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Today, the African Union (AU) Commission, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria join the rest of the world to commemorate World AIDS Day 2021 under the theme “End Inequalities. End AIDS”. This year marks an important milestone as the HIV community reach 40 years since the first reported case of HIV.

These past 40 years of experience in the HIV response have provided evidence of what works and instilled a hope that solutions to the HIV epidemic exist.  As we reflect on the journey, we celebrate the global solidarity and community resilience that has saved millions of lives in Africa.

There is evidence of a substantial reduction of AIDS-related deaths and new HIV infections globally in Africa in the last decade. However, the gains in the fight against HIV/AIDS remain unequal between and within countries. Decades of experience and evidence from the HIV response show that intersecting inequalities prevent ending AIDS in Africa. 

Vulnerable and socioeconomically disadvantaged groups report higher new HIV infections and lower access to the health care services they require. Young women and adolescent girls in Africa are at higher risks of contracting HIV due to structural, social and cultural factors. If we are to end AIDS by 2030, we must end inequalities.  Furthermore, COVID-19 is exacerbating inequities and disruptions to services, making the lives of ‎many people living with HIV more challenging. ‎

“HIV-related related policy frameworks endorsed by AU Member States call for an end to inequalities driving the AIDS epidemic. They strongly advocate for people-centred approaches that seek to have a deep understanding of the determinants of inequalities in HIV/AIDS response and their association to the risk of HIV infection and HIV prevalence,” said H.E Amira Elfadil‎, Commissioner for Health, Humanitarian Affairs and Social ‎Development of the AU ‎Commission.

H.E Amira Elfadil reiterated that “To achieve the HIV eradication targets set out in the AU Agenda 2063, Africa Health Strategy and the Catalytic Framework to end AIDS, TB, and Malaria by 2030, the African Union (AU) Member States must strategically and consistently implement the outlined recommended actions. They should also scale up and sustain HIV response efforts”.

UNAIDS Executive Director, Ms. Winnie Byanyima, emphasised that “Today we have the ‎knowledge and tools to prevent every single new HIV infection and avoid every AIDS-related death. Growing inequalities in access to healthcare, gender, race, and denial of ‎human rights obstruct progress in the HIV response.  It’s time to invest, to match ‎our political ambition and equip stakeholders to end AIDS by 2030. Eliminating  ‎inequalities is not just the right thing to do; it is essential for making the world healthier ‎and safer for all.” ‎

The Global Fund’s Executive Director, Mr. Peter Sands, strongly expressed that “Despite the fact that AIDS, tuberculosis, and malaria still kill millions of people each year ‎across multiple countries and regions, these diseases are no longer talked about as ‎pandemics, but are generally called epidemics, or endemic diseases. By epidemic, we ‎mean a pandemic that no longer kills large numbers of people in the richest countries. By ‎endemic, we mean a disease the world could get rid of but hasn’t. HIV and AIDS, ‎tuberculosis, and malaria shouldn’t be labelled as “just” epidemics or endemic. They are ‎pandemics that have been beaten in rich countries, and allowing them to persist elsewhere is a ‎policy choice and a budgetary decision. Low- and middle-income countries are now concerned ‎that the same will happen with COVID-19. As people begin to talk of the new virus becoming ‎endemic, I hear alarm bells ringing…”‎

HIV advocacy programs are significantly responsible for the global community’s success in reducing the burden of HIV. Advocacy initiatives built on proven approaches of the HIV response and critical lessons learned from the intersecting HIV and pandemics have particularly proven effective in Africa. These, among many other issues, were incorporated into the Common Africa Position (CAP) at the 2021 High-Level Meeting of the ‎General Assembly on HIV/AIDS. The draft position was crucial in negotiating ‎Africa’s voice during the 2021 High-Level Meeting (HLM) of the UN General ‎Assembly on HIV/AIDS, which took place between 8th and 10th June 2021, to ‎adopt a new political declaration to guide the future direction of the ‎HIV/AIDS response.‎

“Prime examples are the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA)‎ and Free To Shine Campaign. Launched by the African Union (AU) in 2009, the CARMMA aims to reduce high rates of women dying in childbirth (maternal mortality) and children dying before they reach the age of 5 years due to preventable causes. Co-led by the AU Commission and the Organisation of African First Ladies Against HIV/AIDS for Development (OAFLAD), Free to Shine is a bid to prioritise children, adolescents and mothers in the fight against HIV,” noted H.E Amira Elfadil.

“The AU Commission recently launched the ‎#ProtectedAndInformed digital campaign in collaboration with UNAIDS to strengthen advocacy for HIV ‎prevention and care in Africa. We encourage the AU Member States to unite people and organisations at the local and global levels to advance the progress of these advocacy initiatives,” H.E Amira Elfadil‎ added.

