According to the analysis prepared by the United Nations ahead of the commemoration of World AIDS Day, it is inequalities that are preventing the end of AIDS. On current trends, the world will be unable to meet the agreed global targets on AIDS. In this sense, the new UNAIDS report, Dangerous Inequalities, insists on a series of urgent actions to address the inequalities that can jump-start the AIDS response.
Earlier this year UNAIDS already warned that the response to AIDS is in danger as a result of the increase in the number of new infections and the continuing deaths in many parts of the world. Now a new UNAIDS report brings to light the underlying reason: the world’s inequalities. This report presents world leaders as protagonists to end inequalities and asks them to be courageous to carry out what the tests themselves are asking of us.
Dangerous Inequalities reveals the impact on the AIDS response of gender inequalities, inequalities faced by key populations, and inequalities between children and adults. Furthermore, it highlights how worsening financial constraints now make it more difficult to address these inequalities.
The report also shows how gender inequalities and harmful gender norms are slowing down the end of the AIDS pandemic.
“The world will never be able to defeat AIDS if we continue to reinforce patriarchy,” said Winnie Byanyima, Executive Director of UNAIDS. «We have to face all these inequalities of which women are victims. In areas with a high burden of HIV, women subjected to intimate partner violence face a 50% higher chance of contracting HIV. In 33 countries between 2015 and 2021, only 41% of married women aged 15-24 could make their own sexual health decisions. In this context, the only effective roadmap to end AIDS, achieve the sustainable development goals and ensure health, rights and shared prosperity is a feminist roadmap. Women’s rights organizations and movements are already on the front lines doing this bold work. Leaders need us to support them and learn from them.”
The effects of gender inequalities on women’s HIV risks are especially pronounced in sub-Saharan Africa, where women accounted for 63% of new HIV infections in 2021.
In sub-Saharan Africa, adolescent girls and young women (ages 15-24) are three times more likely to contract HIV than adolescents and young men in the same age group. The determining factor is strength. According to one study, allowing girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%. When this is reinforced with a training support package, the risks for girls are further reduced. Leaders must ensure that all girls can attend school and are safe from violence, often normalized even through child marriages, and that an economic path is opened for them to enjoy a hopeful path.
By disrupting power dynamics, policies can reduce girls’ vulnerability to HIV.
Harmful masculinities discourage men from seeking medical care. In 2021, while 80% of women living with HIV were accessing treatment, only 70% of men were on treatment. Precisely for this reason, to stop the advance of the pandemic, it is essential to increase gender-transformative programs in many parts of the world. Advancing gender equality will benefit us all.
The report shows that the AIDS response is being held back by inequalities in access to treatment between adults and children. While more than three quarters of adults living with HIV are on antiretroviral treatment, just over half of children living with HIV are receiving life-saving treatment. And this has had deadly consequences. In 2021, children represented 4% of all people living with HIV, although they alone accounted for 15% of all AIDS-related deaths. Clearly closing the treatment gap for children will save lives.
Discrimination, stigma and criminalization of key population groups are costing lives and preventing the world from reaching agreed AIDS targets.
The new analyzes do not show a significant decline in new infections among gay men and other men who have sex with men in the West and Central African regions, and in the Eastern and Southern African regions. Failing to make progress in key population groups in the face of an infectious virus undermines the entire AIDS response and helps explain the slowdown in progress.
Worldwide, more than 68 countries still criminalize same-sex sexual relations. Another analysis echoed in the report underscores that gay men and other men who have sex with men living in African countries with the most repressive laws are more than three times less likely to know their HIV status than their counterparts living in countries with the least repressive laws, where progress moves much faster. Sex workers living in countries where sex work is criminalized are seven times more likely to be living with HIV than those from countries where sex work is legal or partially legal.
The report shows us that progress is indeed possible to end inequalities, and highlights areas where the AIDS response has already made notable progress. For example, while surveys among key populations often reveal lower service coverage among them, three counties in Kenya have achieved higher HIV treatment coverage among sex workers than among the general population of women. (between 15 and 49 years old). This has been supported by a strong HIV program over many years, including, among other things, community-led services.
“We know what we have to do to end inequalities,” said Ms Byanyima. “We have to make sure that all our girls can go to school, are safe and strong. We must address issues related to gender violence. We have to give our support to women’s organizations. Foster healthy masculinities: replace harmful behaviors that exacerbate risks for all. Ensure that services for children living with HIV reach them and meet their needs, in order to close the treatment gap so that we end childhood AIDS for good. Decriminalize people in same-sex relationships, sex workers and drug users,
The new report reflects that donor funding is helping to catalyze increased domestic funding: increases in external HIV funding for PEPFAR and Global Fund countries during 2018-2021 were correlated with increases in domestic funding from most national governments. New investment is urgently needed to address HIV-related inequalities. Just when international solidarity and the need for financing are needed more than ever, too many rich countries have decided to cut aid for global health. In 2021, the funding available for HIV programs in low- and middle-income countries was reduced by US$8 billion.
Budgets must prioritize the health and well-being of all people, especially vulnerable populations most affected by HIV-related inequalities. There is a need to expand the fiscal space for health investments in low- and middle-income countries, including through substantial debt cancellation and progressive taxation. Ending AIDS is much less expensive than not ending AIDS.
In 2021, 650,000 people lost their lives due to AIDS and 1.5 million new HIV infections were recorded.
“It is self-evident what world leaders have to do, there is no question about it,” said Ms Byanyima. «In a single word: Match. Equal access to rights, equal access to services, equal access to the best science and the best medicine. By matching, we won’t just be helping the marginalized. We will be helping everyone.”
Source: UNAIDS