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Millions of lives at risk as progress against AIDS falters – UNAIDS

The global HIV response is in danger. Progress in prevention is faltering around the world. Action to tackle the inequalities driving AIDS is urgently required to prevent millions of new HIV infections this decade and to end the AIDS pandemic.

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New data from UNAIDS on the global HIV response reveals progress has faltered, resources have shrunk, and millions of lives are at risk as a result. The new report, In Danger, highlights the human suffering wrought by the AIDS pandemic, especially for marginalized communities across the world. It sets out the devastating consequences if urgent action is not taken to tackle inequalities which drive the pandemic.

UNAIDS data indicates that between 2020 and 2021, the world experienced the smallest annual decline in new HIV infections since 2016 of only 3.6%. More than 1.5 million people in the world were newly infected with the virus last year, with 260 000 coming from Asia and the Pacific region.

In Asia and the Pacific—the world’s most populous region—UNAIDS data now shows new HIV infections are rising where they had been falling. Philippines and Malaysia are among countries with rising epidemics, particularly among key populations and key locations. Young key populations are also being left behind, with over half of the young key populations in the region not receiving comprehensive HIV prevention services.

There is some positive news, such as notable declines in new HIV infections in countries like Viet Nam with a 60% decline since 2010. Cambodia has also made remarkable progress with a 50% decline of new infections since 2010. Progress such as this is attributed to adequately resourcing national responses, adopting sound policies, and making prevention and treatment technologies widely available. Viet Nam has made impressive progress in scaling up the coverage of Pre-Exposure Prophylaxis (PrEP), with an increase of 72% between 2020 and 2021. Cambodia’s scale up of PrEP is also notable, with over 3 000 individuals initiating PrEP through March 2022, 30% of which are young people aged 15 – 24. Lessons from these countries set good examples for neighboring countries in earlier stages of making PrEP available as an option for HIV prevention.

Unfortunately, efforts to ensure that all people living with HIV are accessing life-saving antiretroviral treatment are faltering. Globally, the increase in the number of people receiving HIV treatment last year, 1.5 million, was the smallest since 2009. And while 4 million people living with HIV in the Asia Pacific region have access to antiretroviral treatment, 2 million people still do not. In 2021, 140 000 people died of AIDS-related causes in Asia Pacific, despite it being preventable with available treatment.

The UNAIDS report also highlights how discriminatory attitudes towards people living with HIV remain alarmingly common, despite decades of advocacy and education. No countries in Asia and the Pacific region that reported data to UNAIDS have achieved the 2025 target of less than 10% of people living with HIV and at risk of HIV experiencing stigma and discrimination. 

UNAIDS data have shown increasing risk of new infections faced by gay men and other men who have sex with men (MSM) globally. As of 2021, UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk.

Discriminatory and punitive laws are exacerbating the risks of HIV infection for key populations.  Reforming such laws and creating policies that protect their rights are important to ensure that key populations, who along with their sexual partners make up 70% of new HIV infections globally, are able to access vital health services free of stigma and discrimination.

The trajectory ahead shows the world way off track to reach the global targets. World leaders had pledged that there would be fewer than 370,000 new HIV infections per year by 2025. But UNAIDS new report shows that on the current path the number of new infections that year would be over 1.2 million. That would mean not just missing the pledge on new infections, but overshooting it by more than three times.

It is still possible for leaders to get the response back on track. This requires both national action and international solidarity. Last year leaders agreed a roadmap, set out in the Political Declaration on HIV and AIDS, which can end AIDS by 2030 – if leaders fulfil it.

“We have the recipe for success: ensuring community-led and people-centered services, upholding human rights of all, removing punitive and discriminatory laws and ensuring equal access to prevention, testing and treatment technologies for all. We can end AIDS by 2030 as promised, but we must summon the courage required to close the gaps and end inequalities,” said Taoufik Bakkali, Regional Director for UNAIDS Asia and the Pacific.

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