The AIDS response is in danger. Inequalities are the reason why.
UNAIDS new report Dangerous Inequalities shows that unequal access to rights, services, science and resources is holding back the end of AIDS.
The report unpacks the impact of gender inequalities, of inequalities faced by key populations, and of inequalities between children and adults, on the AIDS response. It sets out how worsening financial constraints are making it more difficult to address those inequalities.
1 In 3 women struggle with gender based violence. It is increasing women’s risks of HIV infection and constraining the access of women living with HIV to life-savings services. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV.
The effects of gender inequalities on women’s HIV risks are especially pronounced in sub- Saharan Africa, where women accounted for 63% of new HIV infections in 2021.
In Rwanda, UNAIDS data for 2021 shows that HIV prevalence among women is almost twice as much as that among men. Similarly data from Rwanda Population Based HIV impact assessment shows that HIV prevalence is 2 or more times greater in adolescent girls and young women compared to boys and young men.
As in the rest of Sub-Saharan Africa, the driving factor is – among others- the unequal power dynamics between men and women, boys and girls. One study showed that enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%. When this is reinforced with a package of empowerment support, girls’ risks are reduced even further.
On the other hand, harmful masculinities are discouraging men from seeking care. UNAIDS Data for 2021 shows that in Rwanda 96% of women living with HIV are on treatment while the figure for men is 92%
While discrimination, stigmatization and criminalization of key populations are costing lives and preventing the world from achieving agreed AIDS targets, Rwanda has taken bold and positives strides to ensure an enabling policy environment. This has been successfully achieved largely through advocacy by CSOs and the responsiveness of the government. In 2018, Rwanda Parliament repealed the law that criminalizes sex workers. This has contributed to increase in access to services by groups of population that would otherwise has been left behind.
Furthermore, the Global report shows that the AIDS response is being held back by inequalities in access to treatment between adults and children. While 94% of adults living with HIV in Rwanda are receiving treatment, children 0 – 14yrs are left behind with only 59% of them receiving ART. This has had deadly consequences. Globally In 2021, children accounted for 15% of all AIDS-related deaths. Closing the treatment gap for children will save lives.
But this is not a counsel of despair. It is a call to action.
The evidence is clear—protecting the safety and human rights of marginalized people expands access to HIV services, accelerating progress in the response to HIV by increasing the number of people on treatment, widening access to prevention tools and reducing new infections.
New investments to address HIV-related inequalities are urgently needed. At a moment where financial resources are decreasing and many high-income countries are cutting back aid for global health funding available for HIV programmes is short of the required need. HIV prevention programs are taking the hard hit.
Increasing donor support is vital to getting the AIDS response back on track. As the new report shows, donor funding also helps catalyse domestic funding: increases in external HIV funding for countries from PEPFAR and the Global Fund during 2018-2021 were correlated with significant increases in domestic funding from national governments. On this note, it is important to appreciate the 30% increase in Rwanda’s pledge for the replenishment of the Global Fund to fight AIDS, TB and Malaria.
African countries are stepping forward to take advantage of the recent exciting developments in biomedical HIV prevention. Injectable, long acting pre exposure prophylaxis will be a game changer in reducing HIV new infections. Zimbabwe was the first to announce the country’s regulatory approval of the drug and Botswana has followed suit recently.
AIDS is not over! Millions of lives are at stake. Globally, 650 000 people died of AIDS-related deaths in 2021 and there were 1.5 million new HIV infections. With the current progress in Rwanda’s HIV response and commitment to advance the inclusion agenda, in addition to the exemplary partnership between government, civil society and development partners, the country is ready to take the leap forward to achieve the last mile to end AIDS as a public health threat in 2030 in the country.
The writer is UNAIDS Country Director, Rwanda