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In 2014, UNAIDS announced its intention to end the AIDS epidemic by 2030. ¹ Now, 6 years later, significant progress has been made in dozens of countries, but they have admitted their 2020 goals will not be fully met and it’s looking unlikely their 2030 ambition won’t be either.² So what has happened, and what hasn’t?

The triumphs worth celebrating

A lot of brilliant achievements have been made. At the end of 2019, 81% of people living with HIV knew their HIV status, 67% were on antiretroviral therapy, (that’s 25.4 million, compared to just 685,000 in 2000),^2,3 and almost 59% had suppressed viral loads. Fourteen countries achieved the 90-90-90 treatment targets. Millions of lives were saved, and new HIV infections have been reduced by 23% since 2010.²

These achievements were made possible through tireless efforts of healthcare and community workers, great financial support, and relentless activism and engagement. There have been scientific breakthroughs, like the groundbreaking 2011 trial results that revealed effective antiretroviral therapy reduces transmission by as much as 96%.⁴ And among other initiatives, the WHO has promoted use of pre-exposure prophylaxis, launched a process for validating the elimination of mother-to-child transmission, and released self-testing guidance.³

Those left behind

But this hasn’t been enough – at least not everywhere and for everyone. Sadly, echoing UNAIDS’ original commitment in 2014, to ‘make sure that no one is left behind’,¹ some groups charged forward, while many others struggled. So much so, that inequality was the theme for UNAIDS’ latest report.²

Between countries, levels of service vary greatly and funding can be unpredictable. While progress has been made in Eastern and Southern Africa, cases rose in Eastern Europe, Central Asia, the Middle East, North Africa and Latin America.

There is variation within countries, too; the report found that 62% of new infections were in key populations and their sexual partners, and stigma has stopped, and still does stop, marginalised groups from seeking the help they need. Gender-based violence and inequalities remain a strong driving force for the epidemic: in Sub-Saharan Africa, adolescent girls and young women accounted for 1 in 4 new infections, whereas women and girls of all ages accounted for 59% of new infections.²

Funding has already fallen, and now resources are being affected by COVID-19. UNAIDS has urged countries to increase their investments in HIV, but only time will tell if governments will respond.²

How can we bridge the gaps? We can learn from the success stories. The UNAIDS report found common themes among countries hitting their goals: determined political leadership on AIDS, strong community engagement, rights-based and multisectoral approaches, and consistent guidance by scientific evidence. And where HIV services were comprehensively provided, transmission levels were reduced significantly.²  The AIDS 2020 conference also highlighted some key areas for focus: creating an enabling environment, countering complacency in leadership, considering patients’ comprehensive health needs, and finally, strong collaborations.⁵

UNAIDS is now looking at its strategy for 2021 and beyond.⁶ With fewer than 10 years to go until 2030, they’ve committed to accelerating the pace of action. Development of the next strategy will be data-driven and lean heavily on the opinions and experiences of experts and those involved.

Ending the AIDS epidemic is still possible. But to do so, we – in healthcare, governments and other public bodies – must act soon, taking all the steps necessary to make sure that everyone can benefit from the scientific advances we’ve made. Then, as a united force, we will have truly succeeded. 

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References

1. UNAIDS. Fast-Track – ending the AIDS epidemic by 2030. 18 November 2014. Available at: https://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report (Last accessed September 2020).
2. UNAIDS. Seizing the moment. 06 July 2020. Available at: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf (Last accessed September 2020).
3. World Health Organization. Welcome to 2020 – the decade for disease elimination. 20 December 2019. Available at: https://www.who.int/news-room/feature-stories/detail/welcome-to-2020-the-decade-for-disease-elimination (Last accessed September 2020).
4. World Health Organization. Groundbreaking trial results confirm HIV treatment prevents transmission of HIV. 12 May 2011. Available at: https://www.who.int/hiv/mediacentre/trial_results/en/ (Last accessed September 2020).
5. Cheney C. Devex. Where does the HIV/AIDS movement go from here? 13 July 2020. Available at: https://www.devex.com/news/where-does-the-hiv-aids-movement-go-from-here-97618 (Last accessed September 2020).
6. UNAIDS. Protect and accelerate progress towards the end of AIDS: Ready, set, go! Available at: https://www.unaids.org/en/Global_AIDS_strategy (Last accessed September 2020).