A senior United Nations Programme on HIV and AIDS (UNAIDS) official says that although notable progress has been made globally against HIV and AIDS, the world is still off-mark with respect to targets related to combating the epidemic.
Dr Catherine Sozi, Regional Director for UNAIDS in East and Southern Africa (ESA), told delegates at a dialogue convened by Champions of a HIV-Free Generation on sustainable innovative HIV financing here, that a lot still needed to be done to overcome HIV and AIDS.
“Just ahead of the recent July 2018 International Youth Conference, we at the UNAIDS launched the Miles to Go Report as a mid-term appraisal of progress towards the 2020 fast track targets. The Report is very clear in its message: at the half-way point to the target, the pace of progress is just not matching the global ambition,” she said.
Warning that the global AIDS response was at a precarious point, Dr Sozi said partial success in saving lives and stopping new HIV infections was giving way to new complacency.
Yet all was not lost. Dr Sozi said the report states, also, that accelerated, strategic, resourced action can still put the world back on course to reach the 2020 targets.
She said the timing of the dialogue which brought the Champions together with other stakeholders who included Cabinet Ministers, Members of Parliament, staff of the SADC Parliamentary Forum and Heads of National AIDS authorities was opportune. It allowed delegates to assess what they could do better in terms of closing gaps, breaking barriers, righting injustices to achieve the critical 2020 targets and getting back towards ending AIDS as a public health threat.
She said the dialogue provided an opportunity, also, to discuss ideas related to protecting gains realised in the global AIDS response and to talk about sustainability.
Dr Sozi said the ESA was home to nearly 19.4 million people living with HIV, of which 60% were women. She acknowledged that domestic and international investments had led to significant increases of people on Anti-Retroviral Treatment (ART,) something that was not thought to be possible at the turn of the millennium.
“This scale-up on ART has actually led to a reduction in AIDS-related deaths, with more women on treatment than men in the ESA Region. However, even with these huge investments, significant gaps still remain.”
She said there was still need to identify approximately 1.7 million people living with HIV. Additionally, about four million people living with HIV were yet to be started on treatment. Of the ones who had started treatment, only 48% had actually achieved viral suppression, indicating that investments were not being maximized.
“As we strive to ensure that people with HIV have good quality lives, we have failed to date to turn off the tap of new infections significantly. There is a very slow decline in new HIV infections in this region and this is uneven among countries and population groups.”
Adolescent girls and young women, key populations including sex workers, men who have sex with other men, trans-gender persons and people who use drugs, continue to have disproportionally high rates of infection and access to existing services does not meet their demands, according to Dr Sozi.
She said it was evident that many people including young people who move from rural areas to peri-urban areas and include girls and adolescents, were still marginalized.
Dr Sozi said structured drivers of HIV such as gender inequality and violence increase the risk of HIV and undermine the progress in enabling access to prevention, treatment and care services.
The UNAIDS official said many people were still struggling to access food and nutrition, education, housing and clean water.
“We are simply not moving fast enough… Bio-medical interventions by themselves will not protect the people left behind. Are our current resources being invested in programs that will enable the very well-known bio-medical interventions to work? Can we commit any national resources to ensure that what we have done so far is sustained and that it goes beyond?”
Speaking at the same occasion, Dr. Mbulawa Mugabe, the Country Director of UNAIDS in South Africa warned that the region would not be able to meet the interim target of half a million new infections by 2020 at the pace at which infections were increasing.
“There has been a lot of progress in terms of saving lives, putting people on treatment and in terms of the targets that were set as part of the political declaration of ensuring that 90% of people living with HIV are tested, that we are able to put 90% of those on treatment and that 90% those can reach viral load suppression. We have been making significant progress,” Dr Mugabe said.
He said globally in terms of the 90-90-90 targets, it was clear that at least 80% of people living with HIV were aware of their status and that of those, 81% were on treatment. Be that as it may, there were still approximately 15 million people unable to access treatment.
“These are people that we need to ensure that we fast-track services to so that they get treatment.”
Dr Mugabe said there was a positive correlation between what had been achieved around prevention and what had been achieved around treatment.
“In other words, primary prevention for us has not delivered the dividend that we want. The Champions of an HIV-Free Generation have also made prevention their key strategic objective to put this agenda forward.”
He said there were international commitments that Member States had made for themselves starting with Sustainable Development Goals.
He explained that shortly after the adoption of the SDGs, the General Assembly of the United Nations convened a high-level meeting on HIV which took forward SDG 3 into a Political Declaration which seeks to set the international community on a fast-track to ending AIDS by 2030.
UNAIDS then picked that up as part of their global strategy, while national governments had also developed their own national strategic plans on this goal.
“The African Union also took this goal as part of its catalytic framework for ending AIDS, TB and Malaria, which sets out very specific targets from the African continent for us to end AIDS by 2030,” he said.
He said current statistics indicate that globally, at 30 years into the HIV pandemic, almost 40 million people were living with HIV.
“In terms of new infections, we have almost two million new infections per year. In terms of AIDS-related deaths, there has been some progress at less than a million, but these are our fellow human beings.”
He explained that the epicenter of the global HIV pandemic remained sub-Saharan Africa.
“This is where the focus need to be if we are to turn this epidemic around. Fast-track would require that our region moves at speed for us to be able to achieve the target that has been agreed.”
Turning to HIV financing, Dr Mugabe said contrary to wide-spread beliefs, the AIDS epidemic in low-income countries had been largely driven by domestic funding.
“Today, 56% of the expenditure on AIDS in low and middle income countries is from domestic funding. This is important in terms of whether we can still continue to push our treasuries and Ministries of Finance to put more than they have already put, or what needs to change. In terms of international funding, this has been the mainstay of the epidemic in terms of international solidarity.”
He explained that disbursement in 2016 and 2017 had actually increased.
Dr Mugabe said there were about 44 countries classified as low income and middle income economies and that depend on international funding for 75% of their national responses.
“How we are going to sustain this and what would happen if this should decline and there are no new commitments from the international community?”
He said member states could not constantly look up to their national treasuries for resources.
“Countries need to ask themselves what else they can do in terms of efficient and effective use of the resources currently on the table and what role parliaments can play. I think it is important that while we continue calling for additional new funds, we should also be talking about what we have on the table.”
Dr Mugabe said there was evidence pointing to the fact that not much progress was being made on the prevention front.
“We cannot talk about sustaining this response if we do not deal with this prevention crisis… If we cannot deal with the vulnerability of women and girls in this region, then we are fighting a losing battle.”
He concluded: “We are saving lives, but we are not sufficiently reducing new infections. We need to clearly match saving of lives with reducing new infections. We need to reinvigorate our HIV response, particularly prevention. We should be holding our partners and governments to some of the commitments around resourcing the AIDS response. That will only happen if we take a more integrated and strategic approach to HIV.”