António Guterres, United Nations Secretary-General

On 19 June 2024, the United Nations General Assembly convened to evaluate the progress made in the response to the AIDS epidemic. The yearly session provided a platform for Member States to reflect on achievements, confront persistent barriers, and chart a course forward towards ending AIDS by 2030. The UN Secretary-General’s progress report formed the basis of the debate. 

Member States celebrated the significant achievements towards ending AIDS, while highlighting ongoing challenges that must be overcome to reach the promise of ending AIDS as a public health threat by 2030.   

The commitment to the 95-95-95 targets and the progress made in eliminating vertical transmission of HIV, especially through the use of decentralized community-based services, were highlighted as pivotal to the success of the HIV response.  

Many member states stressed the crucial role that promoting a human rights-centered approach has had in the fight against HIV. They highlighted the significance of comprehensive multi-sectoral responses, including education on sexuality and robust support for sexual and reproductive health and rights. They pointed to the harm of actions that undermine gender equality and LGBTQI+ rights. They emphasized the shared duty of every country to protect everyone’s human rights.  

The need for continued global solidarity and enhanced multilateral cooperation was emphasized as key to tackling the remaining challenges. Calls for increased domestic and international funding were echoed, noting that sustained investment is crucial to maintaining progress and for expanding access to innovative prevention and treatment options.  

The UN General Assembly annual review served as a poignant reminder of the collective responsibility to uphold the rights and dignity of all people affected by HIV. 

Inspired by the lessons learnt from the AIDS response, the upcoming Summit of the Future scheduled for September 2024 will explore how common challenges can be overcome. 

Against a backdrop of geopolitical shifts and economic uncertainties, the HIV response serves as a beacon of how multilateral solidarity saves and transforms lives. 

1 December 2023 

World AIDS Day arrives at a defining moment.

AIDS-related deaths have fallen by almost 70 per cent since their peak in 2004, and new HIV infections are at the lowest point since the 1980s.

But AIDS still takes a life every minute.

We can — and must — end AIDS as a public health threat by 2030. 

Reaching this goal means heeding this year’s theme: Let Communities Lead.

The path to ending AIDS runs through communities.

From connecting people to the treatment, services and support they need — to the grassroots activism pushing for action so all people can realize their right to health.

Supporting those on the frontlines of the battle against AIDS is how we win.

That means placing community leadership at the centre of HIV plans, programmes, budgets and monitoring efforts. 

We must also remove barriers to community leadership, and ensure space for local civil society groups to take forward their vital work.

Above all, we need funding.

The AIDS response in low and middle-income countries needs over 8 billion dollars more per year to be fully funded.

This must include scaled-up funding for local programmes led by people living with HIV, and prevention initiatives led by communities.

AIDS is beatable.

Let’s finish the job by supporting communities to end this scourge in their neighbourhoods, their countries and around the world.

One year after adopting a new Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030, United Nation’s Member States have highlighted the need to work together to speed up progress on implementation.

In advance of the meeting, the UN Secretary General released a report entitled Tackling inequalities to end the AIDS pandemic on the implementation of the political declaration on HIV/AIDS. The report sets out how inequalities and insufficient investment “leave the world dangerously underprepared to confront the pandemics of today and tomorrow”

The AIDS pandemic is responsible for more than 13,000 deaths every week.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) data show that HIV infections and AIDS-related deaths are not currently declining fast enough to end the pandemic by 2030 as pledged.

The Secretary General’s report highlights solutions including (a) HIV prevention and societal enablers; (b) community-led responses; (c) equitable access to medicines, vaccines and health technologies; (d) sustainable financing for the AIDS response and wider pandemic prevention, preparedness and response; (e) people-centered data systems and (f) strengthening global partnerships.

The UN Secretary General’s statement to the General Assembly, delivered by Chef de Cabinet Courtenay Rattray, outlined three immediate steps to reverse current trends and get back on track. “First, we need to tackle intersecting inequalities, discrimination and the marginalization of entire communities, which are often exacerbated by punitive laws, policies and practices”. He called for policy reforms to reduce the HIV risks of marginalised communities including sex workers, people who inject drugs, prisoners, transgender people and gay men. He noted how stigma is obstructing public health: “Stigmatization hurts everyone. Social solidarity protects everyone”.

