SDGs

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.

GENEVA, 29 September 2023—The topic of the global AIDS response—including its successes and invaluable lessons for handling pandemics—permeated many discussions during last week’s United Nations General Assembly (UNGA) in New York. From three High-Level meetings on health, to the Sustainable Development Goals (SDG) Summit to remarks given to the General Assembly and at High-Level Side events, the lessons from 40 years of responding to HIV—including the principle of leaving no one behind—were repeatedly referenced in the context of a future of health and equality for all.

In his remarks to the General Assembly, United States President Joe Biden referenced success against AIDS as a platinum example of what global solidarity and shared responsibility can achieve. “HIV/AIDS infections and deaths plummeted in no small part because of PEPFAR’s work in more than 55 countries, saving more than 25 million lives,” said President Biden. “It’s a profound testament to what we can achieve when we act together when we take on tough challenges and an admonition for us to urgently accelerate our progress so that no one is left behind.”

At the opening of the SDG Summit, Irish prime minister, Leo Eric Varadkar noted that half-way to the 2030 targets we are not where we would wish to be with only 15% of the SDGs on target. He added that despite this there is progress. “More than 800 million people have been connected to electricity since 2015, 146 countries have met or are on track to achieving the under-five mortality target, and effective HIV treatment has halved global AIDS-related deaths since 2010,” said Mr Varadkar. “This progress shows that change is possible, that backsliding is not inevitable, and that poverty, pollution and gender inequality are not pre-ordained. They are trends that can be reversed, problems that can be solved and tragedies that can be averted.”

While celebrating the collective success against AIDS, UNAIDS urged leaders to keep HIV high on political agendas for three reasons. “Firstly,” said Winnie Byanyima, Executive Director of UNAIDS, “The job is not yet done—43 years into the pandemic, there are still more than 9 million people waiting for life-saving treatment, more than 1.3 million new HIV infections every year and AIDS took a life every minute in 2022. Secondly: We know how to end AIDS and, we have the path and the power to do it. And thirdly: The AIDS response is a smart investment yielding other health, social and economic impacts.”  

A number of ministers and heads of state spoke about the economic challenges they face as the result of multiple and concurrent crises, and the need for cooperation and solidarity to overcome these crises while continuing to make critical investments in development and health. Many political leaders noted that while the political will is there, there are not enough domestic resources to invest in health, education and social protection.

The UN Secretary-General Antonio Guterres reminded the international community that there is an urgent need to rethink—and reconfigure--the international financial architecture in order to achieve the SDGs. The same is true for UNAIDS's mission to end AIDS as a public health threat and ensure those gains are sustained well beyond 2030. Ending AIDS requires new and sustained resources, and a different political discourse on funding for development. UNAIDS highlighted the importance for maintaining bilateral funding for PEPFAR and multilateral funding for the Global Fund to Fight AIDS, TB and Malaria.

UNAIDS stressed that as we develop a global architecture for pandemics prevention, preparedness and response, we need to draw from over 40 years of responding to AIDS, because the AIDS response is pandemic prevention, preparedness and response.

The importance of community-led responses as essential to reaching marginalized groups and people most affected by pandemics was emphasized. UNAIDS highlighted that the Pandemic Accord must acknowledge the central role of community-led responses and commit member states to include communities and civil society in decision-making, planning, preparation, implementation and monitoring. 

The call to end inequalities was a central theme to UNAIDS’ messaging at UNGA. UNAIDS highlighted the need for equitable, affordable access to life saving medical products and how inequality drives, and prolongs, pandemics. UNAIDS advocated metrics, targets and accountability systems for focusing the response and additionally for advancing human rights to improve public health and warned that human rights violations undermine trust and drive people away from health services.

Finally, UNAIDS called for a multisectoral/whole of society approach to effectively prevent, prepare for and respond to pandemics because pandemics are not merely health crises—they also present political, social and economic challenges which require transformative action by all.

The Executive Director of UNODC, Ms Ghada Waly, on behalf of UNAIDS’ cosponsoring organizations acknowledged that, “The multi-sectoral partnership on HIV/AIDS is as important as ever, bringing together the expertise, assets and comparative advantages of 11 Cosponsors in an exemplary partnership for the development approach of the SDGs.”

