On 10 June 2021, the last day of the High Level Meeting on the Implementation of the Declaration of Commitment on HIV/AIDS, the United Nations General Assembly adopted a new political declaration: Member states commit to eliminating HIV by 2030 by ending the inequalities that continue to fuel the pandemic. Why is this day special?
A date that links turning points in the global HIV response
The date of the meeting was historic in multiple ways: 40 years earlier, in June 1981, the US Centers for Disease Control and Prevention first reported on a cluster of pneumocystis pneumonia cases among gay men in Los Angeles. Similar symptoms found in men, women and children were soon reported from other countries. From 1982 onwards, the disease was called Acquired Immunodeficiency Virus. In an interview with the Lancet, Peter Piot, who worked at the Institute of Tropical Medicine in Antwerp at the time, vividly remembers a visit in a hospital in what was then Zaire in 1983: When I walked through the internal medicine wards for men and for women, they were full of young adults and they were totally emaciated, had cryptococcal meningitis, and were dying. The last time I’d been there was 1980 and that was not the case. It was so overwhelming that I took a deep breath, and I knew this is bad’. Peter Piot was right. Over the coming years, the HIV pandemic spread across the world, hitting countries in Eastern and Southern Africa particularly hard. From 1995 until 2001 Piot served as first Executive Director of UNAIDS, the programme the UN founded to organise a global response to the pandemic.
June 2001: The first UN Special Session on HIV/AIDS
In June 2001, 20 years prior to the current High-Level Meeting, there was a first United Nation’s Special Session on HIV/AIDS, hailed as a watershed event and drawing representatives from the highest levels of government and close to a thousand representatives of civil society, including many people living with HIV/AIDS, from countries around the world. At the end of this first HIV-related UNGASS session, governments agreed on the need for a multi-sectoral and rights-based response to deal effectively with prevention, care, and treatment and to mitigate the impact of HIV/AIDS.
In times of COVID-19, it is important to remember that, this first UNGASS declaration included governments’ obligation, in the face of a pandemic, to make drugs, goods, and services available to the maximum extent possible, and to continuously improve access for all people – within their own borders and, for wealthier countries, for the populations of poorer countries through development and bilateral assistance.
This in turn paved the way for the declaration of the World Trade Organization on the Trade-Related Intellectual Property Rights (TRIPs) Agreement and Public Health later in the same year, granting poorer countries the right to compulsory licensing of drugs needed to combat the pandemic and making all governments directly accountable for making needed medication available to infected people, no matter where they live in the world.
June 2021: The battle is far from won
In the first decade of this millennium, the global community mobilised an unprecedented multisectoral response to the HIV pandemic. Many contributions of German Development Cooperation are documented in the German Health Practice Collection. Yet despite these global efforts, UNAIDS estimates that HIV/AIDS has so far killed 32·7 and infected 75·7 million people. And the battle is far from won: The global targets set by the last high-level meeting of the United Nations General Assembly on HIV were missed by a wide margin: Instead of less than 500,000, UNAIDS counts 1.7 million new HIV infections as well as 690,000 instead of 500,000 AIDS-related deaths per year. And this is so even though, today, the tools to eliminate HIV – including pre- and post-exposure prophylaxis and antiretroviral treatment that reduces the viral load to an undetectable and untransmissible level – exist. Why is this so?
As long as key populations such as men having sex with men, transgender women, sex workers and people who inject drugs are stigmatised and discriminated against in their access to prevention, diagnosis and treatment and in the way they are treated by countries’ laws, the HIV pandemic will prevail. As the declaration notes with concern, ‘these populations and their sexual partners account for 62% of new HIV infections globally’.
Over the past year, COVID-19 has further exacerbated this situation, e.g. by disrupting supply chains for drugs and tests and by causing sickness among health and care workers. It is no coincidence that since the start of the COVID-19 pandemic, the number of HIV tests performed in low- and middle-income countries has dropped by 40 percent.
Germany is committed to fighting the inequalities that fuel the pandemic
This is why Germany, along with all other signatories of the declaration, commits to fighting the inequalities that fuel the spread of HIV, including by changing discriminatory laws, policies and practices, and by ending stigma and discrimination against key populations. This commitment is reflected in Germany’s ongoing contributions to the global HIV response:
As the fourth largest donor, Germany is financing the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) with a total of EUR 1 billion in the financing period 2020-2022. For the response to the COVID-19 pandemic, the German Federal Ministry for Economic Cooperation and Development (BMZ) provided a further EUR 150 million in 2020 and EUR 140 million in 2021 for the GFATM’s COVID-19 Response Mechanism (C19RM). The funds will help partner countries sustain programmes tackling HIV/AIDS, malaria and TB, including through the procurement of COVID-19 tests and protective equipment for health workers.
In addition, German Development Cooperation, through KfW Entwicklungsbank, supports social marketing programmes that address HIV-related stigma and misinformation in Africa’s ECOWAS- and CEMAC regions. In South Africa and in Zambia, through Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), it supports bilateral projects with a particular focus on young people and young women in particular, improving health interventions and sexuality education in schools and tackling the triple risks of HIV infection, teenage pregnancies and gender-based violence.
The HIV pandemic cannot be ended without recognising and ensuring human rights to all. In the report it prepared for the High-Level Meeting, ‘Global Commitments. Local Action’, UNAIDS has charted the course. Germany will continue to provide its full support.
Maja Opua & Anna von Roenne, June 2021