On 1 December every year WHO and its Member States and partners mark World AIDS Day to raise awareness about HIV, to show solidarity with people living with HIV, to remember those who have died from AIDS-related illnesses, and to express gratitude to those who are working towards ending AIDS. This year’s World AIDS Day is of special significance. First, it marks the end of the lifecycle of the 2020 Fast-Track targets. Second, it falls in the inaugural year of the world’s decade of action towards achieving the Sustainable Development Goal (SDG) targets. And third, we commemorate the day as WHO and its Member States and partners in the South-East Asia Region and across the world continue to respond to the COVID-19 pandemic.
Both the Region and world have in recent years made notable progress towards ending the AIDS epidemic as a public health threat by 2030. Between 2010 and 2019 the Region reduced new HIV infections by 23.8% and AIDS-related deaths by 26.7%. An estimated 60% of people in the Region living with HIV are currently receiving antiretroviral therapy (ART). Maldives, Sri Lanka and Thailand have eliminated mother-to-child transmission of HIV and syphilis. India has decriminalized same-sex relations, reflecting Region-wide efforts to promote inclusivity, reduce stigma and increase access to HIV services. Globally, between 2000 and 2019 new HIV infections fell by 39% and HIV-related deaths by 51%. More than 15.3 million lives have been saved due to ART.
Both the Region and world will nevertheless fail to achieve the Fast-Track targets, which aimed to ensure that by 2020 90% of people infected with HIV were aware of their status; that 90% of people who were aware of their status were on treatment; and that 90% of people on treatment achieved viral suppression. As the theme of this year’s World AIDS Day highlights, we must act in global solidarity and with shared responsibility to achieve our targets and goals, for which strong, resilient HIV services are key. This is especially important as WHO and its Member States and partners continue to respond to COVID-19.
A recent WHO survey of 61 countries showed that 38 had experienced disruptions in HIV testing, 23 in HIV viral load testing, and 17 had experienced disruptions in key population-related services. At least four of the Region’s 11 Member States experienced similar challenges from March to May, with significant decreases in HIV testing and treatment initiation. Since then, Member States have made tremendous efforts to revive, maintain and enhance the resilience of essential health services, including for HIV. Member States have in recent months dispensed antiretroviral drugs on a multi-month basis; provided take-home dosages of drugs for opioid substitution therapy; and worked with key populations to ensure that both demand and supply-side barriers are overcome. They have engaged, supported and protected frontline health workers, including nurses and midwives.
Throughout the COVID-19 response, recovery and beyond, three priorities must chart the path ahead. First, efforts to empower communities to prevent HIV infection, and to access services that detect and treat it, must be strengthened. This will help all countries make full use of a range of new tools, including better antiretrovirals, community-based testing, HIV self-testing and pre-exposure prophylaxis (PrEP). Thailand is already providing PrEP to people at high risk, while India, Indonesia and Nepal have piloted PrEP among key populations. Myanmar and Sri Lanka are set to follow. Second, the insights of affected communities must be leveraged to maximum effect. Epidemics are dynamic and change over time. New barriers emerge and can require new information and innovations to overcome. Acting on the knowledge of key populations is a precondition of success. Third, all initiatives must be fully funded and aligned with the quest to achieve universal health coverage, which the Region has pursued as a Flagship Priority since 2014. To end this epidemic, we must leave no one behind.
On World AIDS Day, WHO reiterates its commitment to accelerate progress towards the Fast-Track and SDG targets and to ensure that services to prevent, detect and treat HIV are maintained, that their resilience is strengthened, and that they remain accessible to all throughout the COVID-19 response. With global solidarity and shared responsibility, we can drive game-changing impact, both in the Region and world. As we begin this decade of action, let us be bold and united in our quest to end the AIDS epidemic as a public health threat by 2030, for all people everywhere, and especially the most vulnerable.