Munich, Germany — Since its discovery, HIV has become a global health crisis.
"My friends, your determination has brought the world this far. At least 77% of people living with HIV around the world are now on antiretroviral treatment, compared to 47% nine years ago - a 30% increase. They said it could not be done, but with solidarity, you did it, we did it. So well done," said Winnie Byanyima, Executive Director of UNAIDS.
However, Byanyima cautioned, "But just as we can see the finish line, some leaders are beginning to walk backward. They are having doubts."
She called on world leaders to take three critical steps that can put them on the path to achieving the target of 2030, ending AIDS as a public health threat. First, she highlighted the resource in the response. She said that there is a need to close the $9.5 billion funding gap, pointing out that the same donors have spent $500 billion on the war in Ukraine, making the HIV response affordable in comparison. Second, she stressed the urgency of making long-acting treatments, like Gilead's Lenacapavir, available in low- and middle-income countries now, not years later. Thirdly, Byanyima called for tackling discrimination and stigma by urging political leaders to decriminalize same-sex relations and sex work, fight stigma, and speak out against hate, actions that require political will rather than financial resources.
"And by leaders, I mean political leaders and business leaders. First, ensure that the work to end AIDS is fully resourced. Aid has been critical in supporting the HIV response in developing countries. It got us here, and it must continue. Don't cut it - increase it, sustain it. Find the frontline heroes gathered here today, and all the HIV activists out there in the communities. Fund them. And then, free developing countries from the struggle of debt," said Byanyima.
Byanyima urged Gilead, a research-based biopharmaceutical company focused on the discovery, development, and commercialization of innovative medicines to lower the price of Lenacapavir.
"Gilead, I'm warning you - I know you're in the room. You have a long-acting injectable called Lenacapavir, which I call a miracle preventive tool. This will transform access for gay men, trans people, sex workers, and young women in Africa, freeing them from stigma and fear. But right now, Lenacapavir is priced for people in rich countries. Some smart people have calculated that generic manufacturers could produce this tool for less than $100 per year in developing countries, instead of over $40,000 as it is priced in America. So, Gilead, make this happen now, not in four or five years," said Byanyima.
"We are six years away from that target," she said. "The leaders' decisions today will decide what will happen by 2030."
A person dies of HIV-related illness every minute.
"The world is not on track to end AIDS by 2030," she added.
Byanyima also addressed the issue of LGBTQI+ rights in Uganda, urging the need for justice. "Stand for justice. Stand for justice. When governments, such as my own, Uganda, announce that they are going to hunt down LGBTQI+ people as criminals simply for who they are and who they love, it's no surprise that those people will not walk up to a clinic to get lifesaving prevention and treatment," she said.
"Punitive approaches are driving LGBTQI+ people, sex workers, people who use drugs, and other marginalized communities away from services," she said. "This is an injustice."
She called for world leaders, and political leaders, to scrap these hateful, harmful laws. "End the discrimination faced by girls and women that is driving the AIDS pandemic, especially in Africa."
"Three out of four newly infected people are girls. One is a boy. There's an injustice there," Byanyima said. "We must deal with the vulnerability of girls and young women."
It is estimated that 85,6 million people are living with AIDS and that 40,4 million are dying from an AIDS-related illness. Young women, particularly, suffer the most from the global HIV epidemic. According to UNICEF, girls are more heavily impacted by the HIV epidemic. This is partly because of gender inequalities that often leave girls unable to negotiate safer sex. The lack of access to HIV prevention and sexual and reproductive health services, as well as poverty, play a crucial role in exacerbating this problem. A staggering 63% of new infections among young people aged 15 to 24 were associated with adolescent girls and young women in Sub-Saharan Africa in 2022. The HIV prevalence among adolescent girls and young women, aged 10-24 years, is persistently over three times higher than among their male counterparts.
"Let the girls be in a safe space of school. Give them sex education to free them, to give them knowledge," Byanyima urged.
"The evidence is very clear," she said. "The path that ends AIDS is well signposted. It's proven and it has been promised by the governments of the world. We can't turn away from solidarity when of the 40 million people living with HIV in the world today, almost a quarter do not have access to lifesaving treatment. We can't turn away when every minute, every minute somewhere in the world, a person dies of AIDS-related causes. Success or failure will be determined by the actions of leaders, both political and business leaders today," she said.
