We have come a long way. In the mid 1980s, when I started to work on the campaigns to respond to HIV and AIDS, there were no medicines.
We were able to warn the public of the dangers. Hence the public education campaign “Don’t Die of Ignorance” which used all the means of communication which were then available, including television, posters and newspaper advertisements. That campaign helped bring down new cases.
But, at that time in the mid 1980s, HIV was an almost certain death sentence. My abiding memory of that period is of my conversations with patients who were in the last weeks of their lives and with despairing doctors and nurses who knew that at that moment there was nothing they could do to halt the infection for those who had already contracted it. All that we could provide was care.
For millions of people across many countries today, that position has been transformed. Treatment is now available and, with that treatment, people living with HIV can lead long and successful lives, and will not transmit HIV.
We have the tools. All over the world there are examples of good practice that can increase the uptake of HIV prevention, testing, and treatment services.
We can now say this: We can end AIDS.
And yet, in just the last year alone, 650,000 people died of AIDS-related illnesses and 1.5 million people became infected with HIV. So why are people still dying of AIDS? And why are there so many new HIV infections year after year?
The COVID-19 crisis, the Ukraine crisis, and all the financial challenges that have resulted, have knocked the response off track - impacting services and increasing risks.
The deeper challenge is that the world has not sufficiently addressed the inequalities which drive the pandemic.
That is why UNAIDS has put tackling those inequalities at the heart of its strategy to end AIDS as a public health threat by 2030 and is calling on countries to equalize access to life-saving HIV testing, treatment and prevention services.
One of the inequalities standing in the way of ending AIDS is inequality in access to education. Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among girls. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%.
All children – including both those who dropped out in the COVID crisis and those who were out of school even before COVID – should get to complete a full secondary education, including comprehensive sexuality education. Yet as countries struggle with the current fiscal challenges, education and health are too often amongst sectors that are suffering the biggest budget cuts.
That is why the Education Plus initiative, co-convened by UNICEF, UNESCO, UNFPA, UN Women and UNAIDS, with governments, civil society and international partners, is pressing political leaders to accelerate the actions and investments needed to ensure that every African girl is in school, safe and strong.
Another inequality standing in the way of the end of AIDS is inequality in the realization of human rights. Some 68 countries still criminalise gay men. Laws which punish same sex relations, in addition to contravening the human rights of LGBT people, help to sustain stigma and discrimination against LGBT people. Such laws are barriers to LGBT people seeking and receiving healthcare for fear of being punished or detained. The repeal of all such laws worldwide is vital to helping the world end AIDS.
In Singapore, the Prime Minister made the point in his annual policy speech when he announced the repeal of laws that criminalized sexual relations between men: Gay people, he said, were fellow Singaporeans who wanted to live their own lives, participate in the community, and contribute fully to Singapore.
The evidence is clear—protecting the safety and human rights of marginalized people expands access to HIV services, accelerating progress in the response to HIV by increasing the number of people on treatment, widening access to prevention tools and reducing new infections.
Decriminalisation saves and changes lives.
I am disappointed that the football authorities who have chosen to showcase the World Cup in Qatar, and the political leaders taking part, are not highlighting more directly the important public health and human rights case for decriminalisation.
Just as there is a need for courageous political leadership in advancing girls’ and women’s empowerment, and the human rights of gay people, so too there is a need for courageous political leadership in international cooperation in the fight against AIDS. Currently, at a moment when international solidarity and a surge of funding is most needed, too many high-income countries are cutting back aid for global health. In 2021, international resources available for HIV were 6% lower than in 2010. And when you exclude the United States whose contribution to the global AIDS response has been the most generous, international assistance for the AIDS response from other bilateral donors has plummeted by 57% over the last decade. I do not underestimate the challenges faced by donors, but wealthy countries need to remember that ending AIDS is far less expensive than not ending AIDS.
What is at stake is hundreds of thousands of deaths and millions of new infections - all preventable. What is at stake is end of a pandemic at the end of this decade, in contrast to a pandemic that goes on and on. Current trends indicate we will miss the UN target of ending AIDS as a public health threat by 2030 but there is no inevitability in that.
Beating pandemics is ultimately a political challenge. We can end AIDS by 2030 but only if we are bold in our actions and our investments. We need courageous leadership. And we need people worldwide to insist that their leaders be courageous. Whether we end AIDS is up to all of us.
/ENDS
Lord Norman Fowler, an ambassador for UNAIDS, former Health Secretary, former Lord Speaker and current Vice Chair of the APPG on HIV and AIDS.