The HIV response is in danger—the promise of ending AIDS is under threat

Although affordable treatments are available to prevent most AIDS-related deaths, 650 000 people died of AIDS-related illnesses in 2021.

Krittayawan Boonto

Krittayawan Boonto

The Jakarta Post


Creative work for noble cause: Students paint slogans on T-shirts about HIV/AIDS during a program organized by the Indonesian Red Cross (PMI) at Hotel Indonesia Traffic Island Circle in Jakarta recently. The program was organized as part of PMI’s campaign to raise awareness about HIV/AIDS among youngsters. (The Jakarta Post/Dhoni Setiawan)

July 29, 2022

JAKARTA – Last year world leaders came together at the United Nations in New York and agreed a groundbreaking Political Declaration on HIV and AIDS. That plan takes on the inequalities that drive the pandemic and will dramatically reduce new HIV infections and AIDS-related deaths by 2025 and end the AIDS pandemic as a global health threat by 2030 – if world leaders fulfil it.

But the world, including Indonesia, are not on track in achieving those goals.

Data just released in the new UNAIDS report, In Danger, reveals that the world is not on course to end AIDS by 2030. The 3.6 percent reduction in global HIV infections in 2021 is the smallest annual fall since 2016. On the current trajectory, there will be a projected 1.2 million new HIV infections worldwide in 2025, more than three times higher than the target of 370 000. Eastern Europe and central Asia, Middle East and North Africa and Latin America have all seen increases in annual HIV infections over several years. In Asia and the Pacific—the world’s most populous region—UNAIDS data now shows new HIV infections are rising where they had been falling. Climbing infections in these regions are alarming

New HIV infections have increased since 2015 in 38 countries. Fortunately, in Indonesia the number new infections continue to fall. In 2010 the number of estimated new infections were 50.000, in 2015 it decreased to 39.000, and until 2021 to 27.000. Even so, we must go further faster. The human cost of a stalled HIV response is chilling.

Globally, more than 1.5 million people became infected with HIV last year. That’s 4,000 people every day, more than a quarter of them young people aged 15-24. Worldwide, an adolescent girl or young woman acquires HIV every two minutes.

Although affordable treatments are available to prevent most AIDS-related deaths, 650 000 people died of AIDS-related illnesses in 2021.

In Indonesia, around 27 000 people became infected with HIV in 2021, and almost half of them are young people aged 15-24. Although affordable treatments are available to prevent most AIDS-related deaths, 26 000 people died of AIDS-related illnesses in 2021. Treatment coverage is still very low at 28 percent.

The COVID-19 pandemic and the global economic crisis have created extraordinary headwinds that threaten national AIDS responses. Global solidarity is fraying, richer countries are cutting or redeploying humanitarian budgets, low- and middle-income countries are saddled with debt repayment and being forced to cut back spending on essential services like health and education and, in many countries, there is a lack of political will to challenge inequalities, gender-based violence and the criminalization and marginalization of vulnerable groups of people that continue to drive HIV infection levels.

In Indonesia, discrimination against people living with HIV (PLHIV) and key populations is also still very high. Discrimination against PLHIV and key populations occurs in various sectors of their lives, both in private and public areas. In the private context, discriminatory treatment occurs even within one’s own family, and it is common for PLHIV or those who are part of a key populations to be driven out of their homes because of their HIV status, gender identity, or sexual orientation. Not only that, there are discriminatory laws, regulations and bills that affect PLHIV and key populations. All forms of discrimination, marginalization, over-criminalization and a lack of adequate access to justice further increase vulnerability of PLHIV and key populations, which not only hinder their access to health services, especially HIV services, but also hinder the enjoyment of all their human rights as citizens.

The human and financial cost of not ending AIDS by 2030 would far outweigh the cost of the immediate and necessary action to turn the ship around.

The good news is that success is possible. We know how.

For example, UNAIDS Indonesia is supporting civil societies to advocate for a comprehensive anti-discrimination law that protects vulnerable groups from discrimination. We are also working with the National Commission on Human Rights to strengthen accountability mechanisms on HIV-related discrimination and promoting the rights of PLHIV and key populations.

Communities play a crucial role in leading and responding to the HIV epidemic, including in Indonesia.

During the COVID-19 pandemic, we see community-led response in HIV becoming increasingly crucial at a time when the health system is overburdened. Communities around the world, including Indonesia, worked to ensure people with HIV can still access medicine with efforts such as home deliveries. During humanitarian situations, such as earthquakes, it is also communities that step up to help key populations and people living with HIV gain access to the essential services they need.

We continue to work to strengthen the capabilities of communities to be able to lead responses, particularly in the areas of community-led monitoring which can lead to more accountability in access to health services. We are certain that with more communities regarded as equal and leading partners, the AIDS response will improve.

Here are five ways that countries can defend and expand their HIV response.

Address the inequalities that stop people receiving HIV prevention, testing and treatment services. In diverse settings, countries and communities are taking action to end inequalities and close gaps. Building on this momentum, policy makers need to strengthen their understanding of localized epidemics to focus on eliminating the inequalities that are slowing progress against the pandemic.

Realize human rights and gender equality. Punitive, discriminatory, counterproductive laws and policies must be removed. The human rights of women and girls, including their sexual and reproductive rights, must be upheld. Countries must prioritize and integrate focused, well-resourced efforts to end gender-based violence into national HIV responses.

Make a new push for HIV prevention. Countries urgently need to elevate the political and financial prioritization of HIV prevention and move to large-scale implementation of prevention projects so that innovations such as PrEP and long acting injectables become much more widely accessible, especially to vulnerable groups of people like young women and adolescent girls, gay men and other men who have sex with men, sex workers, people who use drugs and transgender people.

Support and effectively resource community-led responses. Countries must recognize the essential role of community-led responses and integrate them into national HIV planning, implementation and monitoring. Communities should be effectively resourced and laws that impede community-led responses should be removed.

Ensure sufficient and sustainable funding. Major new investment to ensure a fully funded global AIDS response is essential both from international donors and governments in low- and middle-income countries. Coordinated international action is also required to alleviate the debt crisis facing too many countries and to counteract the need for short-sighted and counterproductive national austerity measures. Ending AIDS is a promise that can and must be kept.

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