ADDRESSING INEQUALITIES AND GETTING BACK ON TRACK TO END AIDS BY 2030

Report of the Secretary-General

There has been intensive action and progress against HIV in some places and population groups, while inaction in other places has allowed HIV epidemics to expand and deaths to mount. Six years after the United Nations General Assembly set an ambitious global goal to end AIDS by 2030, momentum is being lost. Global targets for 2020, agreed in the 2016 Political Declaration on Ending AIDS, were missed.

The stark contrast of successes in some areas and failures in others confirms that HIV remains a pandemic of inequalities. The global AIDS community and UNAIDS have used an inequalities lens to develop a bold new strategy, with new targets that are ambitious, granular and tailored to reach the furthest behind first. The upcoming High-Level Meeting on AIDS provides a critical opportunity to advance this strategy, which includes new, ambitious global targets for 2025. Achieving these targets will require urgent, transformative action to reduce and end inequalities, as well as increased domestic and international investment in HIV, health, social protection, humanitarian responses and pandemic preparedness and control systems.

RECOMMENDATIONS

In order to advance the Decade of Action, get the world on track to end AIDS as a public health threat by 2030 and accelerate progress towards the Sustainable Development Goals, Member States and all stakeholders are encouraged to urgently implement the following recommendations:

RECOMMENDATION 01 Reduce and end the acute and intersecting inequalities that are obstructing progress to end AIDS by:

  • A

    Committing to achieve the holistic set of 2025 targets that address inequalities and will reduce annual new HIV infections to under 370,000 and annual AIDS-related deaths to under 250,000 by 2025;

  • B

    Establishing epidemiological, behavioural and programmatic monitoring and evaluation systems that provide the granular data needed to reach the populations that are currently being left behind;

  • C

    Establishing policy and programmatic frameworks that protect the rights of people living with, at risk of and affected by HIV throughout their life course in healthcare, education, workplace, housing, legal and justice systems, humanitarian emergency situations, community and family settings;

  • D

    Prioritizing funding and actions that bring to scale proven innovative solutions for impact, based on the best available scientific evidence and technical knowledge, as well as in research and development of more effective HIV prevention and treatment methods, including an HIV vaccine and a functional cure for HIV.

RECOMMENDATION 02 Prioritize HIV prevention and ensure that 95% of people at risk of HIV infection have access to and use appropriate, prioritized, person-centred and effective combination prevention options by 2025 by:

  • A

    Increasing national leadership and resource allocation for proven HIV combination prevention, including condom promotion and distribution, pre-exposure prophylaxis, voluntary male medical circumcision, harm reduction, enabling legal and policy environments and comprehensive sexuality education;

  • B

    Meeting the diverse HIV prevention needs of key populations, including sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, people in prisons and other closed settings and all people living with HIV;

  • C

    Delivering integrated services that prevent HIV and unintended pregnancy among adolescent girls and women, including economic empowerment, protection and promotion of their sexual and reproductive health and rights, and interventions that transform unequal gender norms;

  • D

    Strengthening the role of the education sector as an entry point for HIV prevention, testing and treatment, and ending stigma and discrimination, in addition to its role in addressing the social and structural factors that perpetuate inequalities and increase HIV risk;

  • E

    Providing access to quality, gender-responsive and age-appropriate comprehensive sexuality education, both in and out of school, that addresses the realities faced by adolescents and young people in all their diversity;

  • F

    Removing parental and spousal consent requirements for sexual and reproductive health services, and HIV prevention, testing and treatment services.

RECOMMENDATION 03 Close gaps in HIV testing, treatment and viral suppression that are limiting the impact of HIV responses, and achieve by 2025 the 95–95–95 testing and treatment targets within all subpopulations, age groups and geographic settings, including children living with HIV by:

  • A

    Establishing differentiated HIV testing strategies that utilize multiple effective HIV testing technologies and approaches, including HIV self-testing, and rapidly link newly diagnosed people to treatment;

  • B

    Using differentiated service delivery models for testing and treatment, including community-led and community-based services that overcome challenges such as those created by the COVID-19 pandemic by delivering treatment to the people in greatest need where they are;

  • C

    Achieving equitable and reliable access to affordable, high-quality medicines, health commodities and technologies by accelerating their development and market entry, reducing costs, strengthening local development, manufacturing and distribution capacity, including through aligning trade rules and public health objectives under a human rights framework, as well as encouraging the development of regional markets;

  • D

    Expanding access to the latest technologies for TB prevention, screening, diagnosis and treatment, ensuring that 90% of people living with HIV receive preventive treatment for TB by 2025.

RECOMMENDATION 04 Eliminate vertical HIV transmission and end paediatric AIDS by:

  • A

    Identifying and addressing gaps in the continuum of services for preventing HIV infection among pregnant and breastfeeding women, diagnosing and treating pregnant and breastfeeding women living with HIV, and preventing vertical transmission of HIV to children;

  • B

    Ensuring by 2025 that 95% of pregnant women are tested for HIV, syphilis and hepatitis B, that 95% pregnant and breastfeeding women in high HIV burden settings are re-tested during late pregnancy and in the post-partum period, and that all pregnant and breastfeeding women living with HIV are on life-long antiretroviral therapy, with 95% achieving viral suppression before delivery;

  • C

    By 2025, testing 95% of HIV-exposed children by two months of age and after the cessation of breastfeeding, and ensuring that children living with HIV are provided treatment regimens and formulas optimized to their needs;

  • D

    Finding undiagnosed older children and providing all adolescents living with HIV with a continuum of treatment, care and social protection proven to improve health outcomes as they grow and progress through youth and into adulthood.

