Last week the High Level Meeting on HIV / AIDS took place in New York, United States, in which the Member States of the United Nations adopted (not without controversy) a new Political Declaration on HIV and AIDS that, According to UNAIDS, it is ambitious and achievable, aiming to end inequalities and be in a position to end AIDS by 2030.
To find out what happened there and analyze the situation of the pandemic globally, we spoke with Florence Riako Anam, program manager at the Global Network of people living with HIV (GNP+) based in Kenya.
First of all… what are your feelings after the conclusion of the High-Level Meeting on HIV/AIDS? Was the resulting political declaration forceful? Have the points demanded by civil society been included?
I, and many others are excited that the UN member states were able to adopt the political declaration on HIV and AIDS last week. I believe that the political declaration broadly aligns with the priorities of the UNAIDS’ New Global Aids Strategy released earlier this year. It addresses many urgent calls to overcome structural barriers such as discrimination, gender inequality, criminalization, the realities of underfunding, exclusion of people living with HIV, the key populations and other high-priority groups who are vulnerable to HIV, including immigrants and people in conflict zones and humanitarian settings. It is also exciting to note that the declaration includes the pledge to eliminate the vertical transmission of HIV and pediatric AIDS by 2025. This is critical to ensuring an HIV-free generation and is, in my opinion, one of the good things that happened last week. However, and I don’t think it comes as a surprise to anyone, the process leading up to the HLM and the adoption of the political declaration exposed the conflicting views of UN member states regarding certain topics, especially on equality, human rights and the inclusion of key populations. So, there was a lot of back and forth on that. This political declaration was not achieved by consensus, it was adopted by majority vote, the first time for a political declaration on HIV. However, the votes in favor of the political declaration as it stands were 165, with 4 against.
After the HLM of 2016, the international community has consistently failed to meet its 5-year prevention, diagnosis, treatment and financing targets, thus endangering the ultimate goal of ending AIDS as a public health problem in 2030. Will it be any different this time, even more so, given the Covid19 ‘monopoly’ in the world?
We were unable to meet any 2020 target, but I believe the High-Level Meeting of 2021 was an opportunity for member states and all global health actors to recommit to and revitalize the path that leads to the broader goal of ending AIDS by 2030. And now we have a political declaration in place that is very much aligned with the Global Aids Strategy. It will be important for governments, donors, technical partners, members of the private sector, community, and civil society to unite their efforts. We have to make the Global Aids Strategy come alive in terms of action. We need strong political leadership and commitment, particularly around issues addressing structural barriers like gender equality, criminalization and stigma and discrimination that continue to pose barriers to HIV prevention and treatment services. We require funding commitments, training task teams for community-led responses, programming that is transformative with regard to human rights, and multi-sectoral approaches. We have to use scientific evidence to guide HIV responses and we have to ensure that some or all of these issues are fully funded if we are to achieve our ultimate goal. For that to happen, I believe we need strong monitoring and accountability mechanisms that arise from community-led responses, because community is absolutely critical for keeping governments and all stakeholders accountable in achieving these goals.
A few months ago, the Global Fund released some highly concerning data on the fight against other pandemics in these times of Covid-19 and said that tests to diagnose HIV fell by 41% in low-income countries in Africa and Asia. The incidence is expected to rise in the coming months. Will Covid-19 mean an increase in AIDS-related deaths and undo years of progress?
Covid-19 continues to be at the heart of every government’s response mechanism and in many ways, it has exposed the inequalities and incapacities of our health systems. This is also evident in the impact on several of our HIV programmes. I believe the Global Strategy and the political declaration on HIV adopted last week include components that address the HIV and Covid-19 epidemics, and the dualities of HIV and other epidemics, either new or preexisting. It is critical to ensure that all the work that goes into addressing Covid-19 does not happen at the expense of HIV, and our work now must be focused on maintaining the gains that have already been made, ensuring that we speed up all that that needs to be accelerated to end AIDS by 2030. We cannot afford to fall back on testing, we cannot afford to lose people who are already in care. And we will require extensive efforts, energies, and resources to restore what was lost in 2020 and subsequently accelerate and move forward.
June 5 marked 40 years since the first clinical description of what was later called Acquired Immune Deficiency Syndrome (AIDS). It is estimated that around 40 million people have died of AIDS worldwide; some 38 million live with HIV today, about a million people are still infected annually, and some 700,000 die per year. After all this time, we still have no effective preventive vaccine. Meanwhile, in just a year and half, we have witnessed an impressive development of vaccines, diagnostics, and tools for a new pandemic, with unprecedented public investment from most developed countries. Is there a feeling that some diseases seem to matter more than others?
