Ahead of World AIDS Day (1 December), a new report by UNAIDS released its report, 'Take the rights path to end AIDS.' Credit: UN AIDS

By Ed Holt
BRATISLAVA, Nov 26 2024 (IPS)

Gaps in realising human rights could stop AIDS being ended as a public health threat by 2030, UNAIDS has warned in a report to mark World AIDS Day.

In the report, entitled Take the Rights Path, the group says the global HIV response is at an inflection point and that decisions taken now by governments will determine whether the AIDS pandemic is no longer a public health threat by the end of the decade, a commitment in the UN Sustainable Development Goals (SDGs).

It highlights that a litany of widespread rights abuses, including girls being denied education, impunity for gender-based violence, arrests of people for who they are or who they love, and other barriers to accessing HIV services simply because of the community a person is from, are endangering efforts to end the pandemic.

The group has called on world leaders to ensure rights are upheld so that everyone that needs to can reach lifesaving programmes and AIDS can be ended, or risk “a future of needless illness, death, and unending costs.”

“It is entirely possible to end AIDS—the path is clear. Leaders must only choose to follow it,” Winnie Byanyima, UNAIDS Executive Director, told IPS.

HIV/AIDS activists and public health experts have in recent years increasingly pointed to the effects of repression of human rights on efforts to fight HIV/AIDS.

They have highlighted a growing marginalization and stigmatization of key populations, including LGBT+ people, and drug users, in a number of countries, including the introduction of legislation directly discriminating against those communities. Meanwhile, women’s rights continue to be repressed or not fully upheld in many parts of the world.

The UNAIDS report points out that currently, only three countries report no prosecutions over the past 10 years for HIV non-disclosure, exposure, or transmission and have no laws in place criminalizing sex work, same-sex relations, possession of small amounts of drugs, transgender people, or HIV nondisclosure, exposure, or transmission. It also shows that 44 percent of all new HIV infections worldwide are among women and girls.

Activists say it is essential that criminal and other laws that harm people’s rights must be removed, and at the same time laws and policies that uphold the rights of everyone impacted by HIV and AIDS are enacted.

“The science couldn’t be more clear—criminalization is prolonging the HIV epidemic and erodes the trust in the health system that is necessary not only for an effective HIV response but also for strong pandemic responses more broadly. But these gaps can be overcome—what’s missing is political will,” Asia Russell, Executive Director of campaign group Health GAP, told IPS.

There is concern, though, that against a backdrop of growing authoritarianism and a pushback against rights in many countries, this will be challenging.

“Scapegoating and criminalizing communities is a tool dictators and autocrats are turning to more frequently, driving people away from life-saving health services and making all communities less safe,” said Russell.

Ganna Dovbakh, Executive Director at the Eurasian Harm Reduction Network (EHRA), went even further, suggesting widespread criminalisation meant that achieving the end of AIDS as a public health threat increasingly appeared to be “wishful thinking.”

“It sounds unrealistic. Taking into account anti-gender and anti-human rights movements across the globe, it sounds too ambitious,” she told IPS.

However, while the report raises concerns about how the failure to ensure human rights is impacting efforts to fight HIV/AIDS and the potential for inaction on the matter to halt or even reverse progress in battling the disease, UNAIDS points out that there has been success in countries where people-centred approaches to fighting HIV have been adopted.

“Seven countries in Africa (Botswana, Eswatini, Kenya, Malawi, Rwanda, Zambia, and Zimbabwe) have already reached UNAIDS testing and treatment targets (95-95-95) for the general population.

“This is a testament to global solidarity, African political leadership, and the strong collaboration between governments, communities, civil society, science, and the private sector,” said Byanyima.

“While there are rising threats from anti-LGBTQ fundamentalists in the US, Russia, Uganda, Kenya, Tanzania, and elsewhere, not all countries are blindly embracing criminalization,” said Russell. “Some governments, however, have recently rejected this approach—such as Namibia, pointing to the racist and colonial origin of such laws and their destabilizing effect not on the HIV response but on society as a whole.”

However, the report lays bare the scale of the global challenge to end AIDS by the end of the decade.

In 2023, 9.3 million [7.4 million–10.8 million] people living with HIV were still not receiving antiretroviral therapy, and 1.3 million [1.0 million–1.7 million] people newly acquired HIV. In the regions where numbers of new HIV infections are growing the fastest, only very slow progress is being made in scaling up pre-exposure prophylaxis (PrEP). These regions also lag behind sub-Saharan Africa in progress towards meeting the 95–95–95 HIV testing and treatment targets, according to the report.

It also said that coverage of prevention services among the populations at greatest risk of HIV is very low—typically at less than 50 percent—and that HIV infections are rising in at least 28 countries around the world.

“These countries need to look at their policies and programmes and build a rights-based approach to turn their epidemics around,” said Byanyima.

Despite this, the group remains optimistic that the disease can be ended as a public health threat by the end of the decade—if governments take action now.

“It is still possible, but leaders must act now to dismantle barriers to health. I remain hopeful, but it will only happen if countries with expanding epidemics change course and protect everyone’s rights to protect everyone’s health,” said Byanyima.

Some others agree, but say it is likely governments will need to be pushed into taking the action necessary to end AIDS.

“We have the interventions that can deliver the defeat of the AIDS crisis—if deployed at scale, with the people most in need at the front of the line rather than pushed to the back. What’s missing is equitable access to the advances of science and human rights and the political will,” said Russell.

“The case for closing the HIV funding gap, reversing criminalizing laws, and accelerating deployment of superior prevention technologies could not be stronger. Unfortunately. Many governments are not, on their own, showing the leadership we need… pressure is needed now to compel government action—political will in response to the AIDS crisis rarely happens because of benevolence; it emerges in response to the pressure of accountability from communities,” she added.

Mark Harrington, Executive Director of the Treatment Action Group campaign organisation, said decades of advances in medical science meant “the toolkit we have to prevent and treat HIV, and to ensure that people can live healthy long lives regardless of HIV status, is better than it’s ever been,” but that governments must be pushed to ensure they are “responsive to the health needs of their people to fulfill the promise of all these results of decades of research and activism.”

“Political will has to be continually created and strengthened. As activists, that is our job. Over the past four decades, scientists and activists have made unbelievable progress against a once untreatable disease. We need to keep on reminding policymakers of their duties and communities of their rights to health,” he told IPS.

IPS UN Bureau Report

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