Communities at The Forefront in the HIV/AIDS Response

Goal 3

Viewpoint by Somar Wijayadasa*

NEW YORK (IDN) – Since the first identification of HIV/AIDS in the United States of America (USA), in 1981, approximately 80 million people have been infected with HIV, and over 40 million have died of AIDS – the highest global death toll of all time – and also one of the world’s most serious public health challenges.

Each year, on December 1, the world commemorates World AIDS Day to show support for people living with HIV and to remember those who have died from AIDS-related illnesses.

The theme for this year’s World AIDS Day, “Communities Make the Difference”, denotes that communities are the lifeblood of an effective AIDS response and an important pillar of support.

After years of engagement in all corners of the world to fight against this deadly disease, it is now evident that the communities are in the forefront in the AIDS response as they ensure that HIV services reach the people who need them most.

Emphasizing the significance of communities, Winnie Byanyima, the Executive Director of UNAIDS, opines that “without communities, 24 million people with HIV would not be in treatment today”.

Global HIV/AIDS pandemic: No end in sight

According to UNAIDS, the authority on global HIV/AIDS statistics, in 2018, there were: 37.9 million [32.7 million–44.0 million] people living with HIV.

1.7 million [1.4 million–2.3 million] became newly infected with HIV.

770 000 [570 000–1.1 million] died from AIDS-related illnesses.

74.9 million [58.3 million–98.1 million] people have become infected with HIV since the start of the epidemic, and 32.0 million [23.6 million–43.8 million] have died from AIDS-related diseases since the start of the epidemic.

Thirty-eight years after HIV/AIDS was identified, and quarter century after UNAIDS was created to provide a concerted effort to eradicate this deadly virus, current data is somewhat encouraging but still behind expectations.

For example, in 1996, there were 21.8 million people living with HIV/AIDS, and by 2014, perhaps the peak of the pandemic, the numbers rapidly grew to 36.9 million. We now have approximately 37.9 million [32.7 million–44.0 million] people living with HIV/AIDS.

Though only 1.7 million [1.4 million–2.3 million] people became newly infected with HIV, today’s high number of people living with HIV/AIDS can be attributed to people living longer – thanks to quick diagnostic testing for HIV, and easy availability of low-cost and effective antiretroviral therapies.

What terrifies me most is the fact that about 8.1 million people living with HIV/AIDS even do not know that they carry the virus that may potentially contribute to new HIV infections.

However, I am constrained to assume that we are unable to curtail this “man-made” disease because it is evidently exacerbated by the reckless lifestyles of “us” humans.

I call it a “man-made” disease only because the major causes that led to the relentless spread of this disease from 1981 to date have mostly been due to people engaging in high risk behaviors such as: unprotected sex with multiple partners; gay men and other men having sex with men; drug addicts sharing used/contaminated needles; female sex workers, their clients and partners; and transgender women.

UNAIDS statistics highlight those at risk

According to UNAIDS, “the majority of global new infections were among key populations” who make up a small proportion of the general population, and “they are at extremely high risk of acquiring HIV infection”.

The risk of acquiring HIV is:

22 times higher among men who have sex with men.
22 times higher among people who inject drugs.
21 times higher for sex workers.
12 times higher for transgender people.

Key populations and their sexual partners account for:

54% of new HIV infections globally.
More than 95% of new HIV infections in Eastern Europe and Central Asia.
95% of new HIV infections in Middle East and North Africa.
88% of new HIV infections in Western and central Europe and North America.
78% of new HIV infections in Asia and the Pacific.
65% of new HIV infections in Latin America.
64% of new HIV infections in Western and central Africa.
47% of new HIV infections in the Caribbean.
25% of new HIV infections in eastern and southern Africa.

(More data can be found in the 2019 Global HIV & AIDS fact sheet (https://www.unaids.org/en/resources/fact-sheet)

First global response to the HIV/AIDS pandemic

In 1994, realizing that “only a special United Nations system program is capable of orchestrating a global response to a fast-growing epidemic of a feared and stigmatized disease whose roots and ramifications extend into virtually all aspects of society”, six United Nations agencies (WHO, UNDP, UNESCO, UNFPA, UNICEF and the World Bank) created the Joint United Nations Program on HIV/AIDS (UNAIDS) to combat the epidemic.

Later, UNAIDS was joined by UNHCR, WFP, UNODC, UN Women, and ILO. These 11 co-sponsors from different parts of the UN family now work together in a cohesive and broad-based partnership against the epidemic — making it not only the first ever but also to date the only multi-agency program of the United Nations.

Since its establishment in 1995 to 2008, UNAIDS was headed by Dr. Peter Piot (Belgium), and from 2009-2019 by Mr. Michel Sidibé (Mali).

Recently, Ms. Winnie Byanyima (Uganda) became the new Executive Director of UNAIDS. She has over 30 years of diverse work experience in Africa, was the Director of Gender and Development at the United Nations Development Program UNDP), and since 2013, the Executive Director of Oxfam International.

I am confident that Byanyima will use her years of experience to guide UNAIDS towards its goal of eradicating HIV/AIDS.

Ambitious treatment targets

Over the years, UNAIDS earmarked many fast-track commitments such as: a vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, and a principle of leaving no one behind; the 2014, 90-90-90 initiative to work towards ensuring that by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment, and 90% of people on treatment have suppressed viral loads; and the 2016 United Nations Political Declaration on ending AIDS by 2030 – to name a few.

At the end of 2016, according to UNAIDS, “the total number of people living with HIV stood at 36.7 million, with the 90–90–90 targets standing at 70% of people living with HIV knowing their HIV status, 77% of people who knew their HIV-positive status accessing treatment, and 82% of people on treatment having suppressed viral loads” – an impressive achievement indeed.

The statistics prove that the pace of progress in reducing new HIV infections, increasing access to treatment, and ending AIDS-related deaths are progressing in keeping with expectations.

Slow but steady progress

The fact that only 1.7 million people became newly infected with HIV, in 2018, proves that innovative and tireless efforts by UN agencies, governments, medical and other health workers, schools, and community organizations at grass-roots level to combat the HIV/AIDS pandemic have been effective.

It is not a figure to be complacent about. More needs to be done, especially to reach out to all people at all levels to encourage them to take blood tests, use preventive measures in sexual relations, and to ensure that everyone with HIV has access to HIV treatment.

We have come a long way from the 1980’s when AIDS patient had no treatment or hope except fear, stigma and ignorance. Today, HIV is preventable and treatable.

Now, people in any corner of the world have easy access to test HIV status, preventive measures, a variety of affordable treatment options including pre-exposure prophylaxis (PrEP), and Antiretroviral therapies that help people with HIV live longer and healthier lives.

However, approximately 1.7 million of people newly infected with HIV, and nearly 800,000 deaths due to AIDS, is a painful reminder to the care giving communities throughout the world that we have to work harder until we find a preventive HIV vaccine that will ultimately end the HIV/AIDS pandemic.

*Somar Wijayadasa, is an International lawyer who worked for IAEA and FAO (1973-1985) and was UNESCO delegate to the UN General Assembly from 1985-1995, and was the Director of the UNAIDS New York Office, and simultaneously, Representative of UNAIDS at the United Nations from 1995-2000. [IDN-InDepthNews – 24 November 2019]

Image source: UNAIDS.

IDN is flagship agency of the International Press Syndicate.

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