It’s all in the headline: “The erosion of progress against AIDS puts millions of lives at risk”. It is the one that was chosen for the last UNAIDS report on the state of the fight against AIDS in the world. He is not good. “Progress in prevention and treatment is slowing around the world, putting millions of people at grave risk,” the UN agency said. Several concomitant phenomena explain this. Thus, for several years, “Eastern Europe and Central Asia, Latin America, the Middle East and North Africa have recorded an increase in annual HIV infections”. “In Asia-Pacific, current data [de l’agence] reveal an upsurge in new HIV infections where they had fallen. If cases are increasing, so are the “inequalities that fuel the AIDS epidemic”. They are not stemmed even though their end would “avoid millions of new HIV infections [durant] this decade” and would bring about the end of this pandemic.
As has been said before — this is not the first report to make this observation — the fragile progress of recent years has been undermined by a “slowdown in progress in the fight against the HIV pandemic” and a ” resource reduction. This has accelerated over the past two years with the outbreak of Covid-19 and then other global crises (Russia’s invasion of Ukraine, for example), putting millions of lives in danger.
The new UNAIDS report, In Danger (its official title) was presented before the launch of the Aids 2022 conference in Montreal, as a warm-up on the issues that needed to be debated for the participants, but also as caution. Worldwide, the number of new HIV infections fell by just 3.6% between 2020 and 2021, the lowest annual decline since 2016, the UNAIDS document explains. In different regions (Eastern Europe, Central Asia, Middle East, North Africa, Latin America, etc.), cases are no longer falling or even rising. The resumption of infections in these regions is alarming. “In Eastern and Southern Africa, the momentum has slowed considerably in 2021 after years of progress at a steady pace,” said UNAIDS. Of course, the agency is keen to show that there is some encouraging data: new HIV infections in West and Central Africa and the Caribbean are falling dramatically.
However, all regions of the world, whether experiencing a decline or an increase in cases, are seeing their HIV response threatened by reduced resources. “These data show that the global AIDS response is in serious jeopardy. If we don’t make rapid progress, we are losing ground as the pandemic thrives in the context of Covid-19, mass displacement and other crises. Let’s not forget the millions of preventable deaths that we are trying to prevent, “said the executive director of UNAIDS, Winnie Byanyima, but it seems that we hear little.
Stagnation = infection
This stagnation in progress has translated into around 1.5 million new infections in 2021, more than 1 million above global targets. These objectives are the ones that must be met if we want to reach the end of the epidemic in 2030.
New infections have disproportionately affected young women and adolescent girls—this was already the case in previous years—with one new infection every two minutes among this population in 2021. sex, particularly for young African women and girls, has occurred against a backdrop of disruption of essential HIV prevention and treatment services, pandemic-induced millions of girls being out of school, and spikes in teenage pregnancies and gender-based violence,” analyzes the report. In sub-Saharan Africa, adolescent girls and young women are three times more likely to contract HIV than adolescents and young men.
Exposed key populations
In recent years, key populations have been particularly affected in many communities with prevalence rising again in many places, the report highlights. In addition, ethnic inequalities aggravate the risks of HIV. In the United Kingdom and the United States, new HIV diagnoses have declined more among white populations than among black people. In countries such as Australia, Canada and the United States, HIV acquisition rates are higher in Aboriginal communities than in non-Aboriginal communities. The report also points to a “sagging” of efforts to ensure access to life-saving antiretroviral treatment for all HIV-positive people. In 2021, the increase in the number of people on HIV treatment was the lowest in more than a decade. Although three-quarters of all HIV-positive people have access to antiretroviral treatment, about 10 million others do not, and only half (52%) of HIV-positive children have access to life-saving drugs. Here, the gap between the coverage of anti-HIV treatment in children and adults is tending to widen rather than shrink, points out UNAIDS.
One death per minute
“In 2021, the AIDS pandemic was responsible for an average of one death per minute, or 650,000 AIDS deaths despite the existence of effective HIV treatment and tools to prevent, detect and treat infections opportunists,” the report notes. “These figures are totally dependent on political will. Is the empowerment and protection of our daughters important to us? Do we want to end AIDS deaths among children? Do we prefer to save lives rather than criminalize? asked Winnie Byanyima. “If we want to, then we have a duty to close the gap in the AIDS response. » Significant differences exist between countries. The Philippines, Madagascar, DRC and South Sudan are among the countries that have recorded the largest increases in the number of new HIV infections since 2015. In contrast, South Africa, Nigeria, India and the United Republic of Tanzania have seen some of the steepest declines in the number of HIV infections, even in the context of Covid-19 and other crises. There is therefore a lot of room for maneuver if the States agree to real efforts in the fight against AIDS.
The UN report describes the “devastating consequences if urgent measures against the inequalities that promote the pandemic are not taken”. “It shows that at the current rate, the number of new infections per year would exceed 1.2 million in 2025. This year corresponds to the deadline set by United Nations member states to reduce new HIV infections to less than 370 000. This would not only mean that humanity did not meet its promise on new infections, but that the latter would be more than three times higher than this target”. It is easy to understand that millions of preventable HIV infections each year complicate action and increase the costs of ensuring that people living with HIV have access to life-saving treatment and that the goals of ending the AIDS pandemic are achieved. here 2030.
Added to this is the international context (Covid-19 pandemic, war in Ukraine) which fuels the risks for the response to HIV and systemic problems: debt repayment, for example. “Debt repayments for the world’s poorest countries have reached 171% of all spending on health, education and social protection combined, nipping their ability to respond to AIDS in the bud, explains UNAIDS. Domestic funding for the HIV response in low- and middle-income countries has been falling for two years.” And the report points out: “One of the consequences of the war in Ukraine is the considerable increase in world food prices. This worsens food insecurity for HIV-positive people around the world and makes HIV treatment disruptions much more likely.”
We need more solidarity
“At a time when we need international solidarity and increased funding more than ever, too many high-income countries are cutting aid, and funding for global health is in serious jeopardy. In 2021, international financial resources available for HIV were 6% lower than in 2010. Overseas development assistance for HIV provided by bilateral donors other than the United States of America fell by 57 % over the last decade”, tackles the UNAIDS. “The response to HIV in low- and middle-income countries is $8 billion short of what is needed by 2025. Global trade rules prevent low- and middle-income countries from producing the medicines that can end HIV infection. the pandemic, including innovative and promising long-acting HIV treatments. Moreover, they keep prices too high for these countries to buy them in large quantities”. Today, global solidarity is stagnating as international support is needed more than ever. The leaders are always able to bring the response back on the right track, still wants to believe Winnie Byanyima. This requires both national action and international solidarity; but we are still a long way off.
In June 2021, leaders agreed on a roadmap to end AIDS by 2030 if fully met. The goal is achievable and affordable. In other words, “eradicating AIDS will cost much less than continuing to live with AIDS”. It is important to note that the actions needed to end AIDS will also allow humanity to be better protected against the threats of future pandemics. In the current context, the argument could also bear fruit. Solid in his convictions, Winnie Byanyima recalled, on the occasion of the release of the report In danger “We can end AIDS by 2030 as promised (…) but it takes a bit of courage. Who hears him?
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