HIV Treatment

GENEVA, 10 July 2024— UNAIDS has welcomed the release of Gilead Sciences’ trial results on the injectable long-acting HIV medicine Lenacapavir for HIV prevention. The result “provides hope of accelerating efforts to end AIDS”, UNAIDS says, “but only if Gilead ensures that all people who need it can have access to this game-changing medicine.”

The recent trial of the medicine among cis-gender women in Uganda and South Africa was so successful that it was halted early. Twice-yearly injections of Lenacapavir showed overwhelming efficacy for preventing HIV infections compared to standard oral preventative HIV medicines, known as pre-exposure prophylaxis (PrEP). Additional trials are ongoing in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.

UNAIDS has welcomed the “exciting development,” and urged the company to allow generic production of Lenacapavir to all low- and middle-income countries by negotiating voluntary licensing agreements through the Medicines Patent Pool (MPP). The MPP is a UN-backed programme with extensive experience negotiating generics agreements between originators and generic pharmaceutical companies.

Gilead has not yet announced its plans for low and middle-income countries. However, UNAIDS is concerned that Gilead’s latest statement regarding its access strategy for low and middle-income countries mentions only “high incidence countries and resource limited countries” and makes no specific mention of upper-middle-income countries or the Medicines Patent Pool. Upper middle-income countries account for 41% of new HIV infections and 37% of all people living with HIV. These countries are home to millions who cannot afford the prices Gilead charges high-income countries.

“The success of Gilead’s recent Lenacapavir trial is an exciting development. While we still await regulatory approvals, normative guidance and results from the other ongoing trials, this news offers hope that we can enable everyone who would benefit, including especially the most marginalised communities, to have access to the help they need. Enabling equitable global access to new technologies can help get the world on track to end AIDS as a public health threat by 2030,” said Winnie Byanyima, Executive Director of UNAIDS. "However, it is concerning that Gilead’s latest announcement seems to mention neither upper-middle income countries, where people cannot afford anything like Lenacapavir’s current $42,250 price tag, nor a commitment to work with the UN-backed Medicines Patent Pool. Without these safeguards, it cannot be assured that this game-changing medicine will reach all those who need it."

/ENDS

Notes

Data in this press release comes from UNAIDS 2023 Epidemiological estimates (aidsinfo.unaids.org)

The UNAIDS Executive Director joined more than 300 experts and activists calling for a generic version of Lenacapavir to be licensed to all low and middle-income countries through the MPP, in a letter coordinated by the People’s Medicines Alliance: https://peoplesmedicines.org/wp-content/uploads/2024/05/Gilead-Open-Letter_May-2024.pdf

The AIDS Vaccine Advocacy Coalition provides an overview of the Lenacapavir for PrEP trials: https://avac.org/resource/infographic/an-overview-of-lenacapavir-for-prep-trials/ 

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.

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. 

Four Albanian cities—Kolonja, Durrës, Pogradec, and Shkodra—have signed the Paris Declaration on AIDS committing to ending AIDS as a public health threatby 2030. By signing the declaration, the Mayors committed to achieving the 95-95-95 targets by 2025 and called on other municipalities in Albania, including the capital Tirana, to join this effort. 

The Albanian cities are the latest additions to the list of more than 550 other cities around the world that are part of the Fast-Track Cities initiative which aims to fast-track action at local level to improve the quality of life of people living with and affected by HIV. 

In order to fulfill their commitments, the cities have developed different plans of action based on their local circumstances. For instance, the Municipality of Durrës plans to increase investments in methadone maintenance therapy, aiming to expand the number of people benefiting from such services by 10% each year.  

The Municipalities of Pogradec and Kolonja are focused on raising awareness among migrant populations to increase HIV testing rates in these regions. As border cities with a significant male population migrating for work, ensuring these communities are well-informed and have access to necessary health services is crucial.  

