Sustaining Progress in the Fight Against HIV/AIDS
By Florence Riako Anam, Co-Executive Director, GNP+ and Sharon Quntai, Africa Media Relations Specialist, FINN Partners
With the global population of people living with HIV standing at 39 million as of 2022, the need for sustainable methods to combat the epidemic has never been greater. The end of AIDS as a public health threat is in sight, however, and the good news is that the path there is clear and affordable.
Treatment of HIV is an astonishing success story. Any cardiologist or family physician in North America would be delighted if she had all of her hypertension patients identified and 60 percent of them well controlled. British and Finnish studies suggest that even treated hypertension shortens life expectancy by about five years.
By contrast, many African countries are at or very close to the UNAIDS goal of having 95 percent of people living with HIV diagnosed; 95 percent on effective treatment; and 95 percent with suppressed viral load. By the end of 2022, 29.8 million people living with HIV/AIDS had access to ARTs, representing 76% of all people living with the disease. Those who start treatment early and keep on it have a normal life expectancy. In short, treatment of HIV is working beyond the wildest of expectations.
Effective treatment helps society too. It makes it virtually impossible for the person being treated to pass on HIV when they have an undetectable viral load. Undetectable = Untransmittable. Those on modern treatment can usually find a regimen that has acceptable adverse events and that allows them to work, volunteer, parent, lead and take a full part in national life. We need to do more of it.
New vaccines and prevention technologies such as long acting prophylactic medicines must play second fiddle to what we know works. Studies suggest that further investments in these methods may bring us closer to the goal of eradicating HIV, but many other limited studies haven’t scaled up well. If there are spare resources, let’s target them on new prevention methods for the most vulnerable.
Communities and their health workers (CHWs) explain why HIV treatment works so much better than treatments for many chronic diseases in rich countries. The HIV efforts also strengthen health systems and empower communities. Their ability to reach even the hardest to reach areas, means their impact extends beyond numbers — they build trust and foster community resilience.
For many countries in Africa, the reliance on funding from PEPFAR and the Global Fund showcases a significant dependency on external donors, revealing the importance of these organizations in supporting HIV programs, highlighting the need for sustainable funding models to maintain progress in combating HIV. Governments in the region must prioritize securing additional funding for HIV from their own budgets to address the funding gap resulting from declining donor support.
However, amidst these obstacles, there are valuable opportunities to enhance HIV sustainability. One such opportunity lies in learning from the management strategies employed for other diseases, such as Non-Communicable Diseases (NCDs), which are relatively managed with very little donor support and integrated within the Universal Health Care implementation plans. It’s imperative for HIV response to evolve by drawing lessons from such successful approaches utilized in managing other health conditions. Additionally, as the population of people living with HIV ages, with many now over 50 years and others born with the virus needing sexual and reproductive health services, integrating HIV care into broader health services becomes increasingly important.
Stigma and discrimination continues to threaten the progress made, especially at the community and health facility level. Individuals living with HIV face emotional and psychological issues such as shame, fear, guilt, abandonment, and harassment, which can hinder their willingness to seek and adhere to treatment. Adolescents and men, especially, have been noted to take breaks from their HIV medication due to factors such as stigma and emotional distress, contributing to interruptions in their treatment adherence. Sometimes they take involuntary treatment breaks because they cannot take time off work to track down the pills they need.
The Global Network of People Living with HIV/AIDS (GNP+) mission is to provide global leadership in advocacy for all individuals living with HIV, firmly grounded in the principles of Greater Involvement of People Living with HIV/AIDS (GIPA). Our work spans advocacy, capacity building, and community support. Over the years, GNP+ has developed and implemented numerous projects focused on ensuring that the voices of those living with and affected by HIV are heard in policy discussions and that their needs are met through sustained funding and effective programs.
Our advocacy for treatment access is driven by the reality that our lives depend on it. Beyond AIDS being a public health threat, the absence of treatment could result in AIDS progression and death. Recently, we launched the Last Mile Grant, supported by the Dutch Government supported Love Alliance grant to strengthen national networks of people living with HIV (PLHIV) to lead and advocate for improved treatment access.
To sustain the progress made in the HIV Response, key policymakers, donors, organizations such as UNAIDS, WHO and PEPFAR and the general public must continue to take concerted action. Policymakers must prioritize funding to ensure that existing HIV interventions that work are maintained and increased where necessary. Furthermore, investing in community led interventions is essential to optimize the delivery and effectiveness of current HIV programs while enhancing health infrastructure to support the delivery of ART, PrEP, and harm reduction services. They also play a vital role in advocating for funding to keep HIV sustainability on the global health agenda. Global solidarity is crucial to support the efforts made by governments, donors, policymakers and organizations and further amplify the message on the importance of sustaining HIV programs by creating awareness.
Like any change process, the sustainability of the HIV response is not a destination with an end date; it is a transition into something new, better, and lasting. This process involves both losses and gains, requiring a commitment from donors to guide each country through their unique journey, driven by their realities and data. We need political commitment and will to sustain the response through its change process, ensuring countries keep their global commitments. Donors and policymakers must also commit to this change process, aiming for person-centered services that are inclusive, respect rights, and center community leadership.
While the pursuit of new vaccines and treatments for HIV is important, it is crucial not to lose sight of the solutions that are already making a significant impact. By sustaining and expanding proven interventions, we can continue to improve the lives of millions of people living with HIV and move closer to ending the epidemic. Moreover, increasing investments in HIV cure and vaccines represents a transformative step towards reshaping the narrative of the AIDS pandemic, offering hope and life-saving outcomes for those whose experiences were once defined by fear and mortality.