In my opinion, viewing this solely through the lens of HIV and COVID-19 is not practical. There has been similar prompt commitment when addressing epidemics after HIV, such as Ebola. I believe we have made considerable biomedical progress in addressing HIV. The issues continue to be about inequal access and persistent barriers arising from the social and structural drivers of the epidemic. The same issues exist for Covid-19, as you can see high levels of inequalities within countries with regard to vaccine or testing access.
Despite everything… are there lessons to be learnt from this health crisis to for better access to HIV treatment, diagnosis, and prevention? Can it be a challenge as well as an opportunity?
There is a lot that we can learn from the HIV response when addressing Covid-19. The incredible work that has been undertaken, all the systems, the diagnostic tools and infrastructures that have been established in order to address the HIV epidemic have been very useful for addressing Covid-19. The structure-based work to address HIV, especially the community, was useful for creating awareness of Covid-19 prevention, education, addressing public fears and misconceptions. There are definitely some lessons to learn, especially that with political leadership we can achieve quicker and faster results to identify solutions for different things, such as vaccines. However, the challenges and experiences remain similar to those of HIV. The disparities in access to tests, to vaccination… Some countries in Africa have not been able to vaccinate more than 0.5 percent of their population. My country, Kenya, has actually vaccinated around 2 percent of its population, and yet we have countries with such high vaccination rates that they are able to formulate policies for not wearing masks. So, these disparities exist, we have seen them within HIV. We are constantly asking for equity in terms of accessing optimized diagnostic tools for testing HIV or testing opportunistic infections, like tuberculosis, quick enough to save lives. We are always asking for optimized treatment with less side effects and those getting to global south. We also identify the kind of advocacy in the community action and the actions of researchers and other health workers or actors, to ensure that very less of these disparity exists. There’s a lot to learn from the HIV movement for Covid responses.
In 2019, key populations and their peers accounted for 62% of new HIV infections. We are talking of sex workers, gay and bisexual persons, and other men who have sex with men, transgender people, drug users, and people in prison and other closed settings. Will it be possible to put an end to HIV as a public health problem while these populations are stigmatized and their human rights denied in so many countries?
No. I do not believe we can ever manage HIV as long as we continue to exclude certain key populations. There are also people living with HIV among these populations and if they cannot access healthcare, I don’t see how we can end AIDS. Because people will still be untreated and die from preventable diseases, and there will still be people without access to means for prevention or testing for treatment.
Furthermore, HIV disproportionately affects young women and adolescent girls, whose rights and freedoms are also restricted in many countries, and who experience gender-based inequalities and gender-based violence. Does the end of HIV entail the empowerment of women?
Of course. We must address gender equality in order to address the disproportionate effects of HIV on young girls, adolescents, and young women. We witness this a lot in areas where their right to information, to access interventions, to autonomy, to choice is infringed upon, and even their basic right to exist. This often happens in areas with high levels of violence. We also see this happening in areas where cultural and religious norms are not very progressive, and they continue to endanger women both with regard to health and finances. So, we will be unable to progress in the fight against HIV if we do not address these issues.
Finally, and to summarize: after years of non-compliance with commitments, insufficient funding, inequalities, Covid-19 and other priorities … do you think we can achieve the United Nations goals of 2030 and we can view HIV/AIDS as a public health problem?
I believe we can achieve our goal of ending AIDS by 2030. We have gotten this far. There are countries that have achieved the 2020 targets of 90-90-90 and some countries in east and southern Africa are nearly there now. And that is why the new political declaration and the global AIDS strategy targets are to achieve 95-95-95. We can reach these targets. We have the mechanisms to end AIDS. We have scientific progress. We have made tremendous progress with regard to policy at global levels in collaboration with WHO to ensure that countries can adopt these policies and to enable interventions that prevent HIV across populations, to ensure that there is treatment and that when administered well, has very few side-effects but leads to rapid viral suppression and can also be helpful in reducing new infections. People are aware that when suppressed, virus cannot pass to other persons, and this is one of the biggest realizations for people who live with HIV, and a great motivation to continue treatment. We have better testing equipment, and we have point of care interventions to bring services closer to people. We have what we need to end AIDS by 2030. What remains pertinent is our strong commitment to do eradicate structural barriers that continue to affect how people come forward for their interventions or continue treatment or behave. We must have resources put in place to ensure that all biomedical interventions are available to all who need them, and we need political commitment to address these structural barriers.