Finally, the Municipality of Shkoder aims to foster a partnership with Podgorica in Montenegro to exchange experiences and best practices in developing the "Healthy Houses" model, which has been successful in the neighboring country. The "Healthy Houses" initiative is a free social service providing psychosocial support to citizens. It focuses on improving the quality of life, reducing risks, and offering support to socially vulnerable groups. The service addresses a range of issues, including HIV, domestic violence, addiction, services for LGBTQ+ peopleand others.  

Olimbi Hoxhaj, Executive Director of the Albanian Association of People Living with HIV, hopes that signing the Declaration and the follow-up actions will not only help prevent new HIV infectionsbut will also significantly reduce AIDS-related mortality.  

Albania has a low HIV-prevalence epidemic but faces an increasing number of new HIV cases. From 1993 to 2023, 1,716 cases were diagnosed, with 113 new cases in 2023 alone. Most HIV testing occurs in the late stages of infection (about 60% of new cases), meaning official figures do not fully represent the actual infection rate. 

The Minister of Health and Social Protection of Albania, Ogerta Manastirliu, emphasized that rapid diagnosis and treatment are key. “The whole fight in this aspect is timely diagnosis so that the treatment can start as soon as possible, and the infection is under control.” 

“While the European region continues to face political, economic, and healthcare challenges due to regional conflicts, migration, and other complexities, it is important to secure commitment from municipalities to advance progress towards the crucial HIV targets,” said Eamonn Murphy, UNAIDS Regional Director for Asia-Pacific and Eastern Europe and Central Asia. 

Technical assistance to all municipalities in developing their local programs was provided through the cooperation between the International Association of AIDS Care Providers (IAPAC), the Fast-Track Cities Institute (FTCI), UNAIDS and the Global Fund’s regional #SoS 2.0 project, which aims to ensure the sustainability of HIV services in 15 countries in Eastern Europe. "Since 2019, with our support, 21 municipalities from Southeast Europe have joined the Fast-Track Cities initiative," said Tetiana Deshko, Director of the International Programs Department at the Alliance for Public Health.

GENEVA, 29 May 2024—As LGBTQ+ communities and allies take to the streets to mark PRIDE month, UNAIDS is speaking out in solidarity, rejecting the criminalization, discrimination and stigmatization of LGBTQ+ people and insisting on respect for all.

“The PRIDE celebrations are a demonstration of the power of inclusivity,” said UNAIDS Executive Director, Winnie Byanyima. “PRIDE has brought the world a long way in the struggle to protect the human rights of LGBTQ+ people. So much has been won. But the progress that has been made is under threat. The world needs the spirit of PRIDE more than ever today: to protect everyone’s health, we need to protect everyone’s rights.”

There is much to celebrate. UNAIDS data shows that 123 countries do not penalize same-sex relations. This represents the highest number of countries rejecting criminalization ever.

More and more countries have been scrapping the harmful punitive anti-LGBTQ+ laws which are often leftovers of colonial rule. Since 2019 alone, Botswana, Gabon, Angola, Bhutan, Antigua and Barbuda, Barbados, Singapore, Saint Kitts and Nevis, Cook Islands, Mauritius and Dominica have all repealed laws that had criminalized LGBTQ+ people.

However, the human rights of the LGBTQ+ community are threatened by a globally coordinated and well-funded extremist anti-rights network who are spending millions promoting hate and social division and are proposing ever more draconian laws to punish LGBTQ+ people. Attacks on LGBTQ+ people violate human rights and undermine public health.

This perilous time calls for courage and solidarity from everyone. PRIDE has always been as much about protest and commemoration as celebration. The first marchers in New York more than 50 years ago knew that PRIDE was the antidote to stigma and discrimination – a rejection of the shame that others sought to impose on them.

Movements spearheaded by LGBTQ+ activists have driven much of the progress that has been made in protecting everyone’s human rights and protecting everyone’s health.

Today we are at a hinge moment: the end of AIDS as a public health threat is realisable in this decade, but progress is imperiled by the pushback on human rights.

