We Can End AIDS, if We Follow the Path of Progress

There is a path to ending AIDS.

The data and real-world examples set out in the 2023 Global AIDS Update, newly released by UNAIDS, make that path very clear. What remains is a political and financial choice. HIV/AIDS responses succeed when they are anchored in strong political leadership: when they follow the evidence; tackle the inequalities holding back progress; enable communities and civil society organizations to play a vital role in the response; and ensure sufficient and sustainable funding.

Worldwide, several countries are on track to end HIV/AIDS. Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the 95-95-95 target, meaning 95% of people living with HIV know their HIV status, 95% of people who know their status are receiving treatment, and 95% of people receiving treatment have a suppressed viral load, reducing the likelihood of their infection being passed on. Another 16 countries are close to doing so, while China has achieved an impressive 84-93-97 ratio.

Progress has been strongest in the countries and regions that have made the greatest financial investments, such as in eastern and southern Africa. The fact that China finances nearly 100% of its national HIV response, including prevention, testing, treatment, and care, is the most telling evidence of its high political commitment to ending AIDS.

Further progress can be achieved by ensuring that legal and policy frameworks do not undermine human rights, but instead enable and protect them. Several countries removed harmful laws in 2022 and 2023: Antigua and Barbuda, the Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore all decriminalized same-sex sexual relations. Existing laws to protect the rights of vulnerable groups have been strengthened in other countries, such as Ghana, India, Spain, Kuwait, Kazakhstan, and the Central African Republic. This courage generates the opportunity for success by ensuring access to services.

These examples of putting people and communities first demonstrate how together we can end AIDS as a public health threat by 2030. As the UNAIDS report notes, however, none of this will come automatically. While 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. AIDS claimed a life every minute in 2022; that year, 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 amongst the poorest and the most vulnerable.

The AIDS pandemic’s ongoing cost to children is among the most painful reminders that AIDS is not over. Even though AIDS-related deaths among children aged 0 to 14 were reduced by 64% between 2010 and 2022, the epidemic still claimed the lives of an estimated 84,000 children last year. It is vital to ensure that children are diagnosed and reached with life-saving treatment. In 2022, China released a national action plan to end mother-to-child transmission of HIV, syphilis, and hepatitis B, which aims to eliminate all three diseases among newborn babies by 2025. UNAIDS applauds China’s timely action and strongly believes that China will become the first large developing country to achieve the triple elimination targets.

Punitive laws and policies, human rights violations, and discrimination continue to greatly increase the risk of HIV transmission and sabotage efforts to control the pandemic among key populations. An analysis of studies from 10 countries in sub-Saharan Africa showed that HIV prevalence among gay men and other men who have sex with men was five times higher in countries that criminalized same-sex relationships than in non-criminalized settings. Where there were recent prosecutions based on those laws, HIV prevalence in this key population was 12 times greater than in countries without prosecutions. And where civil society organizations faced barriers to operating, prevalence was more than 9 times higher than in countries without such obstacles. Other research has shown that 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.

The obstacles in the way of progress are not immutable. We can overcome them. But the path that ends AIDS requires collaboration — between Global South and North, governments and communities, and the UN and its member states.

It also requires bold leadership. This is where UNAIDS comes in. By supporting China in its domestic HIV response and connecting it with the rest of the world through South-South partnerships, UNAIDS aims to bolster China’s role as an emergent leader in global health and diplomacy and as a key contributor to the United Nations’ Sustainable Development Goals and its vision of ending AIDS by 2030 while leaving no one behind.

The route map set out in UNAIDS’ new report shows that success is possible in this decade — provided we move together and with urgency. The path is clear. Taking it will not only help ensure global readiness to address future pandemic challenges, but also advance progress across the Sustainable Development Goals.

Editor: Lu Hua; portrait artist: Zhou Zhen.

(Header image: inside-studio/VCG)

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