Twenty years ago, beating back HIV seemed an almost impossible dream. The disease was ravaging communities across the world, taking a huge toll on lives and societies. Since then, we have come an extraordinarily long way and seen great leaps in prevention, treatment and awareness. The past decade has seen a 38% reduction in HIV incidence and fewer people acquired HIV globally in 2023 than at any point since the late 1980s. This is certainly cause for celebration. But the job is not yet done, and we are at a moment of reckoning in the fight against HIV.
The Sustainable Development Goal 3 (SDG 3) target of ending AIDS as a public health threat by 2030 is a real possibility, tantalizingly close. Now is the time to ramp up our efforts, to address the challenges that remain and scale up effective solutions.
While advances in the fight against HIV have been remarkable, if we zoom in, we see that progress is inconsistent across countries and regions, and above all, this progress is fragile. Despite how far we have come, far too many people are still getting ill and dying. Last year 630,000 people died of AIDS-related causes. Children are dying. They are losing their parents. The widespread suffering still being wrought by this disease is unacceptable.
Several factors are holding us back: There is a growing risk of complacency in the HIV response, with flagging political and financial commitment and weak health systems in many countries – often exacerbated by impacts of conflict, climate change and debt crises. Added to this is the escalating threat of antimicrobial resistance (AMR) and major gaps in the response to pediatric HIV. The growing rollback of human rights and gender equality globally, coupled with the worst and most steadfast enemies of the fight against HIV – inequity, stigma and discrimination – are making people more vulnerable to infection and preventing them from accessing health services.
We have solutions. We have the knowledge and tools to prevent every new HIV infection and each AIDS-related death. We know that human rights are absolutely central to getting where we need to be, and that innovative tools and approaches can accelerate transformative change.
Today we are at an exciting moment for HIV prevention tools. The dapivirine vaginal ring has huge potential to be a game changer in reducing HIV infections. It is the first effective, woman-controlled HIV prevention option ever produced and has major advantages as an alternative to taking oral PrEP pills, giving women more agency and discretion in their prevention measures. Equally promising are innovations such as the long-acting injectable drug lenacapavir, which offers a potential step change in the reduction of new HIV infections.
But we know these innovations alone will not be enough unless we clear a pathway to make them accessible to everyone, everywhere. This means making them affordable, scaling up their distribution to communities and places where there are high rates of infections, and tackling structural barriers to effective HIV services.
A key step toward driving equitable access to these tools is by driving down the cost of health products to prices that can be absorbed by health systems. These efforts, commonly referred to as market shaping, have driven the price of first-line HIV treatments down to as low as $37 per year, down from nearly $10,000 two decades ago.
Innovative approaches are also essential to bring vital tools and support services to those most at risk for HIV (such as gay men and other men who have sex with men, sex workers, trans and gender-diverse people, people who inject drugs, people in prison) and other vulnerable groups such as young women and girls, ensuring they can access the HIV prevention and treatment services they need.
At the same time, it is vital that the global response to HIV addresses the inequities experienced by people affected by HIV, as well as the health workers, peer educators and other community members who support them. This means paying community health workers and peer educators for their work and protecting people from stigma, discrimination, violence and criminalization. It is also vital that people affected by HIV are equipped with knowledge and skills to exercise their health-related human rights and that health care providers and law enforcement agents are trained to provide people vulnerable to HIV with supportive and effective services.
In any race, when you see the finish line you accelerate. We are at this point in the fight against HIV and it is critical that we push forward with everything we have. We have five years to bridge the gap in the HIV response and meet the SDG 3 target of ending AIDS as a public health threat. When innovation meets a rights-based disease response, we have a winning formula. This means accelerating the rollout of the best tools and eliminating obstacles to getting these where they are needed. To echo the message that sums up the UNAIDS 2024 report, this World AIDS Day I would urge all engaged in the HIV response to take the rights path. It is not only the right path, but it is the only path to ending AIDS as a public health threat by 2030.
