End Aids: Let’s get this done

Public health has dominated the world’s headlines for more than a year. The devastating impact of the Covid-19 pandemic on people’s lives and livelihoods and on economies worldwide has reminded us of the destructive power of a microscopic virus.

In the shadow of the Covid-19 pandemic, the world will come together from June 8 to 10 June to set out a bold new agenda to end another pandemic, 40 years after it emerged. At the 2021 United Nations high-level meeting on Aids, in New York and online, leaders, activists and people living with and affected by HIV will forge a new United Nations political declaration to set the world on course to end Aids by 2030.

Huge gains have been made since the first Aids cases were identified four decades ago. After peaking at 1.7 million in 2004, global Aids-related deaths fell to a little less than 700,000 in 2019. New HIV infections have similarly fallen, from 2.8 million in 1998 to 1.7 million in 2019. And HIV treatment has given hope to millions. What was once a death sentence can now be effectively managed. 

In June 2020, 26 million people were accessing life-saving antiretroviral therapy, a treatment that can give people living with HIV a normal life expectancy.

However, these gains are insufficient, though Uganda registered:

a) A 62 per cent reduction in new HIV infections between 2010 and 2020, the country still registers about 100 infections daily and this adds to about 1.4million  people living with HIV that will require treatment for life.

b) A 60 per cent reduction in annual Aids related deaths, despite the decline the country registers about 460 Aids deaths weekly yet treatment and science is available.

c) The country has achieved the 90-90-90 targets of ensuring that 90 per cent of People living with HIV/Aids know their HIV status, 90 per cent are on treatment and 90 per cent are virally suppressed, but we still have the innocent children that have not achieved the targets. There is need to ensure that HIV infected children access and are retained on ART

Accordingly, Uganda has potential to address the pending gaps and be on track to end the HIV/Aids epidemic as a public health threat by 2030—a promise made by Uganda, along with 192 other countries, in the Sustainable Development Goals and at the United Nations high-level meeting on ending Aids in 2016.

With the Covid-19 pandemic still impacting nearly every nation, it’s easy to forget other public health crises. But the HIV pandemic is still with us. It’s still real. And Covid-19 is impacting the progress on ending HIV/Aids.

The HIV/Aids pandemic affects different groups in different countries. In Uganda, it predominantly affects women, especially young women and adolescent girls. In other countries, key populations—gay men and other men who have sex with men, sex workers and their clients, transgender people and people who inject drugs—bear the brunt. At the heart of it, inequalities are the fuel that drives the HIV pandemic.

Covid-19 has exposed weaknesses in health systems at the global, regional and national levels, but the knowledge, expertise and infrastructure built up over 40 years of the HIV/Aids response have been crucial in guiding a human-rights led, people-centred response to the Covid-19 pandemic. Investing in the global health infrastructure has aided the fight against Covid-19, but we have to do more and strengthen those weaknesses in health systems so that the next time a crisis strikes, the world is ready and able to act.

In March this year, the UNAIDS governing body adopted the Global Aids Strategy 2021–2026, which aims to close the gaps that are preventing progress to ending Aids by focusing on the inequalities that drive the pandemic. It aims to promote fairer societies. It sets out targets that if met would place the world firmly back on track to end Aids by the end of this decade.

Building on the global HIV/Aids strategy, the United Nations high-level meeting  will endeavour to change the course of the HIV/Aids response. The political declaration that will result must be bold and must be ambitious. With so little time left, it must give the leadership the world needs to set the course for the last few years of the HIV/Aids response.

In being bold, the political declaration must ensure that no one is left behind. It needs to give strong support to issues that some may find uncomfortable—comprehensive sexuality education, sexual and reproductive health and rights, the human rights of everyone, including key populations, who are often marginalised and criminalised for their gender identities, sexual orientation, livelihoods or dependencies, or for simply living with HIV.

The new political declaration must be backed up by political commitment. Where promises made in the past have not been met, it’s been in part because the world failed to provide the support needed to build on those promises.

We know that when the right level of investment is made in the HIV response, the money works. Each additional $ 1 of investment in implementing the global Aids strategy in low- and middle-income countries will bring a return of $ 7.37 in health benefits.

Now is the time to reenergise health on the global agenda. Covid-19 is the immediate priority, and with it the vital need to roll out vaccination for everyone, everywhere—the huge inequality in access to vaccination is nothing short of a scandal—but the world must not forget HIV. Uganda must not forget HIV.

But we should be optimistic. Uganda has already made great strides in the HIV/Aids response. We know how to diagnose and treat it. We know how to prevent new infections, and how to save lives. Uganda’s support for a strong United Nations political declaration on HIV/Aids is vital if the world is to get to the end point after what, by 2030, will be nearly 50 years of the pandemic.

Winnie Byanyima is the executive director, UNAIDS.