Faced with a projected $1 billion budget deficit and the uncertain replenishment of the Global Fund, UNAIDS recently released their 2019 Global AIDS Update, Communities at the Centre, and admitted to a sobering reality – the UNAIDS 90-90-90 fast-track strategy will likely fail, and the end of the AIDS epidemic is not quite as near as many had hoped.1, 2
Although the overall number of AIDS-related deaths has fallen 33% since 2004, progress continues to shrink each year as the disparity between nations and within populations widens.1 As many of the richer and more developed countries continuously benefit from adequately funded HIV programs, many low to middle income countries (LMICs) remain bound to a different reality. The UNAIDS annual report revealed that HIV infections have risen in Latin America (+7%), the Middle East and North Africa (+10%), and Asia (+29%).1 If this global trend persists, and HIV infections continue to rise in areas where HIV/AIDS is already concentrated, the fragile health systems of many LMICs will likely shatter and give way to a global resurgence of the HIV/AIDS epidemic.
The materialization of this alarming future increases in likelihood as the political will to invest in AIDS programming progressively dwindles – especially for stigmatized populations that have been most impacted by HIV/AIDS.3 The UNIADS report revealed that key populations (i.e. injection drug users, gay men, MSM, transgender people, sex workers and prisoners), accounted for 54% of new HIV infections globally, and 95% of new HIV infections in eastern Europe, central Asia, the Middle East, and North Africa – and yet, less than 50% of key populations were reached with combination HIV prevention services.1 This willful governmental withholding of HIV/AIDS care to those with the most need exposes the magnitude at which prejudice determines the perpetuation of this disease. Although UNAIDS advocated for inclusive HIV/AIDS policies in their 90-90-90 strategy, not enough was done to tackle the discriminatory policies that barred marginalized populations from accessing available HIV treatment and prevention services.2
Misled by the successful reduction in AIDS-related deaths during its first two decades of operation, UNAIDS too quickly assumed that the end of the AIDS epidemic was in reach. Although ambitious, the 90-90-90 strategy failed to account for variations in health system capacity and wrongly presumed that all nations would uphold equitable standards of access to HIV treatment and prevention.4 With UNAIDS’ HIV/AIDS strategy currently underperforming, and with LMICs lacking the resources and support needed to assume their own HIV programming, UNAIDS’ lofty goal of eliminating AIDS as a public health concern by 2030 appears incredulous and highly out of touch with reality.
- (2019). Communities at the Centre: Global AIDS Update 2019. Retrieved from https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf
- (2014). 90-90-90 An ambitious treatment target to help end the AIDS epidemic. Retrieved from https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf
- (2019). Press Release: Kaiser/UNAIDS analysis finds donor governments spent US$8 billion for HIV in 2018, similar to a decade ago. Retrieved from https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20190716_donor-government-disbursements
- Bain, L. E., Nkoke, C., & Noubiap, J. J. N. (2017). UNAIDS 90–90–90 targets to end the AIDS epidemic by 2020 are not realistic: comment on “Can the UNAIDS 90–90–90 target be achieved? A systematic analysis of national HIV treatment cascades”. BMJ global health, 2(2), e000227.
- (2019). Press Release: UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets. Retrieved from https://www.unaids.org/sites/default/files/20190716_PR_UNAIDS_Global_Report_en.pdf