Future HIV/AIDS response: 'Some things we will need to do differently'

Winnie Byanyima, executive director at UNAIDS. Photo by: Amanda Voisard / U.N.

MANILA — Approaches to tackling persistent barriers preventing women and girls, and other key populations from exercising their rights and accessing critical services will need to change.

UNAIDS is engaging a wide range of stakeholders, including civil society organizations and members of other United Nations agencies, in online consultations for its future strategy. Interventions such as those pertaining to harm reduction and the provision of comprehensive sexuality education for young women and men must remain in its next strategy, UNAIDS Executive Director Winnie Byanyima told Devex.

“They are non-negotiable. We cannot take them out. We shall keep them, and take forward a strategy that builds on them,” she said.

“If you're going to end stigma, if you're going to end discrimination, you've got to have political leaders behind it who speak, who identify with, who stand with people living with HIV.”

— Winnie Byanyima, executive director, UNAIDS

But the organization will need to take a real hard look at the barriers that are stunting progress against HIV/AIDS, why it’s not making progress, and take a different approach, the UNAIDS chief said.  

“Some of what we need to do is just to keep the show on the road and keep energy and momentum in it. Some things we will need to do differently,” she said.

Gains have been made in the fight against HIV/AIDS, with over 25 million people on treatment in 2019, according to the organization’s latest report. But the same report revealed 1.7 million new HIV infections in 2019 and 690,000 deaths from AIDS-related illnesses. That’s over the targets agreed to by governments at the U.N. General Assembly in 2016, which aim to reduce both new HIV infections and AIDS-related deaths to fewer than half a million each by 2020.

Those targets are now unlikely to be met, Byanyima said, and the novel coronavirus pandemic is further threatening to throw the global AIDS response off-course. UNAIDS and the World Health Organization have warned governments of additional 500,000 deaths in sub-Saharan Africa in 2021, and a rise in HIV infections in children if disruptions to HIV services due to COVID-19 continue.

Unlocking HIV/AIDS financing during COVID-19

What can be done to mitigate the financial impact of COVID-19 on country resources and maintain sufficient funding for programs, such as those targeting HIV/AIDS?

Byanyima acknowledges the potential financial crunch for development resources because of COVID-19, but she said donors cannot choose one over the other. “Our message to the donors [is] that do not stop fighting one disease to fight another. It will come back to haunt you,” she said.

Tackling barriers

One area where the global response is lagging is on HIV prevention, Byanyima said. There is limited awareness among young people today on HIV infection prevention, but also persistent structural barriers particularly for key populations highly vulnerable to HIV infection.

Same-sex sexual relations, for example, are criminalized in at least 69 countries, according to UNAIDS. This keeps vulnerable groups such as men who have sex with men away from accessing preventative tools, or from getting tested and getting on HIV treatment. The same is true for sex workers, whose livelihood is considered a crime in many countries.

Persistent gender inequality and gender-based violence also continue to drive the epidemic, as well as services that don’t meet the needs of people on the ground.

A young woman could feel judged by getting a preexposure prophylaxis injection at a clinic. A young man, fearing stigma, won’t line up the whole day at a hospital to get his antiretroviral therapies, Byanyima said.

“This is a disease about sexuality. It is a touchy issue. We need the political leadership to drive this. If you're going to end stigma, if you're going to end discrimination, you've got to have political leaders behind it who speak, who identify with, who stand with people living with HIV and normalize them; who call on their workers, health officials, not to discriminate,” she said.

User fees are also prohibiting people from accessing services. Many health facilities across several countries in Africa charge user fees, said the UNAIDS chief.

“Those are some of the barriers that we need to fight that are keeping us from making progress.

And we must think of more creative ways to fight,” she said.

That could come in the form of working with other large social movements, such as those working on human rights and women rights, and organizations working outside the HIV/AIDS community, such as organizations working in the education sector.

Getting a girl to attend secondary school already reduces her vulnerability to HIV infection, Byanyima said. Placing sexual and reproductive health services at schools help reduce that vulnerability further. This is particularly relevant in Africa, where a large percentage of girls are unable to attend secondary education, she added.

Another example is drug control. While it’s not on UNAIDS’ agenda per se, working with other stakeholders to change the way drug control is handled in countries could change the situation for people living with HIV.

“We need to move into that space where we are tackling structural barriers with others. We can't sit back and wait for it to happen … we need to be part of pushing for those structural changes,” Byanyima said.

“They will take us into new areas, but we will be with others trying to find a solution to a barrier.”

About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.