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World AIDS Day: Inequalities hampering efforts to end AIDS pandemic says UNAIDS

By Nkechi Onyedika-Ugoeze, Abuja
01 December 2022   |   12:08 pm
As 650 000 persons died of AIDS in 2021, 1.5 million people newly acquired HIV infection The Joint United Nations Programme on HIV/AIDS (UNAIDS) has said that the world may not meet agreed global targets on AIDS as inequalities are obstructing the global efforts to end of AIDS. UNAIDS had earlier this year warned that…

As 650 000 persons died of AIDS in 2021, 1.5 million people newly acquired HIV infection

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has said that the world may not meet agreed global targets on AIDS as inequalities are obstructing the global efforts to end of AIDS.

UNAIDS had earlier this year warned that the AIDS response is in danger with rising new infections and continuing deaths in many parts of the world.

However, a new UNAIDS report, titled “Dangerous Inequalities’, shows that if urgent action is taken to tackle inequalities, the world can get the AIDS response on the track

According to UNAIDS, about 650 000 people were lost to AIDS in 2021 while 1.5 million people newly acquired HIV infections in the same year.

The report showed that the AIDS response is being held back by inequalities in access to treatment between adults and children adding that while over three-quarters of adults living with HIV are on antiretroviral therapy, just over half of the children living with HIV are on the lifesaving medicine and this has had deadly consequences.

“In 2021, children accounted for only 4% of all people living with HIV but 15% of all AIDS-related deaths. Closing the treatment gap for children will save lives.

It also revealed that discrimination, stigmatization and criminalization of key populations are costing lives and preventing the world from achieving agreed AIDS targets.

The report stated that the only effective route map to ending AIDS, achieving sustainable development goals and ensuring health, rights and shared prosperity, is a feminist route map.

The report revealed how gender inequalities and harmful gender norms are holding back the end of the AIDS pandemic and recommended that Fiscal space for health investments in low- and middle-income countries needs to be expanded, including through substantial debt cancellation and progressive taxation.

The study further showed that there was no significant decline in new infections among gay men and other men who have sex with men in both the western and central Africa and eastern and southern Africa regions.

According to the UNAIDS, facing an infectious virus, failure to make progress on key populations undermines the entire AIDS response and helps explain slowing progress.

The study which identified inequalities as the underlying obstacle to ending the AIDS pandemic showed how world leaders can tackle those inequalities, and called on them to be courageous to follow what the evidence reveals.

“Dangerous Inequalities unpacks the impact on the AIDS response of gender inequalities, inequalities faced by key populations, and of inequalities between children and adults. It sets out how worsening financial constraints are making it more difficult to address those inequalities.

It noted that around the world, over 68 countries still criminalize same-sex sexual relations and that gay men and other men who have sex with men who live in African countries with the most repressive laws are more than three times less likely to know their HIV status than their counterparts living in countries with the least repressive laws, where progress as far more rapid.

“Sex workers who live in countries where sex work is criminalized have a 7 times greater chance to be living with HIV than in countries where sex work is legal or partially legalized”.

Commenting on the new report, Executive Director UNAIDS, Winnie Byanyima stated that the world will not be able to defeat AIDS while reinforcing patriarchy and stressed the need to address the intersecting inequalities women face.

She said, “What world leaders need to do is crystal clear. “In one word: Equalize. Equalize access to rights, equalize access to services, equalize access to the best science and medicine. Equalizing will not only help the marginalised. It will help everyone. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV. Across 33 countries from 2015-2021 only 41% of married women aged 15-24 could make their own decisions on sexual health. The only effective route map to ending AIDS, achieving sustainable development goals and ensuring health, rights and shared prosperity, is a feminist route map. Women’s rights organizations and movements are already on the front doing this bold work. Leaders need to support them and learn from them.”

“The effects of gender inequalities on women’s HIV risks are especially pronounced in sub-Saharan Africa, where women accounted for 63% of new HIV infections in 2021.

The report showed that at a moment when international solidarity and a surge of funding is most needed, too many high-income countries are cutting back aid for global health and in 2021, funding available for HIV programmes in low- and middle-income countries was US$ 8 billion short.

“Increasing donor support is vital to getting the AIDS response back on track. Budgets need to prioritize the health and well-being of all people, especially vulnerable populations that are most affected by HIV-related inequalities”, it added.

“By interrupting the power dynamics, policies can reduce girls’ vulnerability to HIV. Harmful masculinities are discouraging men from seeking care. While 80% of women living with HIV were accessing treatment in 2021, only 70% of men were on treatment. Increasing gender-transformative programming in many parts of the world is key to halting the pandemic. Advancing gender equality will benefit everyone”.

The report noted that progress against inequalities is possible and highlights areas where the AIDS response has made remarkable progress.

‘While surveys among key populations often highlight lower service coverage among key populations, three counties in Kenya have achieved higher HIV treatment coverage among female sex workers than among the general population of women (aged 15-49 years). This has been helped by strong HIV programming over many years, including community-led services”.

“We know what to do to end inequalities. Ensure that all of our girls are in school, safe and strong. Tackle gender-based violence. Support women’s organisations. Promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone. Ensure services for children living with HIV reach them and meet their needs, closing the treatment gap so that we end AIDS in children for good. Decriminalize people in same-sex relationships, sex workers, and people who use drugs, and invest in community-led services that enable their inclusion — this will help break down barriers to services and care for millions of people, Byanyima added.

The new report shows donor funding is helping catalyse increased domestic funding: increases in external HIV funding for countries from PEPFAR and the Global Fund during 2018-2021 were correlated with increases in domestic funding from a majority of national governments. New investments to address HIV-related inequalities are urgently needed.

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