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.

Partners call for urgent action to reverse an explosion in inequalities which are endangering us all

18 July 2023—The Centre for International Cooperation at the University of New York, Development Finance International, Oxfam and UNAIDS are calling for urgent action to save Sustainable Development Goal (SDG) 10: Reduced Inequality.

COVID-19 caused the largest rise in income inequality in three decades, as poorer countries lacked financing to support the incomes of the poor or to confront the COVID-19 and AIDS pandemics. During the COVID-19 pandemic and global inflation crisis, inequality of income, wealth and health outcomes rose sharply. Without seriously tackling inequality, we will not end AIDS by 2030 (SDG 3.3), and the SDGs on poverty, gender and education will be strongly compromised.  

In his 2023 SDG Progress Report, the United Nations Secretary-General announced that SDG10 is one of the worst performing SDGs. Action has never been more urgent on this goal.

For SDG10 to be successful in reducing inequality, it is vital that the international community takes concerted action during the current review of the SDGs which will culminate at the United Nations (UN) General Assembly SDG Summit taking place on 18-19 September 2023.

Action includes better monitoring the inequality of income and wealth within and between countries. This requires using indicators which are used by all member states and institutions including the UN or the World Bank, these indicators are called the Gini coefficient and the Palma ratio.

The official start to the call to action will take place during a high-level meeting on 18 July at the UN in New York, with representatives from government and civil society. H.E. the President of Namibia, Hage Gottfried Geingob, and H.E. the President of Sierra Leone Julius Maada Bio, have expressed their support and willingness to co-sponsor this call to action to Save SDG10 and fight inequality.

In addition, more than 230 leading global economists, political leaders and inequality experts, including former UN Secretary General Ban Ki Moon, Nobel prize laureate Joseph Stiglitz, Thomas Piketty, Jayati Ghosh, Helen Clark and Jose-Antonio Ocampo, are sending an open letter to the UN Secretary-General and the World Bank President urging them to include the incomes and wealth of the rich in monitoring inequality by using Gini and Palma, and to ensure trends in inequality are monitored annually in all countries. This will allow the world to see the true picture of growing extreme inequality, and to strengthen its efforts to promote anti-inequality policies.

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.

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

This story was first published by the WHO

WHO and 12 other signatory agencies to the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) have released their second progress report, Stronger collaboration for an equitable and resilient recovery towards the health-related SDGs. This report presents progress achieved, especially at country level, where SDG3 GAP is being implemented in 37 countries, with its long-term, forward-looking SDG focus and as a platform to support countries’ equitable and resilient recovery from the COVID-19 pandemic. The report also identifies challenges encountered over the last year, acknowledging the important roles that countries, agencies’ boards and donors play in setting the right incentives for effective collaboration among SDG3 GAP agencies.

“The GAP partners have shown their unwavering commitment to countries during the pandemic," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "Collaboration is now more relevant than ever. The GAP provides the platform to improve collaboration in the multilateral system to support countries to recover from the pandemic and drive progress towards the health-related SDGs, with a focus on equity and enabled by stronger primary health care.”

The report highlights ways in the which SDG3 GAP agencies are integrating work at country level, reducing fragmentation through joint work in support of national priorities and plans, creating synergies and increasing alignment within the broader health ecosystem – for example, incorporating parts of the Every Woman, Every Child agenda and working jointly with the Health Data Collaborative (HDC) in countries. Many countries are prioritizing primary health care (PHC) and sustainable financing as well as data for improving equity to understand people’s lives and to know where investments need to be made to reach the most left behind.

At a recent “PHC for UHC Mission to Pakistan”, SDG3 GAP agencies renewed their commitment to better align their support for the roll-out of a universal health coverage (UHC) benefit package. Dr Faisal Sultan, Minister of Health, Special Assistant to the Prime Minister, expressed his appreciation of the mission's work, noting that “implementation of the UHC benefit package will facilitate the strengthening of PHC services and securing sustainable financing will further support us to achieve UHC, ensuring no one is left behind.”

Looking ahead, the agencies will support additional countries under the SDG3 GAP approach. The agencies are committed to reviewing progress and have recently developed a monitoring framework to enable continued learning and enhance shared accountability.

