There is a proven path to end AIDS … are we on it?

As countries respond to and recover from the COVID-19 pandemic, a renewed focus to end AIDS couldn’t be more urgent. Here’s the question – how can we do it better, faster and more sustainably?

The recently released UNAIDS Global AIDS Update Report shows that there is a path that ends AIDS and ensures preparedness to address future pandemic challenges and advance progress across the Sustainable Development Goals.

The data and examples set out in the global report make it very clear what that path is. It is not a mystery. It is a political and financial choice.  HIV responses succeed when they are anchored in strong political leadership to follow the evidence; tackle the inequalities holding back progress; enable communities and civil society organizations in their vital role in the response; and ensure sufficient and sustainable financing.

Several countries are already on track. Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe have already achieved the 95–95–95 targets. This means 95% of people living with HIV (PLHIV) know their status, 95% of PLHIV who knew their status received treatment, and 95% of PLHIV receiving treatment have viral suppression. At least 16 other countries are close to doing so.

Lao People’s Democratic Republic (Lao PDR) has reached 76-77-97, a significant progress we have noticed over a decade of effort between the government, bilateral and multilateral partners, civil society organizations, communities of PLHIV and key populations and other development partners across multiple sectors and levels. With its 10-year National Strategic Plan (2021-2030) and joining the Global Partnership for Action to Eliminate all Forms of HIV-related Stigma and Discrimination, Lao PDR has made solid progress last year in reducing new HIV infections by 6% since 2010. This effort reflects the political commitment, evidence-based response and the community engagement of Lao PDR.

Governments can do – and many are already doing – more to end AIDS. Progress has been strongest in the countries and regions that have the most financial investments, such as in eastern and southern Africa. And a more inclusive approach to legal and policy frameworks is a key here as well. When we decriminalize same-sex sexual relations, we increase participatory engagement and amplify marginalized voices. And that’s when we ensure equal and equitable access to HIV prevention.

The good news is – in 2022, the Lao government invested USD 4.06 million in HIV response and in which 45% came from the domestic sources, commendable increase from USD 2.54 million HIV expenditure with only 7% contribution from domestic sources in 2021.

These examples of putting people and communities first demonstrate how together we can end AIDS as a public health threat by 2030. As the report sets out, however, none of this will come automatically. Whilst access to HIV treatment has helped save 20.8 million lives, these life-saving advances are still being denied to millions of people who urgently need them. 

Globally, AIDS claimed a life every minute in 2022. There were 1.3 million new HIV infections, and 9.2 million people are still missing out on treatment, including 43% of children living with HIV. Ongoing social and economic inequalities within countries and between them are exacerbating and prolonging pandemics and amplifying their impact on the poorest and the most vulnerable.

In Lao PDR, only 62% of children living with HIV are on treatment. About half of pregnant women living with HIV in Lao PDR did not access prevention of mother-to-child treatment services last year resulting in 30% of HIV transmission rate from mothers to children. It is estimated that at least one young adult becomes infected with HIV every day. 72% of total new HIV infections are among key populations (female entertainment workers, gay men and other men who have sex with men, transgender women, people who use and inject drugs) and their sexual partners. Increasing proportion of new HIV infections are among men and boys; they accounted for 68% all new HIV infections in 2022.

The facts and figures are telling us that we have a monumental task to do. We know the steps that need to be taken, and we need to act now.

Yet, around the world, punitive laws and policies, human rights violations and discrimination continue to greatly increase the risk of HIV transmission and sabotage efforts to control the epidemic among key populations. Repressive policing of sex workers almost doubled their risk of HIV or sexually transmitted infection, and there is compelling evidence linking policing practices with increased risk of acquiring HIV. And when civil society organizations faced barriers to operating HIV preventions, the prevalence was more than nine times higher than in countries without such obstacles.

The obstacles in the way of progress can’t be navigated just by avoidance. We must overcome them head-on. The path that ends AIDS requires collaboration – South and North, governments and communities, UN and member states together. And it requires bold leadership. The route map in UNAIDS new report shows how success is possible in this decade – if we move together and with urgency.

There is a long road ahead in our collective fight to end AIDS, and we remain walking on this path with the Lao government and its partners in the HIV response, not just to be AIDS-free by 2030 but also to sustain the response and to build quality healthcare inclusive for everyone now and in the future.