Last year, world leaders came together at the United Nations in New York and agreed on a groundbreaking Political Declaration on HIV and Aids. That plan takes on the inequalities that drive the pandemic and will dramatically reduce new HIV infections and Aids-related deaths by 2025 and end the Aids pandemic as a global health threat by 2030 -- if world leaders fulfil it. But the world -- especially the Asia and Pacific region -- is not on track.
Data just released in the new Unaids report, "In Danger: Unaids Global Aids Update 2022", reveals that the world is not on course to end Aids by 2030. The 3.6% reduction in global new HIV infections in 2021 is the smallest annual fall since 2016. On the current trajectory, there will be a projected 1.2 million new HIV infections worldwide in 2025, more than three times higher than the target of 370,000. In Asia and the Pacific -- the world's most populous region -- Unaids data now shows new HIV infections are rising where they had been falling. Climbing infections in these regions are alarming.
Globally, new HIV infections have increased in 38 countries since 2015. In Asia and the Pacific region, Philippines and Malaysia are among countries with rising epidemics among key populations, particularly in key locations.
The human cost of a stalled HIV response is chilling. Although affordable treatments are available to prevent most Aids-related deaths, last year 650,000 people died of Aids-related illnesses, 140,000 of which were from the Asia-Pacific region.
Globally, more than 1.5 million people became infected with HIV last year. That's 4,000 people newly infected with HIV every day, more than a quarter of them young people aged 15-24. Over half of the young key populations in the Asia-Pacific region are not receiving comprehensive HIV prevention services.
Unaids' new report stresses the urgency to break down societal and legal barriers that hamper access to life-saving services.
Resources for Aids continue to slowly decline regardless of the renewed commitments made by UN Member States in the 2021 Political Declaration on Ending Aids. Overall, low- and middle-income countries fund about 72% of their HIV treatment and care programmes with domestic resources, but only 42% of their prevention programmes.
The good news is that we know the recipe for success.
For example, Cambodia's scale-up of Pre-Exposure Prophylaxis (PrEP), the medicine to prevent HIV infection, sets a good example on making PrEP available as an option for HIV prevention. Cambodia has made notable progress with a 50% decline in new infections since 2010 and is on track to end Aids five years ahead of the global target. Vietnam has also made remarkable progress on PrEP, with a 72% increase in coverage between 2020 and 2021. Vietnam has also scaled up community-led testing and HIV self-testing, and has seen a significant 60% decline in new infections since 2010. Embracing digital technologies and community-led services are also good practices to reach more key populations, especially young people, in countries like the Philippines and Thailand.
If we have learned anything from the Covid-19 pandemic, however, it is that pandemics can't be ended anywhere until they are ended everywhere. Here are five ways that countries can correct course and close the gaps in their HIV response:
First, address the inequalities that stop people receiving HIV prevention, testing and treatment services. In diverse settings, countries and communities are taking action to end inequalities and close gaps. Building on this momentum, policy makers need to strengthen their understanding of localised epidemics to focus on eliminating the inequalities that are slowing progress against the pandemic.
Second, realise human rights and gender equality. Punitive, discriminatory, counterproductive laws and policies must be removed. The human rights of people living with HIV and key populations must be upheld. Countries must prioritise and integrate focused, well-resourced efforts to end gender-based violence into national HIV responses.
Third, make a new push for HIV prevention. Countries urgently need to elevate the political, programmatic and financial prioritisation of HIV prevention and move to large-scale implementation of prevention projects so that innovations such as PrEP and long acting injectables become much more widely accessible, especially to vulnerable groups of people like gay men and other men who have sex with men, sex workers, people who use drugs, transgender people and young people.
Fourth, support and effectively resource community-led responses. Countries must recognise the essential role of community-led responses and integrate them into national HIV planning, implementation and monitoring. Communities should be effectively resourced and laws that impede community-led responses should be removed.
Finally, ensure sufficient and sustainable funding. Major new investment to ensure a fully funded global Aids response is essential both from international donors and governments in low- and middle-income countries. Coordinated international action is also required to alleviate the debt crisis facing too many countries and to counteract the need for short-sighted and counterproductive national austerity measures.
We have the knowledge and the tools. Ending Aids is a promise that can and must be kept.
Taoufik Bakkali is UNAIDS Asia-Pacific Regional Director.