The second step is ensuring the sharing of health technologies, including long-acting antiretrovirals, to make them available to people in all countries of the world.

The third step is to increase the resources made available to tackle AIDS. “Investments in AIDS are investments in global health security. They save lives – and money.”

In his opening remarks, the President of the General Assembly, Mr. Abdulla Shahid, noted that “equal access to healthcare is an essential human right to guarantee public health, for all. No one is safe until we are all safe. Striving to achieve the 2025 AIDS targets is an opportunity to work together to increase investments towards public health systems and pandemic responses, and to draw on the hard-learnt lessons from the HIV/AIDS crisis for our recovery from COVID-19, and vice versa.”

Over 35 Member States and Observers made statements during the AIDS review, which included contributions on behalf of the Africa Group, the Caribbean Community and the Central American Integration System and the European Union.

Statements emphasised the urgency of stepping up collective action to get on track to meet the 2025 targets, and the importance of an inequalities lens to ensure a successful HIV response.

The President of the General Assembly, the Secretary General, the Africa group, the EU and several Member States stressed the importance of fully financing the HIV response and strengthening investment in Global Health.

The Africa Group, along with many others, spoke about addressing stigma and discriminatory laws which keep people from accessing health care and social services.

The debate made clear that the end of AIDS is possible, but only if countries worked together and were courageous in addressing inequalities. “The most important message today,” noted the Secretary General’s conclusion, “is that if we work together to tackle the inequalities that perpetuate HIV/AIDS, we can still end it as a public health threat by 2030.”

All said in under one minute. This is huge and unequivocal.
The Chef de Cabinet delivers to the UN General Assembly the urgent insistence from the UN Secretary-General that the technologies for new long-acting HIV medicines must be shared globally now. There is no time to lose. pic.twitter.com/t1DWlPsdB3

— Ben Phillips (@benphillips76) June 10, 2022

Forty years since the first AIDS cases were reported and just weeks before the United Nations General Assembly High-Level Meeting on AIDS, the United Nations Secretary-General has released a new report with recommendations and targets to get the world back on track to end AIDS

NEW YORK, 30 April 2021—The United Nations Secretary-General, António Guterres, has warned that despite intensive action and progress made against HIV in some places and population groups, HIV epidemics continue to expand in others and issued a set of 10 key recommendations.* If followed by all countries, this will end the AIDS pandemic as a public health threat by 2030 as part of the Sustainable Development Goals. In a new report, Addressing inequalities and getting back on track to end AIDS by 2030, the United Nations Secretary-General urges the world to address the inequalities that are slowing progress. 

“It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” said Mr Guterres in the report. “Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved for people living with HIV, communities and countries.”

The global targets set out in the General Assembly’s 2016 Political Declaration on Ending AIDS were missed by a long way, allowing the AIDS pandemic to grow in many regions and countries. The staggering 1.7 million new HIV infections that occurred in 2019 are more than three times higher than the 2020 target of less than 500 000 new infections. In addition, the 690 000 AIDS-related deaths in 2019 far exceed the 2020 target of reducing deaths to fewer than 500 000 a year.

“Ending AIDS as a public health threat by 2030 is still within reach—many countries are showing that rapid progress against HIV is possible when evidence-informed strategies and human rights-based approaches are adopted,” said UNAIDS Executive Director Winnie Byanyima. “But it requires bold political leadership to challenge and address the social injustices and inequalities that continue to make certain groups of people and entire communities highly vulnerable to HIV infection.”

The report notes that COVID-19 has caused additional setbacks. The United Nations Secretary-General warned that COVID-19 is not an excuse for missing AIDS targets, but rather a stark warning to the countries that they can no longer afford to underinvest in pandemic preparedness and responses.

At the same time, the COVID-19 pandemic has underscored the many spill-over benefits of HIV investments in health and development. Community-led service delivery pioneered by the HIV response is helping to overcome the extraordinary impediments created by COVID-19.

