A new report released by UNAIDS in Munich for the International AIDS Conference 2024 shows that the world is “at a critical moment that will determine whether world leaders meet their commitment to end AIDS as a public health threat by 2030.”
The report, The Urgency of Now: AIDS at a Crossroads, brings together new data and case studies which demonstrate that the decisions and policy choices taken by world leaders this year will decide the fate of millions of lives and whether the world’s deadliest pandemic is overcome.
While the end of AIDS is “within our grasp”, stated the UN agency, “this decade, currently the world is off track.” Globally, of the 39.9 million people living with HIV, 9.3 million, nearly a quarter, are not receiving life-saving treatment. As a consequence, a person dies from AIDS-related causes every minute.
Sadly, even if leaders pledged to reduce annual new infections to below 370,000 by 2025, new HIV infections are still more than three times higher than that, at 1.3 million in 2023. “And now cuts in resourcing and a rising anti-rights push are endangering the progress that has been made.”
“World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” said UNAIDS executive director Winnie Byanyima. “Leaders can save millions of lives, prevent millions of new HIV infections, and ensure that everyone living with HIV can live healthy, full lives.”
The report finds that if leaders take the bold actions needed now to ensure sufficient and sustainable resourcing and protect everyone’s human rights, the number of people living with HIV, requiring life-long treatment, will settle at around 29 million by 2050. But if they take the wrong path, the number of people who will need life-long support will rise to 46 million (compared to 39.9 million in 2023).
The report shows continued (although slower) progress in rolling out medicines to people living with HIV with 30.7 million people now on treatment, more than 3 in 4 people living with HIV. As recently as 2010 treatment coverage stood at just 47%. The expansion of people accessing treatment is a landmark public health achievement that has seen AIDS-related deaths halved since 2010—from 1.3 million to 630,000 in 2023.
However, the world is off track to meet the 2025 target of reducing AIDS-related deaths to below 250,000.
Although tremendous progress has been made in preventing new HIV infections which have fallen by 39% since 2010 globally, and by 59% in eastern and southern Africa, the report shows that new HIV infections are rising in three regions, the Middle East and North Africa, Eastern Europe and central Asia and Latin America, and gaps and inequalities persist.
“Countries are making enormous progress to end the AIDS epidemic by 2030, however there have been many challenges that could slow our efforts,” said Dr Anthony Fauci, former scientific advisor to the US President. “We must do everything we can to be continually vocal and proactive. Failure is not an option here. In fact, it is unthinkable. If we all work together, we shall meet our common goal. I for one will continue to work with all of my strength to make sure that we do indeed end the AIDS epidemic and I implore all of you to commit to the same.”
Gender inequality is exacerbating the risks faced by girls and women and driving the pandemic. HIV incidence among adolescent girls and young women is still extraordinarily high in parts of eastern and southern Africa and western and central Africa.
Because stigma and discrimination against marginalized communities create barriers to vital prevention and treatment services, key populations, including sex workers, men who have sex with men and people who inject drugs, represent an increased proportion at (55%) of new infections globally compared to 2010 (45%).
The report demonstrates that HIV prevention and treatment services will only reach people if human rights are upheld, if unfair laws against women and against marginalized communities are scrapped, and if discrimination and violence are tackled head on.
UNAIDS calculations show that while 20% of HIV resources should be dedicated towards HIV prevention for populations most affected by HIV, just 2.6% of total HIV spending went towards interventions for key populations in 2023.
Around the world, funding is shrinking, holding back progress and even leading to rising epidemics in certain regions. In 2023, total resources available for HIV (US$ 19.8 billion) dropped by 5% from 2022 and were US$ 9.5 billion short of the amount needed by 2025 (US$ 29.3 billion). Domestic funding in low- and middle-income countries—which make up 59% of total resources for HIV—is being constrained by the debt crisis and fell for the fourth consecutive year, with a 6% decline from 2022 to 2023.
Increased resource mobilization is needed, especially in Asia and the Pacific — where the numbers of people living with HIV are projected to almost double by 2050 — and in Eastern Europe and Central Asia, Latin America and the Middle East and North Africa, regions with growing epidemics, but where funding for HIV has decreased significantly. Around half of the total resources needed by 2025, and 93% of the current HIV funding gap, are outside of sub-Saharan Africa.
The Urgency of Now: AIDS at a Crossroads shows that decisions taken this year will determine if global targets are met, AIDS is ended as a public health threat by 2030, and a sustainable HIV response is built.
“The fraying of solidarity between and within countries is putting progress in danger, but the path that ends AIDS is a path that has been proven, and is a path that leaders have promised to take. Whether leaders fulfill their pledge to end AIDS is a political and financial choice. The time to choose the right path is now,” ended Byanyima.
