HIV/AIDS has 'fallen off' the political agenda, says UNAIDS official

More people living with HIV lead longer, healthier lives today. Though this is good news in some ways, the global fight against HIV has become a victim of its own success. “HIV and AIDS … rose to the level of being on the political agenda 20 years ago because they saw death and despair. That is not the case anymore,” Angeli Achrekar, UNAIDS deputy executive director of programs and United Nations assistant secretary-general, told Devex. The number of people dying from AIDS-related illnesses went down from 660,000 in 2021 to 630,000 in 2022, according to new data released by the United Nations Programme on HIV/AIDS. Countries such as Botswana, Eswatini, Rwanda, Tanzania, and Zimbabwe have also achieved the UNAIDS’ 95-95-95 targets. This means that 95% of people living with HIV in these countries know their status, 95% of that number are on antiretroviral treatment, and 95% of those on treatment have virally suppressed HIV, meaning they are highly unlikely to transmit the virus to another person. The data also showed a decline in new HIV infections to 1.3 million in 2022 from 1.4 million in 2021. But a closer look reveals women and girls account for 46% of all those new infections. Every week, 4,000 adolescent girls and women aged 15 to 24 years old were infected with HIV in 2022, with the majority of those infections happening in sub-Saharan Africa. HIV prevalence was also higher among key at-risk populations. It’s 11 times higher among gay men and men who have sex with men and 14 times higher among transgender people. And while fewer people die from AIDS it still claimed a life every minute in 2022. But today’s polycrisis — war, climate change, financial, and humanitarian crises — is pushing the HIV and AIDS agenda on the side. “There are so many crises that the … entire world is challenged by, that HIV and AIDS has fallen off the political agenda,” Achrekar said. A path to end AIDS HIV and AIDS are “one of the deadliest” pandemics, Achrekar said. But it’s still possible to end AIDS by 2030 if taken with “absolute urgency.” In its report, UNAIDS said there is a clear path to ending AIDS. This includes scaling up evidence-based HIV prevention and treatment programs, tackling inequalities, enabling communities and civil society organizations to play their vital role in the response, and ensuring there’s adequate and sustainable funding for the response. But challenges exist. For instance, access to a new long-acting HIV prevention injectable called cabotegravir or CAB-LA that some experts have described as “revolutionary” is limited. A voluntary licensing deal last year between Medicines Patent Pool, or MPP, and ViiV Healthcare, manufacturer of CAB-LA, would allow 90 countries to purchase generic versions of it. Earlier this year, MPP also signed licensing agreements with three companies to produce those generic versions. But the report says it could take years before generic manufacturing of this tool gets “in full swing.” Several upper- and middle-income countries with high HIV burdens were also not part of the deal. Meanwhile, restrictive policies are also being introduced that impede people from accessing services. Uganda’s recently passed anti-gay law is seen by many fighting against HIV and AIDS as a threat to gains made. There is also a widening funding gap for HIV. Only $20.8 billion was available for HIV programs in low- and middle-income countries in 2022, far short of the $29.3 billion needed by 2025. Only 2.3% of that was spent on HIV prevention for key populations, and adolescent women and girls, Achrekar said. “If we’re going to reduce the new infections, we’ve got to prioritize and make sure funding … is made available to do that,” she said. Achrekar and other UNAIDS officials have been engaging with the U.S. Congress to talk about the impact of the U.S. President's Emergency Plan for AIDS Relief, which she said has been critical to the HIV response and ending AIDS as a public health threat. “Reauthorization of PEPFAR is absolutely critical. It's been one of the greatest success stories and the job is not yet done,” she said, adding that PEPFAR’s reauthorization also demonstrates that HIV and AIDS, as well as the U.S. leadership role in the response, is on the political agenda. But it is also time for other donors to step up, she added. “It's extraordinary what the U.S. has demonstrated. But the global HIV response cannot be carried by one country,” she said. “It is a pandemic, and we need everyone stepping up to finish what we all started — to end this thing.”