Devex CheckUp: On World AIDS Day, fears about the future of the fight against HIV

On Sunday, it will be 36 years since the first World AIDS Day. Initially created to raise awareness of the disease and honor those who died because of it, the observance has lately become a rallying point to push toward the goal of ending AIDS as a public health threat by 2030. But this year, the day is more likely to serve as a warning that the goal is about to slip out of reach

Big gaps persist: In 2023, 630,000 people died of AIDS-related illnesses despite the availability of effective treatment, according to UNAIDS. An estimated 9.3 million people who are infected are not accessing those lifesaving drugs. And despite a broad suite of prevention services, an additional 1.3 million people acquired HIV last year.

Ongoing criminalization and stigma are only making those gaps worse. As an example, officials at the U.N. program point to the fact that 63 countries criminalize same-sex sexual behavior. In those countries, HIV prevalence among gay men and men who have sex with men is five times higher than in countries without such laws.

“When we continue the way we are now, we will not reach our targets, and we will end up with a much, much higher number of people living with HIV … long after 2030 [that] we will all collectively have to be responsible for and need to take care of,” warns Christine Stegling, a UNAIDS deputy executive director.

But countries are failing to deliver on their commitments to bring down legal and policy barriers that enable this. And the incoming Donald Trump presidency in the United States might only exacerbate some of those challenges.

In an opinion piece for Devex, John Plastow, the executive director of Frontline AIDS, voices concern that Trump — who already enacted anti-trans policies during his first administration — may take additional steps to isolate the LGBTQ+ community. This could have global consequences.

Plastow also warns about the fate of the President’s Emergency Plan for AIDS Relief, or PEPFAR, the signature U.S. program funding HIV treatment and prevention programs in many of the countries with the highest rates of infection. Some conservative members of the U.S. Congress have already begun an assault against the program that could continue under the new administration.

Opinion: Trump is a threat in fight against AIDS, but we must hold the line

Read: PEPFAR chief warns waning political will could hurt AIDS fight (Pro)

+ Not yet a Devex Pro member? Start your 15-day free trial today to access all our exclusive reporting and analyses, data-driven funding insights, members-only events, the world’s largest global development job board, and more. Check out all the exclusive content available to you. 

The last mile

Pakistan offers insight into the health consequences when some members of the LGBTQ+ community face stigma or worse.

In Pakistan, the transgender population has the right to health services. That includes access to prevention and treatment of HIV, for which they face an outsized risk. But that right doesn’t necessarily translate into access.

The transgender community is legally recognized by a 2018 law designed to prevent discrimination and harassment. And members of the population can access national identification cards marked with a third gender beyond male or female which gives them access to directly targeted health services.

But the reality is that stigma persists, and transgender people are denied opportunities to get care and even to work. This can lead to people living in poverty and unhygienic conditions that fuel the spread of infectious diseases. It can also mean members of the transgender community turn to sex work, which increases their risk of syphilis, tuberculosis, hepatitis B, and, of course, HIV.

Despite the heightened health risks, many people feel uncomfortable using government and private health services, where stigma and discrimination persist. That means missing out on critical HIV services, among others.

There are refuges: Community-based organizations can give health care workers a foothold from which to offer services that people will feel comfortable accessing. These include treatment but extend to forms of prevention that include preexposure prophylaxis, or PrEP, which can dramatically reduce the risk of acquiring HIV.

In Rawalpindi, the twin city of Pakistan’s capital Islamabad, the police service has also pioneered an initiative working to ensure members of the transgender community aren’t discriminated against. In addition to delivering justice, this effort has also been a bridge to medical services tailored specifically to this marginalized community.

Read: Increasing health access for Pakistan’s shunned transgender population

RIP

Dr. Faustine Engelbert Ndugulile, the incoming regional director of the World Health Organization’s Africa office, unexpectedly died on Wednesday, just months after he was tapped for the position. Ndugulile had been receiving medical treatment in India. A cause of death has not been specified.

It’s unclear who will take over the position, which Ndugulile was set to inherit in February from Dr. Matshidiso Moeti.

In campaigning for the position, Ndugulile touted his extensive political experience in his native Tanzania, where he had served as deputy health minister and minister of communications and ICT. He held degrees in medicine and public health.

Read: Candidate elected to lead WHO’s Africa office has unexpectedly died

Lifesaving leaves

Are the answers to antimicrobial resistance hiding in plain sight?

African researchers are increasingly looking to the continent’s treasure chest of medicinal plants to develop new drugs to treat the bacteria, viruses, fungi, and parasites that have grown resistant to existing medications.

The rise of AMR has made infections harder to treat and increased the likelihood of severe illness and death. Africa has been particularly hard hit, with the highest number of AMR deaths globally, at 27.3 per 100,000 people.

That has led researchers back to the 45,000 plant species that exist in Africa. At least 5,000 are already used in traditional or modern medicine and there are hopes that these or others might also be useful in developing new treatments.

Already experts from Afrique One, a Côte d’Ivoire-based research institute, have pulled 132 extracts from 27 plants. They discovered that 24 of those extracts were able to stop bacteria from multiplying. Our ability to counter AMR may rest on what else they are able to unlock.

Read: Are Africa's medicinal plants the key to solving its health challenges?

What we’re reading

Donald Trump has tapped Jay Bhattacharya, a physician and economist who rose to prominence for his opposition to COVID-19 lockdowns and mask mandates, to head the National Institutes of Health. [The New York Times]

A combination of mismanagement and anti-vaccination campaigning — including by Robert F. Kennedy, Jr. — fueled a measles outbreak in Samoa in 2019 that caused at least 83 deaths and more than 1,800 hospitalizations. [The Guardian]

New Zealand has declared a whooping cough epidemic, with more than 260 cases reported over the past four weeks. [Radio New Zealand]