At a time when support for human rights defenders is vital and urgent, funding support for civil society organizations is shrinking, as donor countries cut their budgets.

The evidence is crystal clear: stigma kills, solidarity saves lives.

This is a moment for solidarity. This is a moment for PRIDE.

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.

This story was first published by News24.com

Eswatini is one of the countries which has been most affected by HIV. At the peak of the epidemic in 2015, almost one out of three people were living with HIV. In 1995, when there was no antiretroviral treatment for people living with HIV, 73 000 people were living with HIV. 2400 people died of AIDS that year. Worried about the rising number of infections and deaths, communities of people living with HIV mobilized to press that antiretroviral treatment be made available for people living with HIV.

One of the key campaigners for access was Hannie Dlamini. Dlamini is now 50 years old and has been living with HIV for 32 years, after finding out about his HIV positive status at the age of 18. He was one of the first people in Eswatini to publicly declare his positive HIV status in 1995 at a time when the stigma and misinformation around HIV was rife.

Dlamini rallied together other people living with HIV as well as non-governmental organizations working to end AIDS in Eswatini, to ensure that everyone living with HIV and in need of treatment had access to it. They formed a community-led organization called Swaziland AIDS Support Organization (SASO) as a support group for people living with HIV. SASO also provided healthy living information for people living with HIV.

“When we asked the government [in 2002] for ARVs in Eswatini we did a pilot project with NECHA [National Emergency Response Council on HIV/AIDS], to see if people would use the drugs.” Dlamini says the response was overwhelming, with many people keen to start the lifesaving treatment. “We initially planned to enrol 200 people on treatment but the demand was 630.” said Dlamini.

Today, Eswatini is one of the countries which has achieved the ambitious 95-95-95 targets (95% of people living with HIV who know their HIV status, 95% of people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed). This achievement has put the country a step closer to ending AIDS as a public health threat, thanks to the work of community-led organizations, authorities and global partners like UNAIDS, the United States President's Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, TB and Malaria who are working with the government and local communities to end AIDS.

Eswatini’s HIV response strategy includes ongoing nationwide testing and treatment campaigns, use of self-testing kits to encourage more people to take up testing at the comfort of their homes, antiretroviral treatment, male circumcision and pre-exposure prophylaxis (medicine to prevent HIV) and other prevention measures. Community organizations such as Kwakha Indvodza are also key in encouraging men to take full responsibility for their wellbeing and reducing toxic masculinity and gender-based violence which are some of the drivers of HIV.

The driving role of communities in Eswatini to end AIDS is acknowledged by the health authorities. According to Dr. Michel Morisho, HIV management specialist at Mbabane Government Hospital, the government “could not have achieved the 95-95-95 without communities.”

Dr. Morisho says as part of the country’s strategy to end AIDS, HIV testing and treatment are part of disease management for every patient who presents at health facilities for any illness. “When people come to the hospital for whatever, or check up, we offer an HIV test to allow them to know their HIV status,” he said. Dr. Morisho added that treatment is important to bring down viral load and is helping people living with HIV to stay healthy. Eswatini is striving to achieve 100-100-100 [in the number of people who know their HIV status, are on treatment and are virally suppressed].” People who are virally suppressed cannot transmit HIV, thus helping in HIV prevention efforts.

Young women living with HIV have also stepped up to fight the spread of HIV in the country, volunteering their time as peer educators to educate young people about HIV and supporting people newly infected to stay on treatment to live healthily and long lives. Ntsiki Shabangu is a 28-year-old young woman living with HIV. She was diagnosed with HIV in 2015, at the age of 19. She opened up about her status in 2017 and is now working with the Eswatini Network of Young Positives, a local non-governmental organisation working to end AIDS among young people providing counselling and HIV awareness training . Ntsiki believes that: “When you share your story, you bring hope to young people.”