Quotes from SDG3 GAP agencies

Dr Seth Berkley, CEO, Gavi, the Vaccine Alliance:

“The COVID-19 pandemic is exacerbating inequities in many countries. The poorest and most marginalised communities have been hardest hit. Today, in the 68 countries Gavi supports, nearly 10 million children still go without any basic, routine vaccines every year. Equitable and resilient recovery will require us to work together to reach these zero-dose children, so that no one is left behind.”

Dr Muhammad Pate, Director of the Global Financing Facility for Women, Children and Adolescents: 

Partnership is at the heart of the GFF's country-led model. COVID-19 has made it even clearer that collaboration is critical to fight the pandemic and achieve the health-related SDGs. Working together GAP agencies have accelerated their efforts for stronger partner alignment, engagement and accountability behind country-led response and recovery efforts to reclaim the health gains and build a more inclusive and resilient recovery.”

Peter Sands, Executive Director of the Global Fund:

"Today’s global health challenges call for an integrated approach and intensive collaboration between all partners. We are committed to working together to deliver more effective and efficient support to countries, build the path towards an equitable and resilient recovery from the COVID-19 pandemic and accelerate progress towards achieving Sustainable Development Goal 3: health and well-being for all."

Guy Ryder, Director-General of the International Labour Organization

“The ILO welcomes the progress for 2020 and as a new member looks forward to engaging with all SDG3-GAP partners in 2021 and beyond. The COVID-19 crisis has clearly demonstrated the interaction between health, social factors and decent work. It has highlighted the critical need for investments in all three areas. This will foster recovery and lead to a more sustainable, equitable development path. Equally, investments in the health of workers and of care workforce are vital to make progress towards universal health coverage. If we are to achieve SDG3, increased cooperation is needed. By joining this partnership the ILO reaffirms its commitment to support countries during this pandemic and beyond, through a multilateral and coherent approach.”

Winnie Byanyima, Executive Director of UNAIDS:

“We have seen with HIV and now with COVID-19 the critical role communities play in connecting key and vulnerable populations to essential health and social services, in ensuring gender equality, inclusion and rights-based approaches to health and social care, and in reducing inequalities. Resilient health systems rely on communities, this is why they feature prominently as a key pillar in the Global Action Plan and why they must be fully engaged, supported and funded."

Achim Steiner, Administrator of the United Nations Development Programme:

The COVID-19 pandemic affects everyone everywhere, but it is having a disproportionate impact on the world’s most vulnerable. By 2030, eight out of ten people pushed into poverty, as a result of COVID-19, will live in low and medium human development countries. Greater cooperation is the only way to defeat COVID-19 and restore and accelerate progress on the SDGs and on the pledge to leave no one behind. The SDG 3 Global Action Plan (GAP) is enhancing collaboration to support countries with their COVID-19 response and to lay the foundation for an equitable and sustainable recovery.”

Dr Natalia Kanem, Executive Director of UNFPA:

“As the world rethinks health and other systems in the wake of the pandemic, we have a chance to address the inequalities, discrimination and exclusion COVID-19 has laid bare. Let us seize this opportunity to aim for universal coverage that upholds the fundamental rights, well-being and dignity of all. With quality disaggregated data to understand who is being left behind and why, and with women and girls at the centre of our rebuilding efforts, we can identify the best investments for strong, equitable health systems and resilient communities.”

Henrietta H Fore, Executive Director of UNICEF:

"Investing in primary health care is critical to keeping children, women and families safe during and beyond the pandemic. These investments will help countries prevent and fight future epidemics and pandemics, while achieving better health outcomes overall. UNICEF is proud to stand with our GAP partners as we help governments around the world design and deliver scaled-up primary health care services that can reach every child in every community.”

Dr Philippe Duneton, Executive Director of Unitaid:

"If the past year has shown us anything, it's that global solidarity is imperative to address the critical health challenges that confront us all, but particularly the world's most vulnerable populations. Alongside work to defeat the pandemic, we must not let progress against TB, malaria, HIV, other infectious diseases and women and children's health slip backwards, but rather double down on the goal of achieving the health-related SDGs. Equitable access to innovation has a vital role to play in getting lifesaving health products to everyone, no matter where they live."

