Over the past two and a half years, the colliding AIDS and COVID-19 pandemics—along with economic and humanitarian crises, have placed the global HIV response under increasing threat, an UNAIDS Global AIDS Update 2022 has said.
The report says that COVID-19 and other instabilities have disrupted health services in much of the world, and millions of students have been out of school, increasing their HIV vulnerability. Low- and middle-income countries have been challenged to respond as 60% of the world’s poorest countries are in debt distress or at high risk of it, and an estimated 75 to 95 million people have been pushed into poverty, an increase without precedent.
As a result, the AIDS response has faced serious pressure while communities that were already at greater risk of HIV are now even more vulnerable.
In some parts of the world and for some communities, the response to the AIDS pandemic has shown remarkable resilience in adverse times, which has helped avoid the worst outcomes. However, global progress against HIV is slowing rather than accelerating.
The latest data collected by UNAIDS show that while new HIV infections fell globally last year, the drop was only 3.6% compared to 2020—the smallest annual reduction since 2016. As a result, many regions, countries and communities are left to address rising HIV infections alongside other ongoing crises.
Eastern Europe and central Asia, the Middle East and North Africa and Latin America have all seen increases in annual HIV infections over the past decade. In Asia and the Pacific—the world’s most populous region—UNAIDS data now show that new HIV infections are rising where they had been falling over the past 10 years.
Malaysia and the Philippines are among the countries with rising epidemics among key populations, particularly in key locations. Increases in infections in these regions are alarming.
Latin America, an early success story in the roll-out of treatment, has lost momentum, allowing epidemics among young gay men and other men who have sex with men and other key populations to rebound.
Large portions of Eastern Europe and central Asia do not have the harm reduction services needed to turn the tide of epidemics that are predominantly among people who inject drugs and their sexual partners.
In eastern and southern Africa, the region with the highest prevalence of HIV, the AIDS response has shown remarkable resilience in the face of adversity, with HIV treatment and prevention programmes adapting to COVID-19 mitigation efforts. But even there, progress in reducing new infections has slowed significantly rather than accelerating as required to stop the pandemic.
Meanwhile, UNAIDS data show that HIV programmes in this region face growing headwinds as the domestic and international financing that have enabled progress to date are under threat.
There are bright spots, including robust declines in annual HIV infections in the Caribbean and western and central Africa—the latter driven largely by improvements in Nigeria. These decreases in infections represent accelerating progress.
In global figures, however, this progress is being drowned out by a lack of progress in other regions: HIV infections have now increased since 2015 in 38 countries globally.
Every day, 4000 people—including 1100 young people (aged 15 to 24 years)—become infected with HIV. If current trends continue, 1.2 million people will be newly infected with HIV in 2025—three times more than the 2025 target of 370 000 new infections.
The human impact of the stalling progress on HIV is chilling. In 2021, 650,000 people died of AIDS-related causes—one every minute.
With the availability of cutting-edge antiretroviral medicines and effective tools to properly prevent, detect and treat opportunistic infections such as cryptococcal meningitis and tuberculosis, these are preventable deaths.
Without accelerated action to prevent people from reaching advanced HIV disease, AIDS-related causes will remain a leading cause of death in many countries. In addition, continued rising new HIV infection in some regions could halt or even reverse progress made against AIDS-related deaths.
The report stressed that together, world leaders can end AIDS by 2030 as promised, but we need to be frank: that promise and the AIDS response are in danger. Faltering progress meant that approximately 1.5 million new HIV infections occurred last year—more than 1 million more than the global targets.
In too many countries and for too many communities, there are rising numbers of new HIV infections when there was a need to see rapid declines.
“We can turn this around, but in this emergency, the only safe response is to be bold. We can only prevail together, worldwide,” the report said.