Over the last two years, the multiple and overlapping crises that have rocked the world have had a devastating impact on people living with and affected by HIV, and they have knocked back the global response to the AIDS pandemic. The new data revealed in this report are frightening: progress has been faltering, resources have been shrinking and inequalities have been widening. Insufficient investment and action are putting all of us in danger: we face millions of AIDS-related deaths and millions of new HIV infections if we continue on our current trajectory.
Together, world leaders can end AIDS by 2030 as promised, but we need to be frank: that promise and the AIDS response are in danger. Faltering progress meant that approximately 1.5 million new HIV infections occurred last year—more than 1 million more than the global targets. In too many countries and for too many communities, we now see rising numbers of new HIV infections when we needed to see rapid declines. We can turn this around, but in this emergency, the only safe response is to be bold. We can only prevail together, worldwide.
Marked inequalities, within and between countries, are stalling progress in the HIV response, and HIV is further widening those inequalities.
Every two minutes in 2021, an adolescent girl or young woman was newly infected with HIV. The COVID-19 pandemic led to disruptions to key HIV treatment and prevention services, millions of girls out of school, and spikes in teenage pregnancies and gender-based violence.
The AIDS pandemic took a life every minute in 2021, with 650 000 AIDS-related deaths despite effective HIV treatment and tools to prevent, detect and treat opportunistic infections. The number of people on HIV treatment grew more slowly in 2021 than it has in over a decade: while three quarters of all people living with HIV have access to antiretroviral treatment, approximately 10 million people do not. Only half (52%) of children living with HIV have access to life-saving medicine, and the inequality in HIV treatment coverage between children and adults is increasing rather than narrowing.
Amidst crisis, however, we also see strong resilience in a diverse range of countries—and in pockets within many more countries. This is especially true where the required level of funding from national governments, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) or the Global Fund to Fight AIDS, Tuberculosis or Malaria (the Global Fund) comes together with robust community-led responses and cutting-edge science. These exemplars of effective pandemic response have achieved remarkable progress in reducing new HIV infections and increasing access to treatment. They prove that it can be done and guide us in what we need to take to scale worldwide.
But this report also shows far too many instances where we are not moving fast enough to end the inequalities that drive pandemics—or where we are moving in the wrong direction: tech monopolies instead of tech sharing, austerity instead of investment, clamping down on marginalized communities instead of repealing outdated laws, and inhibiting control instead of promoting and enabling inclusive, community-centred delivery.
When international support has been most needed, global solidarity has stalled. Overseas development assistance for HIV from bilateral donors other than the United States of America has plummeted by 57% over the last decade. Leaders must not mistake the huge red warning light for a stop sign.
The data revealed in this report will disturb and shock—but the report is not a counsel of despair. It is call to action. Failure would be fatal, but it is not inevitable. Ending AIDS will cost much less money than not ending AIDS. Importantly, the actions needed to end AIDS will also better prepare the world to protect itself against the threats of future pandemics.
What we need to do is not a mystery. We know it from what we’ve repeatedly seen succeed across different contexts: shared science, strong services and social solidarity. This is the pledge made at the United Nations General Assembly High-Level Meeting on HIV/AIDS in June last year: end the AIDS pandemic by ending the inequalities that perpetuate it.
We can end AIDS by 2030. But the curve will not bend itself. We have to pull it down.
UNAIDS Executive Director