Phumzile Mlambo Ngcuka, Executive Director of UN Women:

"The negative pressures exerted on our societies and economies by the COVID-19 pandemic both demonstrated and exacerbated gender inequalities and their intimate relationship with globally pervasive issues like men’s violence against women and the burden of unpaid caregiving work carried by women and girls.  Resolution of these complex problems underpins the achievement of the SDGs. It demands responses grounded in partnerships, such as the collaboration under the Global Action Plan, that rebalance power, realize women’s rights to health, and recognize their leadership roles as active agents of change in their households, workplaces, and communities." 

Dr Mamta Murthi, Vice President for Human Development at the World Bank:

“The Covid-19 pandemic has exposed weaknesses in health systems worldwide and set back progress towards SDG3. The World Bank is taking fast, comprehensive action to save lives and protect poor and vulnerable people, including with $12bn for vaccines, drugs and therapeutics. Partnerships and close coordination across all agencies is essential to help countries fight the pandemic effectively. We remain fully committed to working with all partners to strengthen countries’ health systems, including for better pandemic preparedness, and ensuring that no one is left behind.”

David Beasley, Executive Director of the World Food Program:

"The COVID-19 pandemic taught us to adapt, innovate and collaborate to save lives. We need to build on these lessons and step our game up even further. Working together even more effectively is critical so we can we meet increasing needs and build back better for a healthier, more well-nourished future."

Read the full report here

GENEVA, 25 February 2021—UNAIDS welcomes the United Nations General Assembly decision for a high-level meeting on HIV and AIDS to take place from 8 to 10 June 2021. The high-level meeting will review the progress made in reducing the impact of HIV since the last United Nations General Assembly high-level meeting on HIV and AIDS in 2016 and the General Assembly expects to adopt a new political declaration to guide the future direction of the response. The high-level meeting will take place as the world marks 40 years since the first case of AIDS was reported and 25 years of UNAIDS.

“World leaders must seize the opportunity offered by this new United Nations General Assembly high-level meeting on HIV and AIDS to maintain their focus and commitment on ending AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development,” said Winnie Byanyima, UNAIDS Executive Director. “The AIDS epidemic is unfinished business and must be ended for everyone everywhere, including for young women and adolescent girls and for other groups of people disproportionately affected by HIV. The right to health belongs to all of us.”

Progress towards ending the AIDS epidemic as a public health threat by 2030 as part of the Sustainable Development Goals has been highly uneven and the global goals for 2020 adopted in the 2016 United Nations Political Declaration on Ending AIDS were not met. Stigma and discrimination, the marginalization and criminalization of entire communities and a lack of access to health, education and other essential services continue to fuel the epidemic. Women and girls in sub-Saharan Africa and key populations (gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and people in prison) and their partners globally continue to be disproportionately affected by the HIV epidemic.

UNAIDS is currently developing a new global AIDS strategy for 2021–2026 through a process that is inclusive of all stakeholders in the AIDS response. The final draft strategy will be considered for adoption by the UNAIDS Programme Coordinating Board in March 2021. The new global AIDS strategy will include new targets to ensure that no one is left behind in ending AIDS, wherever they live and whoever they are. By achieving these targets, the number of people newly infected with HIV would fall to 370 000 by 2025, and the number of people dying from AIDS-related illnesses would be reduced to 250 000 in 2025.

Even the gains already made against HIV are threatened by the disruptions caused by the COVID-19 pandemic. The high-level meeting creates an opportunity to ensure that the world bolsters the resiliency of the HIV response to date, commits to rapid recovery post-COVID-19 and applies the lessons learned from the colliding epidemics of HIV and COVID-19 to create more resilient societies and health systems that are ready to meet future health challenges.

“The AIDS response has taught us that global solidarity is critical to making sustained progress against the impact of health threats like COVID-19,” said Ms Byanyima. “There must be concerted international efforts to reduce inequalities between countries and within them to strengthen the world’s capacity to absorb and defeat future global health challenges that put lives and livelihoods at risk everywhere.”

