What Needs to Be Done to End the HIV/AIDS Epidemic

Progress in addressing the HIV epidemic

Over the past several decades, global efforts to address the HIV epidemic have yielded dramatic results.

Thanks to HIV prevention programs, the rate of new infections in the United States has dropped by more than two-thirds since the mid-1980s.

Globally, new infections among adults declined by 31 percent from 2010 to 2020. Improvements in HIV treatment have also saved millions of lives worldwide.

UNAIDS reports that by the end of 2020, an estimated 27.5 million people with HIV were receiving antiretroviral medication. This treatment can suppress the HIV virus to undetectable levels. This prevents the development of HIV into AIDS, while stopping the transmission of the virus to other people.

Despite these efforts, vulnerable groups in particular have been left behind, reports the Global Fund. Some countries are even seeing HIV transmissions increase due to a lack of commitment and funding, the group adds.

Strategies to end the HIV epidemic

Health leaders in the United States and around the world have outlined several strategies to tackle the HIV epidemic. In 2016 and 2021, the U.N. affirmed its commitment to ending the AIDS epidemic by 2030, with a focus on:

• reducing the number of new HIV infections
• reducing AIDS-related deaths
• eliminating HIV stigma and discrimination

The organization’s stated strategies to end the epidemic include preventing new infections by accelerating outreach and prevention services for key affected communities, including women and children.

Countries must address social and economic inequalities that put some community members at increased risk of infection, delays in diagnosis, and under-treatment. Increased financing is also needed to reach these goals.

Addressing social and economic inequalities

Social, economic, gender, and racial inequalities put certain communities at heightened risk of contracting HIV. Those inequalities also pose barriers to HIV testing and treatment.

In sub-Saharan Africa for example, UNAIDS reports that adolescent girls and young women aged 15 to 24 accounted for only 10 percent of the total population but 25 percent of people with HIV in 2020.

Girls and women who experience gender-based violence are more likely than others to contract HIV. Gender-based violence also makes it harder for them to get treatment.

Other populations at increased risk of HIV include:

• men who have sex with men
• transgender people
• sex workers
• people who inject drugs

In many countries, HIV prevention programs and harm reduction services are poorly accessible or absent for those populations. The U.N. also notes that discriminatory laws in some countries reinforce HIV disparities and stigma, while limiting access to services.

More investment in the communities most affected by HIV is essential to ending the epidemic.

“12 million people living with HIV still do not have access to treatment, especially in Africa,” the U.N. General Assembly stated in its 2021 Political Declaration on HIV and AIDS.

“These 12 million people are prevented from accessing treatment owing to inequalities, multiple and intersecting forms of discrimination, and structural barriers.”

To promote ongoing progress in HIV prevention, testing, and treatment, the U.N. General Assembly has affirmed the need to address these inequalities and gaps in service.

Education and preventative services

Ensuring that children and mothers have access to HIV education, prevention services, and antiretroviral therapy is also among the U.N.’s stated priorities.

According to UNAIDS, more than two-fifths of children living with HIV worldwide do not know they have the virus. The number of children who are receiving treatment for HIV has declined since 2019, and only 40 percent of all children with HIV had suppressed viral loads in 2020.

Many young people around the world lack access to comprehensive sexual education and reproductive health services, which increases their risk of HIV and other sexually transmitted infections. Young people who are not in school are also more likely than others to contract HIV.

Gender inequalities, COVID-19-related school closures, and other barriers are making it harder for many kids and teenagers to get the education and support they need.

Increasing access to age-appropriate education and health services is important for improving HIV prevention and empowering young people to lead healthy lives.

It’s also essential to prevent vertical transmission of HIV from mothers to their children, which can occur during pregnancy, childbirth, and breastfeeding. This means ensuring that women with HIV receive timely diagnosis and immediate and long-term treatment with antiretroviral therapy, including during pregnancy and breastfeeding.

“Seeing young people and women take control of their health by demanding health services and seeking information to sustain their health” is one of the most rewarding aspects of his work, Yoram Siame told Healthline.

