Discrimination and inequality holding back fight against Aids, UN warns

In a report published on Tuesday, UNAIDS found that gender inequalities, harmful gender norms and discrimination have hampered efforts to tackle Aids, with the world unlikely to meet targets to end the disease as a public health threat by 2030. 

“New infections are rising and Aids deaths are continuing in too many countries,” UNAIDS director Winnie Byanyima said. “Dangerous inequalities are undermining the Aids response and jeopardising the health security of everyone.”

The analysis showed that, in 2021, an adolescent girl or young woman acquired HIV – the virus that causes Aids – every two minutes. In sub-Saharan Africa, where women accounted for 63 per cent of new infections in 2021, young women are three times more likely to contract HIV than their male counterparts.

Domestic violence also dramatically increased women’s chances of catching the virus, with women who had been subjected to intimate partner violence in the past year 50 per cent more likely to catch HIV. 

The report also found that discrimination against certain populations such as gay and bisexual men, transgender people and sex workers has hampered attempts to tackle the disease within key groups. Although HIV prevalence has fallen by an average of around 60 per cent among all adults in sub-Saharan Africa, there has been “no significant decline” among gay and bisexual men in the region. 

Speaking at the report launch in Tanzania on Tuesday, Byanyima said discrimination against marginalised people was “putting the brake on the HIV response globally”. She noted that gay men worldwide were 20 times more likely to be infected with HIV than other men, while transgender people were 14 times more likely and sex workers thirty times more likely. 

UNAIDS also warned that “harmful masculinities” were discouraging men from seeking care, with only 70 per cent of men accessing treatment in 2021 compared to 80 percent of women.

“We will not end AIDS unless we end it for everyone,” she said. 

Children are also being left behind in the global Aids response. The findings show that while over three quarters of adults living with HIV are on lifesaving antiretroviral therapy, just over half of children are on the medicine. 

UNAIDS warned this “treatment gap” had “deadly consequences”. Although children made up just four per cent of all people living with HIV in 2021, they accounted for 15 per cent of all Aids-related deaths. 

“These inequalities aren’t merely harmful to individuals: they are impeding progress against Aids, reducing the returns on HIV investments and putting millions of people in danger,” UNAIDS said.

It comes after the UN agency  warned in July that the world is “losing the fight” against HIV, with 1.5 million new infections reported last year – three times more than global targets.

To meet its goal of ending the Aids epidemic by 2030, the UN had set targets to cut annual infections to 500,000 in 2021 and 370,000 in 2025.

According to UNAIDS, 650,000 people died from the disease in 2021, which is equivalent to one fatality every minute. This is despite the existence of effective HIV treatment and tools to prevent, detect and treat infections. 

Inequalities ‘holding us back’

Published ahead of World Aids Day on Thursday, the analysis warned that addressing inequalities was essential for combating the disease. 

UNAIDS said keeping girls in school and ensuring they were protected from violence was vital to reduce the threat of HIV/Aids, as well as expanding access to contraception.

“If we can enable our girls to stay in school until they complete secondary education, this would reduce their vulnerability to HIV infection by up to 50 per cent, and if we include in that education comprehensive sexuality education, which is learning about their bodies and how to protect themselves, then this risk is reduced even further,” said Byanyima. 

The agency also said fighting stigma and decriminalising homosexuality was also key to bringing down infections in gay and bisexual men, with Byanyima noting that 68 countries still have legislation criminalising same sex relationships. 

“Facing an infectious virus, failure to make progress for key populations undermines the entire Aids response and helps explain slowing progress,” said Byanyima. “And where gender and key population inequalities intersect, they are amplified.”

Analysis in the report found that gay men and other men who have sex with men who live in African countries with the most repressive laws are more than three times less likely to know their HIV status than their counterparts living in countries with the least repressive laws, where progress to fight the disease has been far more rapid. 

Byanyima said such laws “take people away from services”. “We don’t only need to decriminalise, but we need to fight stigma,” she added. “Stigma is a sentence passed by society on people for who they are, and stigma kills,” she added.

Byanyima also said “closing the gap” between adults and children living with HIV was essential. 

“With the science we have today, no baby should be born with HIV and no child who is HIV positive to be without treatment. We have everything,” she said. “But today around the world, while three quarters of adults who have HIV are on treatment, only half the children with HIV are on treatment. This is an inequality.”

“We are leaving children behind and we must do something,” she added. “We can’t allow this avoidable injustice to continue.”

Funding cuts

UNAIDS warned in July that increasingly constrained funding was to blame for “faltering progress”, with donors redirecting resources to Covid-19 response and other crises while low- and middle-income countries cut domestic funding for two consecutive years. 

In 2021, funding available for HIV programmes in low- and middle-income countries was $8 billion short.

“In the midst of a debt crisis, in the midst of an austerity crisis, in the midst of widening inequality in the developing countries in the South, some rich countries have also cut back aid for global health and they are considering even deeper cuts,” Byanyima said at the report launch. “This is not right. Now is not the time to step away, now is the time to step up.”

The report referenced the resurgence of malaria and tuberculosis in the 1980s, as resources and attention to the two diseases declined. “We simply cannot allow the same thing to occur in the case of Aids,” it said. “The staggering long-term costs of failure are just too great.”

Byanyima said it was vital that donor funding increased to get the Aids response “back on track”.

“What world leaders need to do is crystal clear,” she said. “In one word: Equalise. Equalise access to rights, equalise access to services, equalise access to the best science and medicine. Equalizing will not only help the marginalised. It will help everyone.”