Africa hailed for HIV success, but unequal progress means targets will be missed
The 23rd International AIDS Conference (AIDS 2020 Virtual) kicked-off with a clear message from UNAIDS to accelerate efforts to end AIDS and not be derailed by COVID-19.
New HIV infections in eastern and southern Africa (ESA) have fallen by 38% in ten years, an achievement celebrated by UNAIDS Executive Director Winnie Byanyima at the launch of UNAIDS’ new 2020 Global AIDS Report, Seizing the moment: tackling entrenched inequalities to end epidemics.
The ESA region, which is the most heavily burdened by HIV, is largely responsible for the 23% decline in worldwide HIV incidence from 2010. Infections have also fallen in the Caribbean (29%), western and central Africa (25%), western and central Europe and North America (15%), and Asia and the Pacific (12%).
But progress is spoilt by shocking increases in HIV incidence across several regions. Over the last 10 years, HIV infections have risen by 72% in eastern Europe and central Asia, by 22% in Middle East and North Africa (MENA), and 21% in Latin America.
With such unequal progress, said Ms Byanyima, global HIV targets won’t be met.
If targets are to be met in 2020, new HIV infections and AIDS-related deaths need to fall below 500,000, with zero instances of discrimination. However, more than three times this many HIV infections occurred in 2019 (1.6 million) and 690,000 deaths were recorded. And although 25.4 million people were on treatment in 2019, this left 12.6 million people not accessing the lifesaving treatment they need.
Despite their small size relative to the global population, key affected populations and their partners – including sex workers, people who use drugs, men who have sex with men and transgender people – made up 63% of all new infections in 2019. Social exclusion, discrimination, and criminalisation exacerbate vulnerability to HIV for these groups.
On the African sub-continent, women bear the brunt of HIV, and accounted for 59% of new infections in 2019. Despite making up just 10% of the entire population, adolescent girls and young women (aged 15 to 24) accounted for one in four (24%) new infections – that’s 4,500 new infections in this group every week.
Positively, it seems that overall women have benefitted from expanded access to treatment. As such, the annual number of new infections has fallen more rapidly among women and girls, with a 27% decrease since 2010 compared to an 18% decrease among men and boys.
But treatment alone will not end AIDS. Ms Byanyima stressed during the report launch that when dealing with epidemics, rights matter; this is not simply a health issue. An effective HIV response requires equitable access to education and health care, and laws and justice and systems that protect the rights of the most marginalised within society.
Where this is happening there is success. So far, 14 countries have reached the 2020 ‘90-90-90’ targets, which call for 90% of people living with HIV to know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally supressed.
In a remarkable story for the HIV response, eSwatini, whose HIV prevalence is among the highest in the world at 27%, announced that they’ve already achieved ‘95-95-95’, joining an exclusive club which includes only one other country – Switzerland. There, strong political will, expanded testing and treatment, in addition to initiatives to overcome stigma of people living with HIV at the grassroots, have turned the tide for the country.
But their journey to reach ‘100-100-100’ is under threat, as Africa struggles to contain COVID-19. Ambrose Dlamini, the Prime Minister of Eswatini, said progress so far is fragile within the context of the COVID-19 pandemic, with their biggest challenge being a lack of resources.
In eSwatini and in other countries, funds intended for HIV programming are being diverted to COVID-19. While at the global level, commodities for HIV are being pitched against commodities needed for COVID-19, which are currently more lucrative for manufacturers.
In a modelling study, UNAIDS finds that a six-month complete disruption in HIV treatment could result in more than 500,000 additional deaths in sub-Saharan Africa over the next year. This could bring the region back to 2008 AIDS mortality levels. “Even a 20% disruption could cause an additional 110,000 deaths,” it notes.
“We cannot take money from one disease to treat another,” said Ms Byanyima. “Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”