Siame is the head of advocacy planning and development for the Churches Health Association of Zambia (CHAZ). This organization is a leading provider of healthcare services in Zambia and one of the organizations that has received grants from the Global Fund.

Funding

Improving education, outreach, and medical services for communities affected by HIV requires material resources.

According to UNAIDS, under-investment in HIV programs is one of the main reasons why the world has not yet met the U.N.’s 90–90–90 targets. U.N. member states committed to mobilizing $26 billion per year by 2020 for the global response to HIV. However, the availability of financial resources fell short of that target by 29 percent.

In its 2021 declaration, the U.N. set a 2025 target of $29 billion per year for HIV investments in low- and middle-income countries. To meet that target, increased funding from domestic and international partners is needed.

More efficient use of available resources is also required. Some countries are not allocating enough funds to programs or communities that face the biggest resource gaps, which limits the impact of investments.

Greater investment is needed in programs that address social and economic inequalities.

Funding can also help support ongoing research into finding a vaccine and potentially a cure for HIV/AIDS. This would have an important long-term impact on the epidemic.

Legal reform

Governments must also address the ways in which restrictive or discriminatory laws contribute to HIV stigma and pose barriers to HIV prevention, diagnosis, and treatment. According to UNAIDS, these include laws that criminalize:

• drug use
• sex work
• same-sex sexual activity
• gender diversity

A 2021 study in BMJ Global Health found that in countries where drug use, sex work, or same-sex sexual activity are criminalized, people with HIV are less likely to know that they have the disease and less likely to have suppressed viral loads.

On the other hand, the study concluded that passing laws to prevent discrimination, gender-based violence, and human rights violations appears to promote improved diagnosis and treatment.

How the COVID-19 pandemic has impacted HIV

The COVID-19 pandemic has highlighted and worsened preexisting inequalities in the United States, as well as the developing countries that are most affected by HIV. It has also added strain to health systems.

In countries where the Global Fund invests, deaths caused by AIDS, tuberculosis, and malaria have declined by 46 percent since 2002. However, some of the progress in those countries has been stalled by the effects of COVID-19.

From 2019 to 2020, the number of people who received HIV testing in those countries dropped by 22 percent. The number of people who accessed HIV prevention services declined by 11 percent.

“The resources and efforts to end AIDS are being undermined by COVID-19,” said Siame. “Among other things, COVID-19 has created fear around health facilities because of the risk of contracting COVID. [It has also] reduced resources available to deliver comprehensive HIV and AIDS services because of the demands imposed on health systems.”

Siame told Healthline that fewer healthcare workers are available to offer HIV prevention, testing, and treatment services due to the demands of managing COVID-19. In some cases, entire healthcare facilities have been converted into COVID-19 centers.

The added strain on healthcare resources makes it harder for healthcare systems to meet the needs of people living with HIV and those at risk of contracting it.

To rein in the pandemic, COVID-19 vaccination services must improve — particularly in low-resource countries where vaccine access remains very limited. Global vaccine inequality is hitting developing countries hard. In Zambia for example, only 3.15 percent of the population is fully vaccinated against COVID-19 as of mid-November 2021.

Local toll-free information lines and mobile healthcare services also help meet the needs of people at risk of HIV and those living with HIV in the COVID-19 context, Siame said.

The takeaway

Although significant progress has been made, the push to end the HIV/AIDS epidemic is not over yet. Millions of people around the world continue to live with HIV. Too many of them cannot access life-saving antiretroviral treatment.

To bring the HIV/AIDS epidemic to an end, governments and other organizations must address the social, economic, gender, and racial inequalities that make it harder for certain communities to access HIV prevention, testing, and treatment services.

Age- and gender-appropriate education and health services must be provided to young people and other community members around the world.

The COVID-19 pandemic must also be brought under control. Along with other measures, that requires improved vaccine access for residents of low-resource countries.

Tackling these challenges will require financial investment and cooperation among governments, civil society members, and others. Only by working together can members of the global community bring this decades-long pandemic to an end.