The set of 10 recommendations to get the world back on track include: addressing inequalities and reaching all people living with or at risk of HIV infection to reduce the annual new HIV infections to under 370 000 and annual AIDS-related deaths to under 250 000 by 2025; prioritizing HIV prevention to ensure that 95% of people at risk of HIV infection have access to effective HIV prevention options by 2025; and eliminating new HIV infections among children.

The report underscores that addressing social and structural factors that perpetuate inequalities is key. It highlights, for example, how gender inequality, underpinned by harmful gender norms, restricts women’s use of HIV and sexual and reproductive health services by perpetuating gender-based violence and limiting decision-making power, including the ability of women and girls to refuse unwanted sex, negotiate safer sex and mitigate HIV risk.

It also shows how vulnerable, marginalized and criminalized communities, such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners and migrants, also remain at higher risk of HIV infection than the general population because they are not receiving essential information and HIV treatment, prevention and care services.

The United Nations Secretary-General describes how communities of people living with, at risk of and affected by HIV are the backbone of the HIV response. Initiatives led by people living with HIV, women, key populations, young people and other affected communities have identified and addressed key inequalities and service gaps, advocated for the rights of their constituents and expanded the reach, scale and quality of health services.

In the report, Mr Guterres applauds UNAIDS’ recently adopted Global AIDS Strategy 2021–2026: End Inequalities, End AIDS. “The lessons from the countries, cities and communities that successfully fast-tracked their HIV responses over the last five years are at the heart of the UNAIDS Global AIDS Strategy 2021–2026,” said Mr Guterres. “The global AIDS community and UNAIDS have used an inequalities lens to develop the strategy, with new targets that are ambitious, granular and tailored to reach the furthest behind first.”

The report comes 25 years after the creation of UNAIDS and describes how COVID-19 has exposed social inequalities and health system weaknesses. The United Nations Secretary-General says that the world should leverage the experience from responding to the AIDS pandemic to strengthen health systems across the world and improve pandemic preparedness. He also calls for enhanced global solidarity to close the HIV resource gap and increase annual HIV investments in low- and middle-income countries to US$ 29 billion by 2025. 

*The 10 recommendations in the United Nations Secretary-General’s report:

1.      Reduce and end the acute and intersecting inequalities that are obstructing progress to end AIDS.
2.      Prioritize HIV prevention and ensure that 95% of people at risk of HIV infection have access to and use appropriate, prioritized, person-centred and effective combination prevention options by 2025.
3.      Close gaps in HIV testing, treatment and viral suppression that are limiting the impact of HIV responses and achieve by 2025 the 95–95–95 testing and treatment targets within all subpopulations, age groups and geographic settings, including children living with HIV.
4.      Eliminate vertical HIV transmission and end paediatric AIDS.
5.      Put gender equality and the human rights of women and girls in all their diversity at the forefront of efforts to mitigate the risk and impact of HIV.
6.      Implement the GIPA (Greater Involvement of People Living with HIV/AIDS) principle and empower communities of people living with HIV, women, adolescents and young people and key populations to play their critical HIV response roles.
7.      Respect, protect and fulfil the human rights of people living with, at risk of and affected by HIV and ensure by 2025 that less than 10% of people living with HIV and key populations experience stigma and discrimination.
8.      Enhance global solidarity to close the HIV response resource gap and increase annual HIV investments in low- and middle-income countries to US$29 billion by 2025.
9.      Accelerate progress towards universal health coverage and strong primary health care systems, build forward better and fairer from COVID-19 and humanitarian crises, and strengthen global health security and future pandemic preparedness.
10.  Leverage the 25 years of experience, expertise and mandate of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in building multisectoral, multi-stakeholder and rights-based collaborative action to end AIDS and deliver health for all as global public good.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

NEW YORK/GENEVA, 3 June 2019—A new report from the United Nations Secretary-General, Galvanizing global ambition to end the AIDS epidemic after a decade of progress, has been presented to United Nations Member States during the 73rd session of the United Nations General Assembly. The Member States gathered at the United Nations in New York, United States of America, to review progress and share their own progress and challenges.

