Equalize! Unite to end the inequalities holding back the end of AIDS
By Dr. Alti Zwandor.
UNAIDS Country Director in Namibia for World AIDS Day.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) new report Dangerous Inequalities shows that unequal access to rights, services, science, and resources is holding back the end of AIDS as a public health threat. Dangerous Inequalities unpacks the impact of gender inequalities, of inequalities faced by key and vulnerable populations, and of inequalities between children and adults in the AIDS response. It sets out how worsening financial constraints are making it more difficult to address those inequalities.
Gender inequalities and harmful gender norms are holding back the end of the AIDS pandemic. Gender-based violence is increasing women’s risks of HIV infection and constraining the access of women living with HIV to life-saving services and medication. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV.
The effects of gender inequalities on women’s HIV risks are especially pronounced in sub-Saharan Africa, where women accounted for 63% of new HIV infections in 2021. Even though Namibia reached the 90-90-90 targets in 2020, not all population groups were reached with the services, especially young people, key and vulnerable populations, and children. New HIV infections among adolescent girls and young women (aged 15 to 24 years) contributed to 30% of total new infections in 2021. Young women have the highest HIV incidence of 0.9% against 0.29% among the general population. Factors fueling these are complex and include individual, social and structural challenges.
Discrimination against, stigmatization, and criminalization of key populations are costing lives and preventing the world from achieving agreed AIDS targets. Facing an infectious virus, failure to make progress on key and vulnerable populations undermines the entire AIDS response. According to the Namibian Integrated Biological Behavioral Surveillance Survey (IBBS) 2019 report, HIV prevalence was estimated at 21.3% among Female Sex Workers (FSW) and 20,9% among Men who have Sex with other Men (MSM). Evidence from key and vulnerable populations interventions undertaken in 2021-2022 shows that a considerable number of individuals within those population clusters fear and experience stigma and discrimination from their communities and health facilities, thus resulting in their avoidance to seek health services. Although efforts from the government and partners have been made to ensure that HIV services reach all people, including key and vulnerable populations, realities related to inequalities, stigma, and discrimination often create barriers for all individuals to access the available HIV services.
The report from the implementation of Community-Led Monitoring in Namibia in 2021 reveals that the prevalence of stigmatization at health facilities affecting services is as high as 17% among key populations against 8% of the general population who use health facilities.
These dangerous inequalities are undermining the HIV response and jeopardizing the health security of everyone. However, this is not a counsel of despair. It is a call to action.
Inequalities in health are not inevitable—countries have the power to overturn laws that criminalize and marginalize entire communities, and they can challenge gender-based violence and protect children by investing in education and health. All over the world, people are mobilizing to challenge the injustices that keep people away from lifesaving HIV treatment, care, and prevention services. We need to promote healthy masculinities—to take the place of the harmful behaviours which exacerbate risks for everyone; and ensure services for children living with HIV reach them and meet their needs, closing the treatment gap so that we end AIDS in children for good. All these are possible!
The evidence is clear. Protecting the safety and human rights of marginalized people expands access to HIV services, accelerating progress in the response to HIV by increasing the number of people on treatment, widening access to prevention tools, and reducing new infections.
Millions of lives are at stake. 650 000 people died of AIDS-related deaths in 2021 and there were 1.5 million new HIV infections—1 million above the 2020 target of 500 000.
Together, it is possible to end AIDS by 2030 but only if governments act now to equalize access to HIV services for everyone. Tackling inequalities will not only help the marginalised. It will help everyone.