Pandemics exacerbate and thrive on inequality. They find the cracks in our societies and dig them. As a result, the poorest and most marginalized always suffer the most.
We have seen it with HIV and are seeing it again with COVID-19. Rich countries are launching booster vaccination campaigns while most people in poor countries go without even a first dose. But as we celebrate World AIDS Day, we must also recognize that inequalities exist both within countries and between countries.
Since the first cases of AIDS were reported 40 years ago, the world has made enormous strides in the fight against HIV. In countries where the Global Fund invests, AIDS-related deaths have fallen by 65% ââsince our inception 20 years ago. Globally, more than 27.5 million people with HIV are on life-saving antiretroviral (ARV) treatment.
Yet in many countries, persistent inequalities have proven to be a formidable obstacle to accelerating progress against the virus. In these countries, new HIV infections are concentrated among people made vulnerable by human rights or gender inequalities. People in communities who are stigmatized or criminalized, and therefore cannot access essential services to protect them from HIV, may be up to 25 to 35 times more likely to acquire HIV infection than the general population. Adolescent girls and young women in sub-Saharan Africa face a range of gender-related barriers that predispose them to HIV: six in seven new HIV infections among adolescents aged 15-19 in the region are among girls .
COVID-19 has exposed the most vulnerable and marginalized communities to even greater risks, as lockdowns and restrictions aimed at curbing the new pandemic have hampered access to life-saving HIV treatment, testing, care and prevention services.
In the fight against HIV, we now face a new reality: we were on the right track even before the pandemic, and COVID-19 has pushed us even further; and what has brought us here will not get us any further.
To accelerate progress – and meet even more ambitious global HIV targets for 2025 – we will need to invest more and smarter. We need to be even more specific and differentiated in designing and implementing prevention and treatment approaches for communities most at risk. Achieving this requires empowering communities themselves to play an even greater role in the design and implementation of interventions.
For prevention, we advance the concept of âPrecision HIV Preventionâ to ensure that we get maximum impact from the scarce resources available. This means we help countries focus their efforts on the places where HIV is most prevalent and on people with greatest HIV prevention needs so that they have the tools, knowledge and power to protect themselves. . For treatment, we support innovative and cost-effective models of drug delivery and care that make services more accessible, which is essential for getting people on ARVs early and improving viral retention and suppression. Such practices include distributing ARVs over several months – now recognized as a best practice for increasing treatment adherence.
We also need to be even more determined to tackle human rights and gender barriers that prevent those most at risk from accessing the services they need. Key and vulnerable populations, including adolescent girls and young women, gay men and other men who have sex with men, people who use drugs and transgender people, face a staggering number of barriers as a result. stigma, discrimination and criminalization. Unless we approach them with a rights-based approach, we will not overcome HIV.
These imperatives are at the heart of the Global Fund’s new strategy, approved by our Board last month. Placing people and communities at the center, this strategy places even greater emphasis on equity, human rights and gender equality, and on strengthening the role and voice of communities living with and affected by HIV.
The strategy also commits the Global Fund to invest in integrated people-centered health systems, including community systems. Without diluting our goal of saving lives and reducing infections, we will further leverage the synergies between the fight against HIV and interventions against other pathogens, to better serve people and improve resilience. and the sustainability of our interventions.
For example, in many countries we are already investing in integrated programs for HIV and TB, but there is now also a need to manage the interaction with COVID-19. High throughput molecular diagnostic instruments installed for viral load testing are now used for COVID-19 testing; testing people for HIV and COVID-19 fights both pandemics at the same time. People living with HIV who are not virally suppressed are more likely to be severely affected by COVID-19, so providing them with ARVs and protecting them from the new virus is all the more important.
Time and time again, we have seen the poorest and most marginalized suffer the most from the most dangerous infectious diseases. We need to take an approach that recognizes this cruel reality. HIV was the last major pandemic to hit mankind, and although we have made great strides, we have yet to overcome it. COVID-19 poses another daunting challenge, especially for communities most at risk of HIV. We need to tackle both pandemics, and overcome both, and do so in a way that tackles the inequalities that they exploit and deepen.
This editorial was originally published by Health Policy Watch.