'Equalise' or lose the Aids battle, UNAIDS warns

The world commemorates World Aids Day on 1 December. The world’s largest HIV epidemic persists in South Africa, with about 8.5 million people in the country living with HIV, according to Statistics SA in its 2022 mid-year population estimate report. 

A new report by UNAids, which was officially launched in Dar Es Salaam, Tanzania, on 29 November, reveals that crucial steps, which can set the world’s Aids response back on track, must be taken to tackle inequalities, and calls on countries worldwide to take action.  

“In one word: equalise. Equalise access to rights, equalise access to services, and the best science and medicine — it will help everyone,” said UNAids’ executive director, Winnie Byanyima, at the launch of the report. 

Equalising for women and girls 

“In Sub-Saharan Africa, adolescent girls and young women are three times more likely to be infected with HIV than boys and men of the same age — and the driving factor is inequality,” said Byanyima. 

The report noted that an estimated quarter of a million adolescent girls and young women (aged 15 to 24) acquired HIV in 2021, with 82% of them living in Sub-Saharan Africa.  

This equates to roughly 4,900 new HIV infections per week among adolescent girls and young women. South Africa is no exception, with the infection rate among adolescent girls and young women rising at an alarming rate.  

Statistics from the Thembisa model, a mathematical model of South Africa’s HIV epidemic, indicated that adolescent girls and young women are disproportionately affected. In 2022, the HIV prevalence for adolescent girls and young women was 8.4%, and 3.6% for their male counterparts of the same age. Read more about how South Africa measures up to UNAids’ HIV targets here.  

Furthermore, the report indicated that in Sub-Saharan Africa, new HIV infections among adolescent girls and young women are declining at a sluggish rate in contrast to males in the same age demographic. Between 2010 and 2021, new infections among adolescent girls and young women declined by 42%, but during that same period, for males of the same age, the decline in new infections was 56%. 

Byanyima noted the importance of comprehensive sexuality education (CSE) in reducing the risk of HIV among women and girls. 

“With education, we can reduce the risk by up to 50%, and with good quality comprehensive sexuality education, we can reduce it even further,” she said.  

Marginalised individuals unaccounted for

Ineffective responses targeted towards marginalised individuals have made it challenging to prevent acquiring HIV, said Byanyima. 

“The risk of acquiring HIV is 35 times higher among people who inject drugs, 28 times higher among gay men, 30 times higher among sex workers, and 14 times higher among transgender women,” she explained. 

The report noted that although countering transmission in key populations is a crucial aspect of addressing HIV epidemics, this is not the case in many countries. Some countries have been HIV prevention leaders but have key populations within their countries that are not benefiting equally from prevention successes. 

Byanyima said there was a growing momentum globally for the decriminalisation of people in these marginalised groups. 

“I suggest, let’s cosign these colonial and harmful laws to history, we don’t need them. God can judge them if they are wrong; we don’t need the laws, they take people away from services,” she added. 

Fighting stigma is also a key concern as stigma prohibits people from coming forward to be tested and receiving treatment, she explained. “Stigma kills. We need to end stigma for people living with HIV and marginalised communities.”  

Children left behind 

There is no reason for a baby to be born with HIV or a child to be living with HIV and no treatment, given the science we currently have, said Byanyima. 

According to the report, there are insufficient testing strategies and inadequate resources to ensure prompt diagnosis of children who acquire HIV during breastfeeding. In 2021, children accounted for only 4% of all people living with HIV, and 15% of all Aids-related deaths, said Byanyima.  

“We need to ensure that services for children living with HIV reach them and meet their needs. We need to close the treatment gap so that we can end Aids in children.” 

According to the report, progress in reducing the number of new HIV infections among children has stagnated, with 160,000 children acquiring HIV in 2021. There is also a gap between adult and children’s treatment, with 76% of adults (15 years and older) with HIV/Aids receiving antiretroviral therapy overall in 2021 and only 52% of children with HIV/Aids accessing treatment. 

The United Nations, international partners, civil society, and governments from the 12 countries with the highest burden (including South Africa) have joined the Global Alliance to End Aids in Children. “Tanzania will host the official launch early next year,” Byanyima said.  

No time for penny-pinching 

Amid a debt crisis, an austerity crisis and a widening inequality crisis in developing countries, some countries had started reducing their financial aid for global health and were deliberating further cuts, said Byanyima.  

“This is widening inequality; this is not right. Now is not the time to step away, it is the time to step up,” she added. 

According to the report, the Covid-19 pandemic and ongoing conflicts, such as the war in Ukraine, have had a negative impact. Numerous significant bilateral donors have reduced international assistance, including the Aids response. 

The report also noted that the World Bank projects that health spending will decline in two out of three countries over the next five years. 

George Simbachawene, Minister of State of Tanzania, explained that this would have detrimental consequences in the fight against eradicating Aids.

“We need increased investments in health and other social sectors like the education sector in order to deal with inequalities effectively,” he explained.  

Bahati Haule from the National Council of People Living with HIV in Tanzania echoed similar sentiments.

“It is time to join efforts at all levels now — global, regional and national — to equalise,” she said. 

Byanyima closed the launch by stressing the importance of equalising in the fight to eradicate. 

“We must rise, we must equalise for all people,” she said. DM/MC