As pandemics collide, push to end AIDS stumbles

The world’s response to the 5-decade-old HIV/AIDS pandemic is faltering badly in the face of declines in spending and the COVID-19 pandemic, according to annual update from the Joint United Programme on HIV/AIDS (UNAIDS). “The data we are sharing today bring painful but vital news,” said the director of UNAIDS, Winnie Byanyima, at a press conference yesterday to discuss the release of the update. “The response to the AIDS pandemic has been derailed by a global crisis from the colliding pandemics.”

UNAIDS issued the lengthy report, titled In Danger: UNAIDS Global AIDS Update 2022 , as a run up to the 24th International AIDS Conference, which will take place in Montreal 29 July through 2 August. “We’re all exhausted, but I know that [the meeting] does have this unique ability to rejuvenate,” said Adeeba Kamarulzaman, president of the International AIDS Society, which sponsors the meeting. “We’re at a crossroads and we need to get out of this danger.”

In a campaign to “end AIDS as a public health threat” by 2030, UNAIDS set targets for 2025 that the new report documents are far from being met. Last year, 1.5 million people became infected by HIV, 1 million more than the 2025 target. And although new infections fell from 2020, the decline of 3.6% was the smallest since 2016. Of the 38.4 million people living with the virus in 2021, 10 million are still not receiving lifesaving antiretroviral drugs, and last year saw the lowest number of new people starting treatment in a decade; most alarming to UNAIDS, 52% of infected children aren’t being treated. “If these trends continue, we could see 7.7 million additional AIDS-related deaths in this decade,” Byanyima said. “We have to sound the alarm.”

In part because of the COVID-19 pandemic, international aid and domestic spending on HIV/AIDS also is declining, and the report notes the war in Ukraine has exacted a particularly heavy toll on health resources there and may have “ripple effects” as refugees flee across the hard-hit regions of Eastern Europe and Central Asia. Assistance from donor countries other than the United States, which has the well-funded President’s Emergency Plan for AIDS Relief, dropped 57% in the past decade. Domestic funding from low- and middle-income countries also fell by 2% last year.

In many countries, the report notes, shortages of cash only explain part of their failing HIV/AIDS responses. Key vulnerable populations—including men who have sex with men, transgender people, sex workers, and people who inject drugs or are incarcerated—face continuing discrimination and stigma that work against prevention and treatment efforts. Human rights violations also bar access to health care. Up to 10% of women suffer sexual violence from their partners, and in sub-Saharan Africa, adolescent girls and young women remain at exceedingly high risk of HIV infection and death from AIDS.

In an interview with Science , Byanyima said UNAIDS hopes to prod country leaders into action. “What drives our report, perhaps more than anything else, is to put the data there for every country to be able to address its real epidemic,” she says.

Byanyima stressed that even if UNAIDS targets aren’t met globally, they inspire individual countries to step up their responses. Even though the world missed the 2020 targets, “some countries achieved them,” she says. “They are not just aspirational. They are real. They are achievable.”

Over the past 6 years, for example, new HIV infections dropped by more than 45% in Lesotho, Vietnam, and Zimbabwe. “National responses that were adequately resourced, adopted sound policies, and made prevention and treatment technologies widely available have demonstrated remarkable resilience and impact,” the report states. Globally, HIV-related tuberculosis deaths have dropped by 62% over the past decade, thanks to increased use of both preventive therapy for that disease and antiretroviral drugs, nearly hitting the 2025 target of an 80% decline.

Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, praised the report at the press conference for documenting the “backsliding” in the HIV/AIDS response, noting that monkeypox is also taking attention away from the problems. “We have to fight twice as hard to get HIV back on the radar screen where it belongs,” Fauci said. “It was here before COVID and monkeypox, and it will be here after COVID and monkeypox. We cannot let down our guard and say we’ve achieved enough of our goal.”