World AIDS Day was observed on Tuesday last under the theme “Global Solidarity, Shared Responsibility”. It is a day when attention is focused on the strides made, or targets missed in ending AIDS around the world. Never cause for celebration, since the world would be much better off if it did not have to contend with HIV/AIDS in the first place, 2020 threw the already deficient global response for a loop as countries scrambled to deal with the coronavirus pandemic.
It is worth mentioning here that AIDS, now suspected to have been around for at least 50 years, only became visible in the early 1980s when it began to ravage the developed world, affecting and killing at that point, mostly gay men. It has long since become apparent that in that first decade, 1980 – 1990, HIV had already been spread over all the continents. When the World Health Organization (WHO), which defines HIV as a global epidemic, gave a nod to observing December 1 as World AIDS Day in 1988, there were some 72,000 cases of people living with AIDS and an estimated 5 to 10 million people living with HIV worldwide based on the previous year’s statistics.
These figures continued to rise exponentially over the next decade. At the end of 1999, globally, some 33 million people were living with HIV and 14 million had died. However, these figures were weighted heavily among minority populations and in developing countries where the antiretroviral drugs that had begun to be used were prohibitively expensive.
Although overtures had been made in the 90s, specifically by the Joint United Nations Programme on AIDS (UNAIDS), established in 1996, the global response towards releasing the grip HIV had on the world really began in the 2000s. There were successful negotiations with ‘Big Pharma’ to reduce prices for antiretroviral drugs, generic drugs being manufactured, and the coming into being of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief.
In fact, these moves should have spelled the beginning of the end of HIV, but it was not that simple. The many factors preventing a more positive outcome and one that should have seen the world in a much better place by this year include poor health systems and a lack of safety nets which meant that those most at risk were not being reached. Additionally, the people problem posed by the twin evils stigma and discrimination and the deprivation of the rights of people in the LGBTQI community, particularly those seeking healthcare, saw continued exposure to HIV and rising epidemics in places.
However, it has not all been doom and gloom. Widespread counselling and testing have seen more people become aware of their status and use this knowledge to make better choices in order to protect themselves and others. Solid approaches to the prevention of mother-to-child transmission of HIV and syphilis have engendered successes particularly in Latin America and the Caribbean as well as some areas of Asia and Europe. Furthermore, millions of people around the world who test HIV positive have immediate access to antiretroviral therapy, when in the past they would have had to wait until they showed signs of developing the opportunistic infections that indicate the onset of AIDS.
As regards statistics, UNAIDS reported this year that since 2010, new HIV infections have declined by 23%, from 2.1 million, to 1.7 million in 2019; new HIV infections among children have declined by 52%, from 310,000 in 2010 to 150,000 in 2019 and AIDS-related mortality has declined by 39% since 2010 – around 690,000 people died from AIDS-related illnesses worldwide in 2019, compared to 1.1 million in 2010. Although the numbers have clearly declined, the figures are still far too high. The world has fallen far short of the targets that should have been attained by this year. Nevertheless, new ones have been rolled out to be achieved by 2025 and they are certainly attainable once approached with the necessary global solidarity.
At this point, the hundreds of millions of dollars that have been spent on ending HIV/AIDS as a global public health threat have created a solid foundation on which countries must now build. The fissures in the response to the epidemic have indeed been widened by the startling impact of COVID-19. But there are also valuable lessons here, which are that no one country can go it alone and, more fundamentally, that the right to good healthcare must be universal.