While Eswatini is on the path to end AIDS, the country is facing other health burdens associated with aging, including non-communicable diseases such as diabetes and cancer. People living with HIV are not often more affected by these illnesses. Some people living with HIV in Eswatini have developed these comorbidities, which presents the need for the strengthening of the healthcare system to provide easily accessible holistic disease management and treatment along with HIV services to improve the quality of life for people living with HIV. As Thembi Nkambule, a woman who has been on HIV treatment for more than 20 years said: “Most of us are sick. Most of us are presenting with kidney issues. We are presenting with hypertension; we are presenting with sugar diabetes. We have a lot of issues.”

To protect the gains that have been made against HIV in Eswatini, the government should invest more resources in building a resilient healthcare infrastructure to strengthen the system to better meet the health needs of people living with HIV and to prepare for future pandemics. Community-led organisations should also be placed at the centre of HIV response and supported, both financially and politically, to reach more people who need HIV services to end the epidemic by 2030 as a public health threat.

13 March 2024—A new report, HIV Prevention: From Crisis to Opportunity shows that HIV infections continue to decline in countries that are part of the Global HIV Prevention Coalition (GPC) faster than in the rest of the world.

Eleven GPC focus countries have reduced their annual number of new HIV infections by at least 66% since 2010. By comparison, the average reduction in new HIV infections since 2010 globally is 38%. The GPC is a coalition of 38 countries working together to accelerate declines in new HIV infections to achieve the target of having 95% of the people who are at risk of HIV accessing effective combination prevention options.

The GPC countries that have prioritised primary prevention and treatment and that have focused on reaching people most at risk have secured the strongest consistent declines in new HIV infections.

Globally, progress in HIV prevention has been highly uneven and a majority of the world’s countries are not currently on track to achieve the 2025 targets. Indeed, several countries are experiencing prevention crises with low access to services and face record rising new HIV infections.

“The findings of this report offer crucial lessons for action,” said Angeli Achrekar, Deputy Executive Director Programme, UNAIDS. “The report shows that sustained political leadership, investment in effective HIV prevention programmes, and an enabling policy environment are crucial to end AIDS as a public health threat by 2030.”

Declines in new HIV infections have been boosted by the cumulative impact of combination HIV prevention options and increased access to antiretroviral treatment which has also increased viral suppression in people living with HIV. People who are on treatment and are virally supressed cannot transmit HIV.

“It’s remarkable to see what has been achieved in the AIDS response in the past 20 years. But the progress to date has not been equitable and is not yet sustainable, and we must never confuse progress with being sure of success,” said Mitchell Warren, GPC co-chair and Executive Director, AVAC. “Our progress is fragile, and what we’ve achieved today could slip away even more quickly than it was achieved if we let complacency take hold.”

Key populations and adolescent girls and young women are still at high risk of new infections

HIV incidence remains unacceptably high among populations where gaps in HIV prevention investments persist. This includes key populations in all regions globally and adolescent girls and young women in parts of sub-Saharan Africa.

Around 3100 young women and girls aged 15-24 became newly infected with HIV every week in sub-Saharan Africa in 2022 and HIV incidence declined less rapidly than it has among young men. Only 43% of the sub-national areas in which there is elevated HIV incidence among young women are being reached with dedicated prevention programmes for young women.

Although GPC countries have shown solid gains in reducing new HIV infections, challenges remain worldwide in reaching key populations most at risk of new HIV infections including men who have sex with men, sex workers and people who inject drugs. Every week, more than 11 000 new HIV infections occur among key populations and their sexual partners globally.

Only 44% of sex workers, 28% of gay men and other men who have sex with men, and 37% of people who inject drugs accessed two or more HIV prevention services in the previous three months according to median values reported by GPC countries ––against a target of 90%.

HIV prevention is being obstructed by shortfalls in prevention financing, and by punitive laws. Social stigma, violence, discrimination and social exclusion are barriers to key populations’ access to health-care services and information, exacerbating their risk of acquiring HIV. Law reform is a crucial enabler of prevention programmes. Protecting the human rights of everyone is vital for protecting the health of everyone.