‎“We need to enable every girl in Africa to complete secondary education and be safe ‎and strong. It is heart-breaking that so many girls get infected with HIV in Africa: six in ‎seven new infections among adolescents aged 15-19 in Sub-Saharan Africa are in girls. ‎Empowering adolescent girls and young women to complete secondary education ‎helps keep them safe, reduces their risk of HIV infection by as much as 30 – 50% in ‎some countries, prevents early marriage and early pregnancies and moves them ‎towards gender equality. This is what we aim to achieve with the Education Plus ‎initiative launched at the Generation Equality Forum in June and co-led by UNAIDS, ‎UNICEF, UNESCO, UNFPA, and UN Women,” said Ms. Winnie Byanyima.

Mr. Sands added that “We know the pandemic has disproportionately impacted the people most affected by HIV, ‎TB, and malaria: the poor, the marginalised, those without access to health care. Because of ‎the disruptions resulting from COVID-19, the people at greatest risk of HIV infection have ‎had less access to the information and tools they need to protect themselves.‎ Despite the setbacks in 2020, there were signs of resilience as countries across Africa and the ‎world adapted HIV programs in the face of COVID-19”.

“Due partly to investments from the ‎Global Fund and partners like PEPFAR, African countries rapidly adapted services to ‎implement multi-month dispensing of HIV drugs, secure community ART delivery and HIV ‎self-testing and other service innovations. ‎We know the situation in many countries would have been even worse without the rapid and ‎determined actions across the Global Fund partnership to mitigate the impact ‎of COVID-19 on HIV, and nowhere was this more apparent than in Africa. As we enter 2022, we must sustain this agility, a sense of purpose, and unity. So many of the ‎poorest and most vulnerable people and communities in Africa depend on us for their lives ‎and health,” added Mr. Sands.

Policy action and advocacy require to be fully resourced to be implemented with consistency and optimal efficiency. Achieving the global HIV goals and targets will also require a peak of annual HIV investments in ‎Africa. The continent must continue to raise a generation of strong advocates for HIV financing and equality.

“The support of our global partners has been incremental in enabling the work of the AIDS Watch Africa Secretariat, through which the AU Commission leads advocacy, accountability, and resource mobilisation efforts to advance a robust African ‎response to end AIDS, tuberculosis and malaria by 2030‎. In collaboration with the AU Development Agency (AUDA-NEPAD), the Secretariat is also leading the African Leadership Meeting (ALM) on Investing in Health Declaration to increase domestic resources for health reorienting ‎health systems in Africa,‎” H.E Amira Elfadil‎ elaborated.

‎“We at UNAIDS are calling for an investment of US$ 29 billion by 2025 in the AIDS ‎response. This price tag is a shared responsibility and would be invested to scale up ‎HIV treatment and prevention services, put people at the centre and tackle the ‎inequalities, reducing annual new HIV infections from 1.7 million in 2019 to 370 000 in ‎‎2025. But every year, HIV resources have fallen far short and insufficient progress in the ‎HIV response is only increasing the long-term costs that will strain already ‎overburdened health budgets. While lessons learnt and resources from HIV should be ‎leveraged for other diseases, this shouldn’t happen at the expense of further progress ‎against AIDS. We cannot afford to lose the ground we have gained against HIV,” said ‎Ms. Winnie Byanyima.

Mr. Sands said, “The economic outlook is extremely challenging, and we recognise the enormous pressures governments are facing to cut and prioritise public spending, but we cannot afford to go backwards in the fight against HIV, TB or malaria. There is no middle ground when fighting diseases as formidable as HIV or COVID-19; we are either winning or losing. We must prioritise health spending to defeat COVID-19 and regain momentum on AIDS, TB and malaria. This will require more funding, plus unprecedented agility and coordination between partners”.

“The Global Fund acted quickly in response to the pandemic, investing over $4 billion to support countries responding to COVID-19 to mitigate the impact on the three diseases. This is on top of the $4.2 billion we invest annually for HIV, TB and malaria interventions. We are committed to working with partners and governments to identify innovative means of crowding in extra financial resources, including by leveraging blended finance mechanisms and Debt2Health swaps, ”added Mr. Sands.

In conclusion, we have achieved much in the fight against HIV in Africa, but we can do more. On this World AIDS Day, we jointly call on global leaders and communities in Africa to unite against the inequalities that obstruct progressive HIV response on the continent and serve those left out of essential HIV care and services.

Authors

H.E Amira Elfadil – Commissioner for Health, Humanitarian Affairs and Social ‎Development, African Union ‎Commission

Ms. Winnie Byanyima – Executive Director of UNAIDS

Mr. Peter Sands – Executive Director of the Global Fund

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