RECOMMENDATION 05 Put gender equality and the human rights of women and girls in all their diversity at the forefront of efforts to mitigate the risk and impact of HIV by:

  • A

    Fulfilling the right to education of girls and young women, economically empowering women through skills trainings and employment opportunities, scaling up social protection interventions for girls and young women, and engaging men and boys in intensified efforts to confront unequal socio-cultural gender norms and undo harmful masculinities;

  • B

    Providing tailored services to prevent gender-based and sexual violence, including interventions that address multiple and intersecting forms of discrimination and violence faced by women living with HIV, indigenous women, women with disabilities, transgender women, sex workers, migrant women and other marginalized populations;

  • C

    Ensuring by 2025 that 95% of women of reproductive age have their HIV and sexual and reproductive health service needs met;

  • D

    Reducing to no more than 10% the number of women, girls, people living with HIV and key populations who experience gender-based inequalities and gender-based violence by 2025.

RECOMMENDATION 06 Implement the GIPA principle and empower communities of people living with HIV, women, adolescents and young people and key populations to play their critical HIV response roles by:

  • A

    Ensuring their global, regional, national and sub-national networks are included in decision-making and provided with sufficient technical and financial support;

  • B

    Revising, adopting and implementing laws and policies that enable the sustainable financing of people-centred, community-led HIV service delivery, including through social contracting and other public funding mechanisms;

  • C

    Supporting community-led monitoring and research, and ensuring that community-generated data are used to tailor responses to protect the rights and meet the needs of people living with HIV and other key populations;

  • D

    Increasing the proportion of HIV services delivered by community-, key population- and women-led organizations, including ensuring that 30% of testing and treatment services are delivered by community-led organizations by 2025.

RECOMMENDATION 07 Respect, protect and fulfil the human rights of people living with, at risk of and affected by HIV and ensure by 2025 that less than 10% of people living with HIV and key populations experience stigma and discrimination by:

  • A

    Removing punitive and discriminatory laws, policies and practices that block effective responses to HIV—including those that criminalize sex work, gender identity, sexual orientation, drug use, consensual same-sex relations, HIV exposure, non-disclosure or transmission, and those that impose HIV-related travel restrictions and mandatory testing—with the aim of ensuring that less than 10% of countries have punitive legal and policy environments that lead to the denial or limitation of access to services by 2025;

  • B

    Adopting and enforcing legislation, policies and practices that realize the rights to health, education, food and nutrition support, housing, employment, and social protection, and that prevent the use of criminal and general laws to discriminate against people living with HIV and key populations;

  • C

    Expanding investment in societal enablers in low- and middle-income countries to US$ 3.1 billion by 2025 and accelerating interventions to end stigma and discrimination;

  • D

    Ensuring accountability for HIV-related human rights violations by securing access to justice for people living with or affected by HIV and key populations through the establishment of legal literacy programmes, increasing their access to legal support and representation, and expanding sensitization training for health-care workers and other duty bearers.

RECOMMENDATION 08 Enhance global solidarity to close the HIV response resource gap and increase annual HIV investments in low- and middle-income countries to US$29 billion by 2025 by:

  • A

    Mobilizing additional domestic resources for HIV investments through a wide range of mechanisms, including public-private partnerships, debt cancellation and restructuring, and progressive integration of HIV response financing within domestic financing systems for health, social protection, emergency responses and pandemic responses;

  • B

    Complementing domestic resources through greater South-South, North-South and triangular cooperation and renewed commitments from bilateral and multilateral donors—including through the Global Fund to Fight AIDS, Tuberculosis and Malaria—to fund remaining resource needs, especially for HIV responses in countries with limited fiscal ability, with due attention to the financing of services for key populations and community-led responses.

RECOMMENDATION 09 Accelerate progress towards universal health coverage and strong primary health care systems, build forward better and fairer from COVID-19 and humanitarian crises, and strengthen global health security and future pandemic preparedness by:

  • A

    Investing in robust, resilient, equitable, and publicly-funded health and social systems that provide 90% of people living with HIV and people at risk with people-centred and context-specific integrated services for HIV and other communicable diseases, noncommunicable diseases, sexual health and gender-based violence, mental health, alcohol and drug dependence, and other services they need for their overall health and well-being by 2025;

  • B

    Utilizing the experience, expertise, infrastructure and multisectoral coordination of HIV actions across diverse sectors such as health, education, law and justice, economics, finance, trade, information, social protection and health as well as among development, humanitarian and peace-building actions;

  • C

    Building on the resilience and innovation demonstrated by community systems during the COVID-19 pandemic in reaching affected communities with essential health services, including multi-month dispensing of antiretroviral medicines and other lifesaving medications, COVID-19 testing and other health and social services;

  • D

    Increasing availability of essential medicines and health technologies and ensuring their fair allocation among and within countries through pooled procurement mechanisms, voluntary licensing, financial incentives and the full use of TRIPS flexibilities.

RECOMMENDATION 10 Leverage the 25 years of experience, expertise and mandate of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in building multisectoral, multi-stakeholder and rights-based collaborative action to end AIDS and deliver health for all as global public good by:

  • A

    Fully resourcing the UNAIDS Joint Programme and supporting its efforts to refine and reinforce its unique operating model so that it can continue to lead global efforts against AIDS and to remain a pathfinder for the United Nations reform;

  • B

    Annually reporting progress to UNAIDS on national HIV epidemics and responses, using robust monitoring systems that identify inequality gaps in service coverage and HIV response outcomes, to inform the General Assembly, ECOSOC and the High-Level Political Forum on Sustainable Development.