The UN’s analysis conducted in advance of World AIDS Day shows that inequality is impeding efforts to eradicate AIDS. On the current trajectory, the world will not reach the AIDS-related global targets. Dangerous Inequalities, a recent UNAIDS report, demonstrates how swift action to address inequalities can restart the AIDS response.
The AIDS response is in danger, according to UNAIDS, as new infections are increasing and deaths are still occurring in many parts of the world. Inequalities are the root cause, according to a recent UNAIDS report. It demonstrates how global leaders can address these disparities and exhorts them to have courage and heed what the facts indicate.
The book Dangerous Inequalities explores the effects of gender inequality, population-specific inequality, and inequality between children and adults on the AIDS response. It explains how the difficulty of addressing those inequalities is increasing as a result of worsening financial constraints.
The report demonstrates how harmful gender norms and gender inequalities are delaying the end of the AIDS pandemic.
Winnie Byanyima, executive director of UNAIDS, said that while patriarchy is being strengthened, the world will not be able to defeat AIDS. “We must address the intersecting injustices that women experience. Women who experience intimate partner violence have a 50% higher risk of contracting HIV in areas with a high HIV prevalence. From 2015 to 2021, only 41% of married women aged 15 to 24 in 33 countries were able to make their own decisions about their sexual health. A feminist road map is the only practical strategy for eradicating AIDS, achieving the Sustainable Development Goals, and ensuring health, rights, and shared prosperity. Women’s rights movements and organisations are already leading the charge in this audacious work. Leaders must help them and take notes from them.
In sub-Saharan Africa, where women made up 63% of new HIV infections in 2021, the effects of gender inequality on women’s HIV risks are particularly pronounced.
In sub-Saharan Africa, adolescent girls and young women (15 to 24 years old) are three times more likely to contract HIV than adolescent boys and young men in the same age group. Power is the motivating factor. According to one study, allowing girls to stay in school until they complete their secondary education can cut their risk of contracting HIV by as much as 50%. Girls’ risks are further decreased when this is supported by a package of empowerment support. Leaders must make sure all girls attend school, are safe from violence, which is frequently normalised through underage marriages, and have access to economic opportunities that promise a bright future.
Policies can lessen girls’ vulnerability to HIV by disrupting the power dynamics.
Men are less likely to seek care because of harmful masculinities. Only 70% of men were receiving treatment in 2021, compared to 80% of women who had HIV. The key to stopping the pandemic is expanding gender-transformative programming in many regions of the world. Promoting gender equality will be advantageous to all.
The study demonstrates how disparities in treatment access between adults and children are slowing down the AIDS response. Just over half of HIV-positive children are receiving the life-saving medication, compared to more than three-quarters of HIV-positive adults. This has had fatal repercussions. Only 4% of people with HIV and 15% of people who died from AIDS in 2021 were children. It will save lives if the treatment gap for children is closed.
Key populations are being stigmatised, discriminated against, and criminalised, which is costing lives and preventing the world from meeting agreed-upon AIDS targets.
In both the western and central Africa and the eastern and southern Africa regions, new analysis reveals no appreciable decline in the number of new infections among gay men and other men who have sex with men. In the face of an infectious virus, the AIDS response as a whole is undermined and the slowing of progress is explained by failure to make progress on important populations.
More than 68 nations still forbid same-sex relationships internationally. Gay men and other men who have sex with men who live in African countries with the strictest laws are more than three times less likely to be aware of their HIV status than their counterparts living in nations with the laxest laws, where progress is much more rapid, according to another analysis highlighted in the report. Compared to nations where sex work is legal or partially legalised, sex workers who live in nations where sex work is criminalised have a 7 times higher chance of having HIV.
The report highlights areas where the AIDS response has made outstanding progress while demonstrating that progress against inequalities is possible. In three counties in Kenya, female sex workers have higher HIV treatment coverage than the general female population, despite surveys among key populations frequently highlighting lower service coverage among key populations (aged 15-49 years). Strong HIV programming over many years, including community-led services, has aided in this.
“We know what to do to end inequalities,” said Ms Byanyima. “Ensure that all of our girls are in school, safe and strong. Tackle gender based violence. Support women’s organisations. Promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone. Ensure services for children living with HIV reach them and meet their needs, closing the treatment gap so that we end AIDS in children for good. Decriminalize people in same-sex relationships, sex workers, and people who use drugs, and invest in community-led services that enable their inclusion — this will help break down barriers to services and care for millions of people.”
According to the new report, increases in external HIV funding from PEPFAR and the Global Fund for countries during 2018–2021 were correlated with increases in domestic funding from the majority of national governments. There is an urgent need for new investments to address HIV-related inequalities. Too many high-income nations are reducing aid for global health at a time when it is most in need of global solidarity and a surge in funding. HIV programmes in low- and middle-income nations lacked $8 billion in funding as of 2021. Gaining more donor support is essential to restarting the AIDS response.
All people’s health and wellbeing must be given top priority in budgets, especially the most vulnerable groups who suffer the most from HIV-related inequalities. It is necessary to increase the fiscal space available for health investments in low- and middle-income countries, including through significant debt cancellation and progressive taxation. It costs much less to eradicate AIDS than it does not.
650 000 people died from AIDS in 2021, and 1.5 million people contracted HIV for the first time.
“What world leaders need to do is crystal clear,” said Ms Byanyima. “In one word: Equalize. Equalize access to rights, equalize access to services, equalize access to the best science and medicine. Equalizing will not only help the marginalised. It will help everyone.”