GENEVA, 29 November 2021—UNAIDS issued a stark warning today that if leaders fail to tackle inequalities the world could face 7.7 million* AIDS-related deaths over the next 10 years. UNAIDS further warns that if the transformative measures needed to end AIDS are not taken, the world will also stay trapped in the COVID-19 crisis and remain dangerously unprepared for the pandemics to come.

“This is an urgent call to action,” said UNAIDS Executive Director Winnie Byanyima. “Progress against the AIDS pandemic, which was already off track, is now under even greater strain as the COVID-19 crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence-prevention programmes and more. We cannot be forced to choose between ending the AIDS pandemic today and preparing for the pandemics of tomorrow. The only successful approach will achieve both. As of now, we are not on track to achieve either.”

The warning comes in a new report by UNAIDS launched ahead of World AIDS Day (1 December) entitled Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics.

Some countries, including some with the highest rates of HIV, have made remarkable progress against AIDS, illustrating what is feasible. However, new HIV infections are not falling fast enough globally to stop the pandemic, with 1.5 million new HIV infections in 2020 and growing HIV infection rates in some countries. Infections are also following lines of inequality. Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among adolescent girls. Gay men and other men who have sex with men, sex workers and people who use drugs face a 25–35 times greater risk of acquiring HIV worldwide.

COVID-19 is undercutting the AIDS response in many places. The pace of HIV testing declined almost uniformly and fewer people living with HIV initiated treatment in 2020 in 40 of 50 countries reporting to UNAIDS. HIV prevention services have been impacted—in 2020, harm reduction services for people who use drugs were disrupted in 65% of 130 countries surveyed.

“It is still possible to end the epidemic by 2030,” affirmed United Nations Secretary-General António Guterres in his World AIDS Day message. “But that will require stepped up action and greater solidarity. To beat AIDS—and build resilience against the pandemics of tomorrow—we need collective action.”

This new report from UNAIDS examines five critical elements of the plan agreed by Member States at the United Nations General Assembly High-Level Meeting on AIDS that must be urgently implemented to halt the AIDS pandemic and which are critical but under-funded and under-prioritized for pandemic prevention, preparedness and response. These include:

• Community-led and community-based infrastructure.
• Equitable access to medicines, vaccines and health technologies.
• Supporting workers on the pandemic front lines.
• Human rights at the centre of pandemic responses.
• People-centred data systems that highlight inequalities. 

The call for upscaled investments and shifts in laws and policies to end the inequalities that drive AIDS and other pandemics is backed by leaders in global health and pandemic response from across the world.

“If ​​we do not take the steps needed to tackle the inequalities driving HIV today, not only will we fail to end the AIDS pandemic, we will also leave our world dangerously unprepared for future pandemics,” said Helen Clark, Co-Chair of the Independent Panel for Pandemic Preparedness and Response, in a special foreword to the UNAIDS report. “Pandemics find space to grow in the fractures of divided societies. The amazing scientists, doctors, nurses and communities who work to end pandemics cannot succeed unless world leaders take the steps that will enable them to do so.”

UNAIDS and global health experts emphasize that while business as usual would kill millions and leave the world trapped with colliding pandemics going on for decades, leaders can, by acting boldly and together to tackle the inequalities in which pandemics thrive, end AIDS, overcome the COVID-19 crisis and be protected from the pandemic threats of the future.

“Pathogens ranging from HIV to the virus behind COVID-19 invade the cracks and fissures in our society with startling opportunism,” said Paul Farmer of Partners in Health, a nonprofit that for decades has effectively treated AIDS in settings of material poverty. “That the AIDS pandemic is shaped by deep structural inequalities need not resign us to inaction, however. Our teams, in rural Haiti and across the world, have routinely shown that with comprehensive care delivery, robust forms of accompaniment and social support and a larger dose of social justice, disparities in HIV outcomes can be rapidly narrowed, and health systems swiftly strengthened. We shouldn’t settle for anything less.” 

This year marks 40 years since the first cases of AIDS were reported. Since that time, where investments have met ambition, there has been huge progress, particularly in expanding access to treatment. By June 2021, 28.2 million people had access to HIV treatment, up from 7.8 million in 2010, although progress has slowed considerably.

Countries with laws and policies aligned to evidence, strong community engagement and participation and robust and inclusive health systems have had the best outcomes, whereas the regions with the largest resource gaps and countries with punitive laws and that have not taken a rights-based approach to health have fared the worst.

“We know what works from seeing brilliant AIDS responses in some places,” said Ms Byanyima, “but we need to apply that everywhere for everyone. We have an effective strategy that leaders adopted this year, but it needs to be implemented in full. Ending inequalities to end AIDS is a political choice that requires bold policy reforms and requires money. We have reached a fork in the road. The choice for leaders to make is between bold action and half-measures.”

* The estimate of 7.7 million AIDS-related deaths between 2021 and 2030 is what UNAIDS models predict if HIV service coverage is held constant at 2019 levels. If the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS is executed and the 2025 targets are achieved, UNAIDS estimates that at least 4.6 million of those deaths can be averted over the decade.

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.

Inequalities and human rights barriers, which have been magnified by the COVID-19 pandemic, are preventing progress towards ending AIDS as a global public health threat by 2030. They facilitate the transmission of HIV by increasing vulnerability to HIV and limiting access to health services, particularly for gay men and other men who have sex with men, transgender people, people who use drugs, sex workers, women and girls.

Ending inequalities is both a human rights imperative and a public health necessity. Yet, despite repeated commitments, human rights barriers that drive inequalities, such as stigma, discrimination, violence and punitive laws, continue to undermine the HIV response. 

To highlight the critical need for progress on human rights barriers, and to call on all stakeholders to play their part to increase action, UNAIDS convened civil society partners, United Nations Member States, jurists and development organizations on the sidelines of the United Nations High-Level Meeting on AIDS in New York. At the event, From Promises to Action: Scaling Up Efforts against Human Rights Barriers, including HIV-Related Stigma and Discrimination, which took place on 9 June, the panellists emphasized the critical need to generate long-term investment and transformative action on human rights and stigma and discrimination, particularly on discriminatory criminal laws, in order to change structural and social barriers and, ultimately, reduce inequalities. 

The panellists exchanged best practices, discussed how human rights-based and gender-transformative approaches could reduce inequalities and issued a call for a rapid scale-up of funding, commitment and action in this area to reach the people most left behind.

The event served as a reminder that 62% of new HIV infections in 2019 were among key populations, who are still criminalized in many countries, and their sexual partners, that due to gender inequality and harmful gender norms, AIDS is still one of the leading causes of death among adolescent girls and young women in sub-Saharan Africa and six out of seven new HIV infections among adolescents (aged 15 to 19 years) in the same region are among girls.

The event also provided hope that action and change is possible. During the event, the Governments of Angola, Costa Rica and the Gambia announced that they are joining the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination.

At the event, Winnie Byanyima, the UNAIDS Executive Director, called on the international community to rally behind the bold new targets and commitments laid out in the Global AIDS Strategy 2021–2026. She highlighted that the strategy was a crucial development, as it set for the first time specific targets to reduce the societal enablers driving inequality, giving them the same priority and commitment as biomedical interventions.  

Having new targets means that there is a need for new tools and guidance, and Ms Byanyima unveiled a new series of human rights fact sheets to support action by all stakeholders on removing human rights barriers, such as criminal laws, stigma and discrimination. The series is available in multiple languages: in addition to English, French, Russian and Spanish (follow the language menu on the top right), it's also available in Portuguese (1, 2, 3, 4, 5, 6, 7).

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