treatment, and other public health programs that are still poor quality and inaccessible to key populations. All of these are aspects of the path we must get off of. What should UNAIDS have focused on, instead? What we expected from UNAIDS was a focus on the dangerous new threats that have emerged since the last report was released a year ago. Instead, those threats are almost imperceptible in this report, but they’re very real in the communities’ lives. Those are the unprecedented rise in anti-LGBTQ hate, the existential threat to the global AIDS response that is embodied in the threat to PEPFAR, the yawning and increasing financial gap in international and domestic investment. It’s also important to mention because UNAIDS focuses in particular on inequities and inequalities and the community-led response, the fact that the gap in access to the benefits of scientific progress, in particular to long-acting injectables for prevention of HIV, has not been resolved. To say AIDS can be ended as a public health threat does not mean that it is ended.