By Sharon Atieno

With multiple and overlapping crises affecting the world including COVID-19, progress made in efforts to fight HIV/AIDS has faltered, a new United Nations (UN) AIDS report says.

Over the past two and half years, the world has registered only 3.6% decrease in HIV infections- the lowest annual reduction since 2016, according to the report.

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 shows that new HIV infections are rising where they had been falling over the past 10 years with Malaysia and the Philippines being among the countries with rising epidemics among key population.

Further, the report notes that since 2015, HIV infections has increased in more than 38 countries across the globe including in African countries such as Algeria, Madagascar, Cape Verde, the Congo, Equatorial Guinea, Mauritania, Senegal, South Sudan, Sudan and Tunisia.

“These data show the global AIDS response is in severe danger. If we are not making rapid progress then we are losing ground, as the pandemic thrives amidst COVID-19, mass displacement, and other crises. Let us remember the millions of preventable deaths we are trying to stop,” said UNAIDS Executive Director Winnie Byanyima.

The stalling progress the report notes, has had a negative impact on preventable AIDS-related deaths with about 650,000 people dying due to opportunistic infections such as tuberculosis and cryptococcal meningitis in 2021 alone.

Further, approximately 1.5 million new infections occurred in 2021  – over 1 million more than the global targets.

The report cautions that progress could worsen with declining resources as many major bilateral donors are reducing international assistance for AIDS. Official development assistance for HIV from bilateral donors other than the United States of America has plummeted by 57% over the last decade, the report reads, adding that in 2021, international resources available for HIV were 6% lower than in 2010.

“Unlike previous years, however, domestic HIV investments are not replacing lost international funding. Instead, domestic funding in low- and middle-income countries has fallen for two consecutive years, including by 2% in 2021,” the report says.

“Global economic conditions and the vulnerabilities of developing countries—which are exacerbated by growing inequalities in access to vaccines and health financing—threaten both the continued resilience of HIV responses and their ability to close HIV-related inequalities.”

The World Bank projects that 52 countries, home to 43% of people living with HIV, will experience a significant drop in their public spending capacity through 2026.

Notably, high levels of indebtedness are further undermining the capacity of governments to increase HIV investments with debt servicing for the world’s poorest countries reaching 171% of all spending on health care, education and social protection combined. Increasingly, paying off the national debt is crowding out health and human capital investments that are essential to ending AIDS, the report notes.

“Middle-income countries—home to 71% of people living with HIV and 71% of people newly infected with HIV—are in danger of being declared ineligible for health and HIV grants as donor countries redirect their resources to Ukrainian refugees and rebuilding rather than expanding international assistance,” the UNAIDS report says.

Cautioning against underinvesting, the report notes:  “Making good on the promises made within the United Nations (UN) General Assembly in 2021 will be markedly less expensive than underinvesting now and risking further backsliding.”

Among the promises includes complementing domestic resources through greater North–South, South–South and triangular cooperation. In this case, South–South cooperation is not a substitute for, but rather a complement to, North–South cooperation, and renewed commitments from bilateral and multilateral donors to fund remaining resource needs, especially for HIV responses in countries with limited fiscal ability, and those whose economies have been severely affected by the COVID-19 pandemic.

Ensuring sufficient and sustainable financing is among the recommendations by UNAIDS to get the response back on track to end AIDS by 2030. The report notes that international action is needed to alleviate the debt crisis that is confronting many low- and middle-income countries and to avoid counterproductive austerity policies.

Additionally, the report says steps are needed to further increase the return on HIV investments, including through price reductions, cost efficiencies and increased investments in HIV prevention. Financial barriers to service utilization must also be removed.

“We urgently need to make resources available, close research gaps, and eliminate the stigma that still pervades thinking. Most crucially, we must ensure that scientists, policy makers and activists come together to achieve progress. It’s time to re-engage and follow the science,”  Adeeba Kamarulzaman, President of the International AIDS Society (IAS) and AIDS 2022 International Conference Co-Chair, said.