HIV prevention is in crisis

Article by Lois Chingandu, Director Evidence and Influence of Frontline AIDS, published on the website Global Cause, November 25, 2020

The global response to COVID-19 has shown what’s possible. Now we need the same commitment to ending AIDS.

AIDS isn’t over. We may have effective treatments and innovative prevention tools, but we have failed to get new HIV infections under control.

Judging by the 1.7 million new infections we saw in 2019 – a figure that has barely changed in the past four years – the world has failed badly in meeting this target.

HIV infection drivers

In Eastern Europe and Central Asia, new HIV infections have jumped by two thirds in the last decade, and in the Middle East and North Africa by 22%. In Africa, although rates of infection are coming down, HIV remains the leading cause of death in women of reproductive age. It is also the second most common cause of death in adolescents.

Although we have a range of biomedical interventions such as male circumcision and Pre-Exposure Prophylaxis (PrEP), significant social and legal barriers remain. If we’re serious about ending AIDS, we must address the social and gender norms that are fuelling the HIV epidemic, and repeal laws that criminalise same-sex relationships, drug use and sex work.

By 2020, the goal was to achieve fewer than 500,000 new infections annually. Judging by the 1.7 million new infections we saw in 2019, the world has failed badly in meeting this target.

The impact of COVID-19

COVID-19 has made things worse, disrupting HIV prevention services such as the provision of condoms, PrEP and harm reduction for people who use drugs. Health systems are crumbling and already fragile and vulnerable people are being pushed into poverty, which is going to particularly expose young people to higher HIV risk.

Restrictions imposed to curb COVID-19 are making many even more vulnerable to HIV. Sexual and gender-based violence increases HIV infection risk for women and girls, and our partners report that this has increased dramatically under lockdown.

Some governments are using COVID-19 restrictions to crack down on people who are already marginalised. In the three months after the onset of COVID-19, we saw applications to our emergency Rapid Response Fund for marginalised groups triple.

We’ve supported sex workers unable to feed their families because they’re being turned away from food aid and provided funds to keep needle and syringe programmes and opioid-substitution therapy running for people who use drugs. In Uganda our partners helped secure the release of 20 young LGBT people who were arrested and imprisoned under the guise of COVID-19 restrictions.

Courageous decisions

In responding to COVID-19, governments have shown that they can make unprecedented decisions when faced with a health crisis. But , and we must not let that be ignored as attention and resources are mobilised to fight COVID-19.

We need governments to show the same commitment and to finally address the barriers to HIV prevention. HIV is not a new pandemic, but courage and leadership are needed now more than ever.