“A world without AIDS was almost unimaginable when the General Assembly held its first special session on the epidemic 18 years ago,” said United Nations Secretary-General António Guterres in the report. “Since then, the global determination to defeat one of history’s greatest health crises has produced remarkable progress … and … inspired a commitment within the 2030 Agenda for Sustainable Development to end the AIDS epidemic by 2030.”

The Secretary-General’s report shows that results once derided as impossible in low-income settings have now been achieved following a decade of progress in the response to HIV. Between 2008 and 2017, there was a 43% reduction in AIDS-related deaths, a 45% reduction in new HIV infections among children and a 19% reduction in new HIV infections among adults globally. The number of people living with HIV on treatment also increased, by 5.5 times, reaching 21.7 million of the 36.9 million people living with HIV in 2017.

“The enormous achievements in the response to HIV in recent decades, under the strong leadership of UNAIDS, is one of the best examples of multilateralism in action,” said María Fernanda Espinosa, President of the United Nations General Assembly. “It is most definitely an indication of what we can achieve when we work together around a common cause."

The report shows that progress has been most marked in eastern and southern Africa, where AIDS-related deaths fell by 53% and new HIV infections among adults and children fell by 36%. An epidemic that once killed more than a million people in the region per year now claims fewer than 400 000 lives per year.

In other regions of the world, including Latin America, the Caribbean, Asia and the Pacific, western and central Europe and North America, increases in the coverage of HIV testing and treatment services have achieved significant reductions in AIDS-related deaths over the past decade. Most of those regions have also experienced declines in new HIV infections.

Notable exceptions are eastern Europe and central Asia, where the annual number of new HIV infections has risen by 30% since 2010, with an estimated 960 000 people newly infected over this time, and in the Middle East and North Africa, where deaths from AIDS-related illnesses increased by 11%, an estimated 140 000 people newly infected, over the same period.

The report notes that services focused on key populations within those regions are few and far between, and harsh punishments for same-sex sexual relationships, drug use and sex work in those regions and elsewhere are proving to be formidable barriers to the few services that are available.

In western and central Africa, insufficient domestic funding, weak health systems, formal and informal user fees for health care, humanitarian situations and high levels of stigma and discrimination continue to undermine efforts to scale up HIV testing and treatment.

Many challenges remain, including stigma and discrimination faced by people living with HIV and harmful gender norms. Laws and policies in many countries prevent young people, women, key populations―gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people―indigenous people, migrants and refugees from accessing health and HIV services.

Funding for HIV responses in low- and middle-income countries globally has also remained flat for most of the past five years. In 2017, donor and domestic investments in low- and middle-income countries were US$ 20.6 billion, about 80% of the 2020 target.

“As the Secretary-General’s report makes abundantly clear, to protect the gains we have made and to tackle the challenges that stand in the way of our promise to end AIDS by 2030, we need to firm up our resolve, strengthen our partnerships and say no to complacency,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “Let’s start with a successful replenishment that results in a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria that will enable it, along with its range of partners, including UNAIDS, to continue to deliver evidence-informed, people-centred and human-rights based support to the people and communities who need it the most.”

The report outlines that there is an important opportunity to seize the growing momentum to achieve universal health coverage, a core principle of which is leaving no one behind. Collaboration between health systems and community groups has been shown to reduce stigma and discrimination and to help to deliver services to the people in greatest need―a key recommendation of the report is the strengthening of the vital role that community groups play in the AIDS response.

In the report, the United Nations Secretary-General urges Member States to adopt the following recommendations to galvanize political will, accelerate action and build the momentum necessary to reach the 2020 targets agreed to by the United Nations General Assembly in the 2016 United Nations Political Declaration on Ending AIDS: (a) reinvigorate primary HIV prevention; (b) diversify HIV testing and differentiate the delivery of health care to reach the 90–90–90 targets; (c) establish enabling legal and policy environments in order to reach marginalized and vulnerable populations; (d) mobilize additional resources and allocate them where they are most needed; (e) support communities to enable them to play their critical roles; and (f) incorporate a comprehensive HIV response into universal health coverage.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.