"Let's continue walking the path of solidarity together and with urgency. We have no time to wait," said Byanyima.
Join the Fight!
Over the past 40 years, HIV-positive people, researchers, policymakers, healthcare professionals, media representatives, and communities have shared knowledge, best practices, and lessons learned. The theme of the AIDS conference call on the global community is to "Put people first".
"Putting people first means that whether in the design of clinical trials or implementing new policies and programs, people living with and affected by HIV must be not just beneficiaries but actors driving our efforts," said Dr. Sharon Lewin, President of the International AIDS Society and AIDS 2024 International Co-Chair.
"We've witnessed an incredible breakthrough with a promising twice-a-year injection to prevent HIV, using a drug called Lenacapavir," said Dr Lewin. "While these advances are truly something to celebrate."
"Science certainly doesn't happen in a vacuum," she said. "All around the world, we are seeing an increase in regressive policies, attacks on human rights, the spread of misinformation, cuts to global health funding, and waning trust in international institutions which are complete roadblocks to progress to ending HIV."
John Nkengasong, the U.S. Global AIDS Coordinator, issued a strong message against complacency during this "critical moment."
"I am honored to be here this week with so many friends and colleagues working together to end HIV and AIDS as a public health threat," Nkengasong said. "While we have achieved a great deal, now is not the time to relax; we must maintain the progress we have fought so hard to achieve and intensify our efforts to eradicate this pandemic. I am confident that the expertise, experience, and energy present in Munich this week will lead to even more dedicated efforts to achieve our shared goals."
"We'll only win the fight against HIV and AIDS if we strengthen the triangular partnership, governments leading the response, partners aligning with the vision of the countries and civil society at the table. We have to upset that table in a way that we all have a seat at the table, we have a voice at the table. An HIV threat anywhere in the world will continue to be a threat everywhere in the world, regardless of whether you have succeeded in ruling back HIV AIDS, once it comes back in any part of the world it's going to be a threat everywhere in the world," said Nkengasong.
German Chancellor Olaf Scholz called for the importance of continued funding and support for global health initiatives. "We, alongside France, Norway, and other partners, support the World Health Organization's investment in global health. The WHO needs more support to effectively coordinate and standardize health efforts worldwide," he said. He called for the need for increased research, improved prevention, and better communication to address HIV. "Research is crucial as HIV is complex and adaptable. The latest mRNA advancements offer hope for future vaccines. In Germany, over 95% of those diagnosed with HIV receive therapy, and we continue to strive for 95% diagnosis awareness. Better prevention and effective treatment are key, but communication and addressing stigma are equally important. Germany is committed to joining the Global Partnership for Action to eliminate HIV-related stigma and discrimination," he added.
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Chris Collins, President and CEO of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, addressed the importance of disease-specific funding programs amid today's political challenges. "For over 20 years, American leaders across political parties have come together, recognizing the critical need to end the AIDS epidemic. Misinformation held up the five-year reauthorization of PEPFAR this year, but a bipartisan commitment to the program remains solid in the United States," said Collins. "Lawmakers know that the Global Fund and PEPFAR are saving millions of lives and if we backtrack on our commitments on AIDS, TB, and malaria, the immediate result would be disease resurgence and the squandered opportunity to end the most deadly infectious diseases."
2030 Target
The UNAIDS recently released a report that the AIDS pandemic can be ended by 2030, but only if leaders boost resources and protect human rights now. The report, The Urgency of Now: AIDS at a Crossroads , showed that the world is at a critical moment that will determine whether world leaders meet their commitment to end AIDS as a public health threat by 2030. According to the report, 39.9 million people live with HIV and 9.3 million do not receive or do not accessible to life-saving treatment. As a result, an AIDS-related death occurs every minute.
Botswana, Eswatini, Rwanda, Tanzania, and Zimbabwe have reached the "95-95-95" targets: 95% of people living with HIV are aware of their status, 95% of those aware are receiving lifesaving antiretroviral treatment, and 95% of those on treatment have achieved viral suppression. In addition, 16 more countries, including eight in sub-Saharan Africa, home to 65% of people with HIV, are close to being able to do so.
