The world has come a long way in the fight against HIV, but inequity – particularly for groups that continue to suffer a disproportionate number of infections – continues to be a hurdle, writes Bience Gawanas, vice-chair of the Global Fund Board.
In Health Policy Watch Gawanas wrote:
Every step we make in the fight against HIV today is going to be painstaking – we must press harder for progress. In the early years of the fight against this virus, our gains were often rapid and immense because everywhere you looked, there was great need.
Those were devastating times: the disease killed 3m people in 2000, more than 2.4m of them in Africa.
In the southern tip of the continent, where I am from, the disease was threatening to disintegrate the very fabric of society.
When the world came together to form partnerships like that of the Global Fund and PEPFAR, it was to challenge the injustice that only the rich could get HIV treatment. It was to stop the possibility of losing a generation of people in many low- and middle-income countries as well as those who were stigmatised and discriminated against because they were considered “different”.
I am proud to say we have since come a long way. From fewer than 50 000 people on treatment for HIV in Africa in 2000 to more than 20m today, HIV prevention innovations have proliferated, reducing infections dramatically.
And yet, more than 1.3m people were infected with the virus in 2022.
These infections are now happening primarily among the most marginalised: men who have sex with men, people who inject drugs, trans women and sex workers. More so, their voices are increasingly silenced, and they are under constant threat of violence and abuse, as discriminatory legislation directed against LGBTI people is surging worldwide.
Among these groups, young people aged 15-24 bear a disproportionate burden of HIV and are even more vulnerable, facing greater barriers to accessing health services.
Long road remains
In Francophone African countries (24 countries – 373.3m people), the HIV burden is lower than elsewhere on the continent. However, they accounted for 16% of all new HIV infections in sub-Saharan Africa in 2022.
Thanks to concerted efforts from the Global Fund and other partners, the Aids-related mortality rate in Francophone African countries declined by 82% between 2000 and 2022. In the same time period, the Aids-related mortality rate fell by 95% in Burundi, by 91% in Rwanda, and by 90% in Côte d’Ivoire and Burkina Faso.
The number of new infections in Francophone Africa also decreased, from 325 000 in 2000 to 108 000 in 2022. Between 2001 and 2022, HIV incidence rates declined by 92% in Burundi and Rwanda, and by 91% in Côte d’Ivoire and Burkina Faso.
Through Global Fund-supported programmes, antiretroviral therapy coverage in Francophone Africa significantly increased from 4% in 2005 to 72% in 2022.
Still, a long road lies ahead to achieve key objectives, like elimination of Aids in children. As many Francophone countries still have high rates of vertical transmission, it is of the utmost importance to improve both prevention and paediatric care simultaneously.
HIV challenge is one of equity, not science
The fight against HIV is no longer a challenge of science, but one of equity. For us to accelerate progress once again, we must reclaim that strong spirit of equity that animated us two decades ago. That means focusing on the communities most affected by HIV.
In Africa, the focus on adolescent girls and boys is an urgent imperative. Although HIV incidence in adolescent girls and young women has greatly declined in the past decade, 4 000 girls and young women still get infected with HIV weekly, worldwide, mainly in sub-Saharan Africa.
This is unacceptable.
If we are to prevent HIV infections in this population, we must bring together diverse partners to invest in long-term efforts to keep girls in schools.
Education turns girls into women with the possibility of more equal opportunities, and protects them from diseases like HIV. Educated girls register lower rates of teenage pregnancies, sexual violence, early marriages, and ultimately lower HIV infections.
We must also accelerate investments in programmes that support comprehensive sexual and reproductive health and rights, particularly for adolescent girls and young women.
And we must ensure they are front and centre of projects that seek to engage them.
These are some of the goals the Global Fund partnership aims to achieve with projects like Voix EssentiELLES and the HER Voice Fund, which strive to meaningfully engage young women and girls in key health programmes and decision-making forums in their communities.
We must seek to renew our focus on promoting equity. We know how to do this. We did it at the turn of the millennium with our drive for equity in HIV treatment.
Let us now move forward and end this unfinished fight by reducing HIV infections among the most affected communities. To get there, we can be re-energised by the goals and the unyielding spirit of those golden years of progress in the fight against HIV.
Gawanas is a Namibian lawyer, advocate and vice-chair of the Global Fund Board. She was appointed as the first Commissioner for Social Affairs by the African Union Assembly of Heads of State and Government, and in her home country of Namibia she served as Public Service Commissioner, Ombudsperson and Special Adviser to the Minister of Health & Social Services and to the Minister of Poverty Eradication & Social Welfare. Gawanas also recently served as the United Nations Under-Secretary General and Special Adviser for Africa.
See more from MedicalBrief archives:
Global report urges more investment in Aids war
African countries commit to end child Aids deaths by 2030
REACH study: Adolescent girls and young women in Africa will use HIV prevention products
A decade of HIV treatment has failed most high-risk young women