UNAIDS expresses its appreciation for the hard work of the high-level meeting co-facilitators, the permanent missions to the United Nations of Australia and Namibia, in the adoption of the resolution as well as to the President of the General Assembly for leading the process.

Given the constraints imposed by measures taken to contain the COVID-19 pandemic, it has not yet been decided if the high-level meeting will be in-person, virtual or a hybrid of the two. In line with the resolution, UNAIDS encourages the highest level of participation of United Nations Member States and the inclusion of civil society organizations and people living with or at risk of HIV in delegations to the high-level meeting. UNAIDS also looks forward to the multistakeholder hearing as a key opportunity to hear the voices of people living with, at risk of and affected by HIV, including key populations.

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.

“I am not ready to share my status or disclose myself to the public. I am afraid of being isolated, stigmatized and discriminated against. For me, it’s good for only me to know my status, rather than disclose it to other people,” said Mara John (not her real name), who comes from a Pacific island and is living with HIV. Similar stories of isolation, self-stigma, poverty and lack of human rights can be heard from many people living with HIV in small island developing states (SIDS).

On 27 September, United Nations Member States meet for a high-level review on SIDS at the United Nations General Assembly in New York, United States of America. In his report published ahead of the summit, the United Nations Secretary-General highlights that SIDS, particularly Caribbean SIDS, continue to be challenged with “high levels of youth unemployment, poverty, teenage pregnancy, and high risk for HIV infection.”

A group of 38 countries, including islands in the Pacific, the Caribbean and elsewhere, the SIDS have been provided with dedicated support owing to the specific constraints they face―for example, the size of their territory, remoteness or exposure to climate change―as a result of the United Nations Conference on Sustainable Development, also known as Rio+20, held in June 2012. In 2014, the SIDS Accelerated Modalities of Action Pathway was adopted by United Nations Member States to outline actions for sustainable development in the SIDS, including a commitment to achieving universal access to HIV prevention, treatment, care and support and to eliminating mother-to-child transmission of HIV.

While the SIDS have seen progress, there are wide differences between, for example, Cuba, the first country globally to be certified as having eliminated mother-to-child transmission of HIV, in 2015, and Mauritius, where 30% of people who inject drugs are reported to be living with HIV.

“The Sustainable Development Goals highlight the importance of leaving no one behind. This is particularly meaningful for people living with HIV in small island developing states, who face isolation, stigma and discrimination and inequalities. We need to do more to ensure that they receive the services they need,” said Gunilla Carlsson, UNAIDS Executive Director, a.i.

Generally in small islands, key populations, including gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs, bear a disproportionately high burden of HIV. In some SIDS, however, HIV also significantly impacts the general population―while key populations and their sexual partners accounted for 47% of new HIV infections in the Caribbean in 2018, more than half of all new HIV infections were among the general population. Stigma and discrimination by health-care workers is still a major challenge in the Pacific. For example, 60% of female sex workers surveyed in Fiji reported avoiding HIV testing owing to fear of stigma from health-care providers, as did more than 30% of gay men and other men who have sex with men.

Another aspect that SIDS have in common is the strength of communities of people living with HIV and the presence of exceptional political will, often at the highest levels. Ratu Epeli Nailatikau, the former President of Fiji and current Speaker of the Fiji Parliament, has been speaking out against stigma and discrimination for many years.

Networks of people living with HIV and of key populations are at the centre of the movement to end AIDS in the SIDS. In the Pacific, people living with HIV came together to publish a report in 2018 describing their situation in their own words. Similarly the Mauritius Network of People Living with HIV has provided vocal leadership to the response and clearly outlines the challenges of the community in its 2018 People Living With HIV Stigma Index report. In the Caribbean, the late activist and academic Robert Carr is credited for helping to shape global thought around the importance of addressing the human rights of vulnerable and marginalized communities as part of the AIDS response. In 2005, he helped to establish the Caribbean Vulnerable Communities Coalition, which works on behalf of the groups most often left behind.

UNAIDS is working to support SIDS through its team for the Caribbean, based in Jamaica, for the Pacific islands from its Fiji office and for the Indian Ocean islands from the UNAIDS office in the Seychelles. Priority is given to SIDS with a higher prevalence of HIV, through programmes targeting the most vulnerable populations.