Investments in both condom and voluntary medical male circumcision programmes, which are both effective in preventing HIV, have fallen in some of the countries with the largest HIV epidemics. In addition, breakthrough HIV prevention options such as pre-exposure prophylaxis (PrEP), medicine to prevent HIV, are still only available to a small fraction of the people who need them.

There are unprecedented opportunities for HIV prevention in 2024. There is a growing array of prevention options including existing tools and new long-acting prevention technologies, as well as country examples of how to implement prevention at scale and increase choices available to communities.

HIV Prevention programmes need to be at scale, efficient and equitable. The actions that are needed for success and sustainability are known, have been shown to work, and have been agreed: collaborate, follow science, tackle inequalities, protect everyone’s rights, let communities lead, and invest in what is needed. Sliding back on resourcing or inclusion would hurt everyone. Solidarity will benefit everyone. Communities, countries and international partners can prevent new infections – together.

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.

Two years of war in Ukraine have resulted in significant humanitarian consequences. Forty percent of the current population of Ukraine,14.6 million people, are in need of humanitarian assistance, 6.4 million refugees have fled the country, and more than 3 million people are internally displaced. People living with and affected by HIV continue to be vulnerable to the effects of the war, even as HIV services have been restored and are functional in most parts of the country.

Russian strikes have continued to wreak havoc on Ukrainian cities, causing death and destruction, impacting access to water, electricity, heating, and health services for millions of civilians.

In addition, there have been 1,570 attacks on health facilities and 630 health facilities damaged.

According to the latest data from The Ukrainian Public Health Center, prior to the war, Ukraine had made significant progress in reducing HIV incidence (-47%) and AIDS-related mortality (-81%) since 2010. Despite the initial disruption to the national AIDS response at the onset of the war, the national AIDS program has gradually resumed routine operations.

As of the end of 2023, the number of patients on antiretroviral therapy (ART) was only slightly below the pre-war figure, standing at 118,348 (130,724 as of February 2022). Additionally, approximately seven thousand patients are known to receive ART abroad. In the last two years, the number of patients on opioid agonist therapy (OAT) increased by 38%, reaching 27,511 people. Pre-exposure prophylaxis (PrEP) more than doubled, reaching 12,354 people.

However, in eastern and southern occupied territories data is incomplete or not available. This is true of Donetsk, Luhansk, Zaporizhzhia, Kherson regions, AR Crimea, and the city of Sevastopol. The same occurred in 2023.  Despite these challenges, the surveillance system in the government-controlled areas remains operational, ensuring the completeness and quality of data on HIV prevention, testing and treatment services.

In addition, 9.6 million people in Ukraine are estimated to be at risk of or living with a mental health condition, and 3.9 million people are estimated to suffer from moderate to severe symptoms. And there has been an increase in gender-based violence.

Ukraine remains committed to the HIV response through a strong coalition of government, civil society, international organizations, and donors, first and foremost The United States President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. This collaboration has secured vital supplies of antiretroviral therapy (ARV), tuberculosis medicines, and opioid agonist therapy (OAT), ensuring uninterrupted HIV treatment and services.

UNAIDS Secretariat, Co-sponsors and UN agencies have joined forces to provide a unified response, ensuring that vulnerable populations, including those on the frontline and in the most severely affected areas, receive comprehensive support. This collaborative effort aims to bridge gaps and address the unique challenges faced by women, people living with HIV and key populations, including the delivery of crucial humanitarian aid and HIV services.

The past two years have been very challenging. Even though the country has managed to maintain HIV services, the unpredictability of what lies ahead has many fearing the worst. Support is needed to ensure sustainability of the AIDS response and to protect key populations affected by the enduring hardships of war.

For more information and more in-depth analysis, read the Situation Report (February 2024)