'Holistic' approach needed to tackle HIV inequalities, UNAIDS' Sidibé says

Michel Sidibé, executive director of UNAIDS. Photo by: Mark Garten / United Nations

More than 18.2 million people worldwide are receiving treatment for HIV, placing the United Nations on track to achieve the goal of reaching 30 million HIV-positive people by 2020. In just six months of this year, an additional 1 million HIV-positive people worldwide accessed treatment.

But inequality gaps for treatment and funding are widening across populations and in certain geographic areas, according to Michel Sidibé, the executive director of UNAIDS. Progress is not happening at the same pace everywhere, he said, speaking at U.N. Headquarters one day before World AIDS Day. Some pockets of persistent pockets of vulnerability remain and others are emerging.

“In West Africa and Central Africa 1 out of 5 people have access to treatment. We are failing to make sure that we can have the same pace in increasing treatment to this region. We should not make that mistake,” he said at a press conference Wednesday afternoon.

Sidibé urged the public health community to continue pushing toward a vaccine, something that will likely require longer-term investment. While the first large study to test a candidate vaccine since 2009 is now launching in South Africa, the drug’s known efficacy rate so far stands at 35 percent.

“If we want to really end AIDS as a public health threat we will need vaccine, we need a cure and we need to continue to advocate, to push, to make sure that investment will go in that direction,” he said at the briefing. “The reality is that we saw a dimunation on investment on research and development for the vaccine. And that is where we have some concern. We need to really continue to advocate for that one.”

Adolescent women, meanwhile, continue to face an increased risk of HIV infection, especially in more highly-affected regions, according to a new UNAIDS report, released Nov. 21. The rate of new infection for females aged 15-24 declined slightly by 6 percent from 2010 to 2015, dropping from 420,000 new cases to 390,000. The U.N.’s target for 2020 would require a 74 reduction of new cases for this demographic between 2015 and 2020.

“Even if we are seeing a decline amongst boys, amongst girls, and particularly young women, it is still increasing. That is a major challenge,” Sidibé said.

Adolescent women are not being properly reached with information on sex education, and are also not being tested for their HIV status. Between 2011 and 2015, only 50 percent of people aged 15-19, in particular, in low- and middle-income countries had been tested for HIV, according to UNAIDS, compared to 76 percent of people aged 20-24.

“Most of the girls, unfortunately … are not having sexual education and they are exposed to major risks. We are seeing early pregnancies and more unsafe abortions and when we reach them sometimes it is too late … we need to look at the taboo in the society, the issues of education … to think about a more holistic approach.”

Funding for other key populations — including men who have sex with men, transgender people, drug users and sex workers — is also marginal, and presenting an ongoing obstacle to UNAIDS in its work. Only about 1.8 percent of total HIV spending goes toward these groups, though an estimated 45 percent of all new infections in 2014 were identified amongst these populations and their sexual partners, according to the UNAIDS report.

Funding is only part of the problem in reaching these key vulnerable groups, Sidibé explained to Devex.

“The resource [issue] is not easy, for the simple reason that in many places even if you have resources available ... you have homophobic laws, you have countries that don’t accept that sex workers exist,” he said in response to a question at the briefing.

“Some countries are not accepting that drug users should have access to preventative measures for treatment and it becomes very difficult even if you have resources. Our biggest challenge today is to also work with those countries to make sure that they also remove those punitive laws.”

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About the author

  • Lieberman amy

    Amy Lieberman

    Amy Lieberman is the New York Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.