Despite Nearing Finish Line, Ending AIDS Epidemic by 2030 at Risk amid Intersecting Inequalities, Shortage of Funds, Political Will, General Assembly Hears
While the world is tantalizingly close to ending the AIDS epidemic by 2030, the risk of backsliding is great due to shortfalls in funding, lack of political will and intersecting inequalities, the General Assembly heard today.
As delegates in the Assembly considered the report of the Secretary-General titled “The urgency of now: AIDS at a crossroads — progress report on the 2025 targets and strategic directions for the future” (document A/79/869), several speakers highlighted the need to shore up the gains made so far. The report notes the key role of the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The funding pause by that Government since the end of January has created deep uncertainty, many speakers pointed out.
If that stream of funding was permanently halted, Amina J. Mohammed, Deputy Secretary-General, speaking for the Secretary-General, noted, the Joint United Nations Programme on HIV/AIDS (UNAIDS) projects 4 million additional AIDS-related deaths and over 6 million new infections by 2029. “This would shatter the possibility of achieving the 2030 Goal to end AIDS as a public health threat,” she said. The increasing suspension of foreign assistance has caused widespread disruption to HIV services, she said, pointing to closing clinics, laid-off staff and decreasing supply of prevention services.
Over 30 Million People Receiving Life-Saving Treatment
Highlighting progress achieved so far, she said more than 30 million people are now receiving life-saving treatment. AIDS-related deaths have fallen to their lowest point since 2004. “What we are seeing is the direct result of countries following data and science,” combined with community leadership, protection of rights and strategic investments, she said. The collective fight against HIV/AIDS is “one of the most powerful public health success stories of our time”, she said.
Stressing the need to work with countries to reverse funding declines, she said low- and middle-income countries need debt relief, tax reforms and increased international support. “Half of sub-Saharan African countries spend more on debt than health, at interest rates far higher than many rich countries,” she pointed out. She also drew attention to the vital work of community-led organizations: “They are on the front lines delivering services, defending rights [and] fighting stigma,” she said. But, today, many of them are being defunded. “We're cutting the rope just as we're pulling people to safety,” she stressed.
HIV Response Must Be Community-Led, Key-Population-Driven
“We agree with the Secretary-General that HIV responses must be community-led and key-population-driven,” Thailand’s delegate said. In his country, HIV services are “in the good hands of communities”, he said, adding that certified community health workers work closely with trained civil society organizations. Noting that stigma and discrimination often drives people living with HIV away from life-saving services, he said Governments must work with strong networks of youth, women and LGBTQ+ communities to tackle this crisis. He regretted that the funding crisis is putting HIV response in jeopardy.
Several speakers from developing countries echoed the need to shore up financing to tackle AIDS. “In the Caribbean, 70 per cent of HIV treatment comes from external sources,” the representative of Bahamas, speaking for Caribbean Community (CARICOM), noted. He added that small island developing States in the region face structural constraints in mobilizing domestic resources and are further burdened by high debt levels.
Political Will, Community Action Recipe for Success
Despite that, his region “exemplifies what is possible when political will meets community action”, he added. Eleven of the 17 countries globally certified by the World Health Organization (WHO) for eliminating mother-to-child transmission of HIV and Syphilis are from his region. “The COVID-19 pandemic reminded the world of what is possible when urgency meets coordinated global action,” he said, calling on the international community to “now apply that same ethos to HIV”.
The representative of the Gambia, speaking for the African Group, noted that, at its February summit, the States of the African Union renewed their commitment to allocate 15 per cent of their budget to health. Partners must support this strategy in line with the Addis Ababa Action Agenda on Financing for Development, he said. While highlighting the significant gains made in fighting HIV/AIDS in sub-Saharan Africa, he noted that “AIDS remains the fourth leading cause of death” in his continent. Adolescent girls and young women are still at three times higher risk of acquiring HIV than adolescent boys and young men, he said. Stigma and discrimination continue to be major barriers, he said, urging for access to prevention tools such as pre-exposure prophylaxis products. He also pointed out that people living with HIV have an increased risk of depression and are likely to encounter a range of comorbidities.
Calls for HIV/AIDS Response to Prioritize Vulnerable Groups, Uphold Human Rights
Zimbabwe’s delegate noted that HIV/AIDS disproportionately affects the 17- to 35-year-old category which is the productive age group. While her country has made commendable strides in mobilizing domestic resources, external financing remains essential. Therefore, “response efforts remain vulnerable to external funding fluctuations and global economic shocks,” she said, highlighting the uncertainty concerning PEPFAR. She was also among several speakers who stressed the vital role of UNAIDS.
“We know what holds us back: intersecting inequalities and structural barriers,” said the representative of the European Union, speaking in its capacity as observer, adding: “We also know what works.” “A truly effective response will prioritize persons in vulnerable situations,” including girls and young women, he said, adding that such a response will uphold human rights and gender equality, fight stigma and meaningfully involve local communities and community-led organizations. It is essential to fully implement the Beijing Platform for Action, and the Programme of Action of the International Conference on Population and Development.
Stressing the need for a holistic approach, he said universal access to antiretroviral treatment remains essential but must be paired with primary prevention methods and innovative prevention technologies such as long-acting exposure prophylaxis. He also reaffirmed the right of every individual to have full control over and decide freely and responsibly on matters related to their sexuality and sexual and reproductive health, free from discrimination coercion and violence.
Along similar lines, the representative of Canada, also speaking for Australia, New Zealand and the United Kingdom, highlighted the need for addressing human rights and gender-related barriers, decreasing stigma and discrimination and reforms to create enabling legal environments. “We have the knowledge, tools and experience needed” to accelerate progress towards ending the epidemic by 2030, he said, adding that “political will and commitment will determine whether we succeed or fail”.
The Russian Federation’s delegate noted that his country provides healthcare free of charge for all Russian citizens without exception. “We are ahead of our own targets,” he said. He then expressed regret that, instead of internationally agreed approaches, the Secretary-General’s report “uses wordings which are not consensual” and mentions controversial notions. He called for respect for national legislations and cultural characteristics.
Innovative Financing Key to Expand Access to Prevention, Treatment
Cherdchai Chaivaivid (Thailand), Vice-President of the General Assembly, delivered a statement on behalf of its President, Philémon Yang (Cameroon). He said it is essential to ensure that “those most affected are at the heart of all we do”. HIV can be exceptionally dangerous for those trapped in conflict, those who are displaced and those in marginalized communities. Also pointing to the role of stigma, he said: “No individual should be denied care or dignity because of outdated perceptions or unexamined prejudice.” Calling on delegates to improve access to sexual and reproductive healthcare, and to work towards zero discrimination against people living with HIV-AIDS, he called for innovative financing to expand access to prevention and treatment “We must get serious about this virus,” he said.