Now is Not the Time to End the Global AIDS Effort | AIDS 2024

Although significant progress has been made reducing new infections of HIV and deaths from AIDS, panelists during a session at International AIDS Conference in Munich, Germany, agreed that a global effort is still needed to address the challenges faced by those who have HIV and AIDS.

Globally, about 39% fewer people acquired HIV in 2023, compared with 2010. But about 1.3 million people still became infected in 2023, which is more than the 370,000 international target goal for 2025.

Additionally, progress has been uneven. Lower income countries continue to face challenges in access to care, and the number of people infected continue to rise in at least 28 countries, according to new report from the Joint United Nations Programme (UNAIDS). Of the 39.9 million people living with HIV globally, 9.3 million are still not receiving life-saving treatment and as a result, one person dies from AIDS every minute.

Political movements around the world are highlighting anti-gay and anti-gender biases that could negatively impact healthcare in general and HIV and AIDS specifically, and there has been slow progress in reducing stigma, discrimination and inequities.

The UNAIDS report highlighted efforts by some countries to integrate HIV care into their broader health strategies.

But panelists during a session on the future of HIV global health argued that international efforts — by the United Nations through UNAIDS in partnership with the World Health Organization; The Global Fund to Fight Aids, Tuberculosis, and Malaria; the U.S.’s President’s Emergency Plan for AIDS Relief (PEPFAR), and other efforts — is critical for continued progress.

Angeli Achrekar

“What was required then [at the beginning of the AIDS crisis] may be what’s required now,” Angeli Achrekar, deputy executive director for the Programme Branch at the Joint United Nations Programme on HIV/AIDS (UNAIDS) and an Assistant Secretary-General of the United Nations said during the session. “We needed then a multifactorial response. We needed an exceptional response to an exceptional crisis. And the success has been extraordinary.”

UNAIDS, Achrekar pointed out, was created in 1996 to provide a global response to HIV and AIDS. “All of the sectors at the UN came together to step up in an exceptional way for focus attention on the HIV response,” she said. “This does not exist for any other health area.”

She said that continued success will be challenging because of the current political environment and current the geopolitical environment with climate change and with human rights violations.

“More than ever, we need a unified solidarity around the HIV response,” Achrekar said. “With the political environment all of us we find ourselves in, human rights violations and gender inequality are things that UNAIDS does not shy away. These things are more challenging now and may get more challenging as we get into the future.”

Lawrence O. Gostin, J.D.

Lawrence O. Gostin, J.D., is a faculty director of the O’Neill Institute for National and Global Health Law and is the founding O’Neill Chair in Global Health Law at Georgetown Law, agree with Achrekar, saying “in a perfect world, we would all have strong healthcare systems, but that is not the world we live in.”

Gostin said the AIDS movement in the 1990s changed the world and is still changing the world. “The AIDS community has defined social mobilization,” he said. “If you wanted to look at one community that stands for justice and equity and fighting for human rights, it’s the AIDS community. Decades ago, the idea of health and human rights didn’t exist.”

He said it’s not possible to talk about progress in HIV, AIDS and human rights without talking about politics, law and policy.

“The elections in the United States and the world really demonstrate that,” he said. “Is there any question that if the Republicans were to be elected that multilateralism will be gone, mutual solidarity will be gone. I wrote in the New York Times, that then-President Trump’s decision to leave the World Health Organization was the most ruinous presidential decision in my life. Is there any doubt that if he were elected PEPFAR would be jeopardized, the Global Fund would be jeopardized, civil society would be jeopardized. And that is just in the United States.”

U.S. funding to the World Health Organization stopped briefly when in May 2020, then President Donald Trump announced the United States would withdrawal from the WHO effective July 6, 2021. President Joseph Biden reengaged with the WHO after he took office. The United States has also invested more than $100 billion to the global HIV/AIDS response through the President's Emergency Plan for AIDS Relief (PEPFAR), which was established in 2003.

AIDS mobilized the world in a way that other disease haven’t or couldn’t, Gostin said during the presentation. COVID-19, for example, was not able to mobilize people for public health in the same way.

“COVID changed the world in ways that eviscerated equity and justice, with vaccine inequity that was scandalous,” he said. “It motivated the anti-vaccine movement, which affected childhood vaccinations around the world. Countries became nationalistic and there were fights with global powers with WHO in the middle.”

He said that COVID-19 showed that we are far from a world that coalesces around strong, integrated, well-funded health systems that focus on the right to health, human rights, global solidarity. “I wouldn’t want to lose the gains we’ve made.”