Opinion: Promise to end AIDS by 2030 is threatened, it’s time to act

Last year, world leaders met at the United Nations in New York and agreed on a groundbreaking political declaration on AIDS. It is an ambitious plan that embodies an urgent response to inequalities, stigma and discrimination, and which aims to end the AIDS pandemic as a global threat to public health by 2030.

However, data recently released in the new UNAIDS report, In Danger, shows that, unfortunately, the world is not on track to meet this fundamental goal for the lives of millions of people.

Although last year there was a 3.6% reduction in HIV infections in the world, the reality is that this is the smallest annual drop since 2016. If the current trajectory is maintained, the UNAIDS projection is that there will be 1.2 million of new HIV infections worldwide in 2025, more than three times the original target for that year of 370,000.

In this context, Brazil has always been considered an example in the response to HIV. The possibility of access to HIV prevention, diagnosis and treatment strategies by the Unified Health System (SUS), including free access to antiretroviral drugs, is a model that serves as a reference for many countries.

But the country is not immune to the danger identified in the UNAIDS global report. The fact that there is a public supply of HIV and AIDS prevention, diagnosis and treatment services does not necessarily imply that people will be able to access these services. Inequalities, exacerbated by discrimination and stigma, are a determining factor for especially vulnerable populations to experience difficulties or be prevented from having access to HIV services that can guarantee them a healthy and productive life.

In Brazil, 27% of people living with HIV still do not receive life-saving antiretroviral treatment. This means that there is still work to be done to strengthen the mechanisms that allow timely diagnosis and immediate adherence to antiretroviral treatment and health monitoring. This is a particularly critical point for populations in situations of greater vulnerability.

An example of proactive action is the possibility of dispensing pre-exposure prophylaxis (PrEP), an important element of combined HIV prevention strategies. This is impressive because in many cities and communities there is still a shortage of medical professionals who can provide this service, which impacts the most vulnerable people. The possibility of nursing professionals also dispensing PrEP increases the possibility of access to those who need it most, especially key and priority populations (sex workers, young people, black population). This model could be extended to other professional categories linked to the health service.

Other elements of inequality, such as structural racism, which make black people more affected by the HIV pandemic, need to be tackled head on and reversed. It is not possible to accept that, over ten years, AIDS cases have increased by 12.9% among the black population, at the same time that they have decreased by 9.8% among the white population. In the same vein, we cannot accept that transvestites and trans women, in addition to the physical and psychological violence they suffer from transphobia, stigma and discrimination, are still at 40 times greater risk of being infected by HIV than the average population.

The good news is that it is possible to end AIDS as a threat to public health.

Here are five ways Brazil can strengthen and expand its HIV response:

• Ensure a strong response to the inequalities that make it difficult or prevent people most vulnerable to receive HIV prevention, testing and treatment services.

• Ensuring respect for and strengthening of human rights and gender equality, including the removal of punitive and discriminatory laws and policies and the integration of efforts and resources to end gender-based violence, stigma and discrimination in the HIV response .

• Strengthen and broaden HIV prevention strategies, including advancing in ensuring access for all people who want and need to innovations such as pre-exposure prophylaxis (PrEP).

• Integrate civil society organizations and communities into the processes of planning, implementing and monitoring HIV responses at the national, regional and local levels, including access to resources and other types of support.

• Prioritize and make sufficient strategic resources available to ensure that the HIV response continues to be carried out in a comprehensive and sustainable manner.

Ending AIDS as a public health threat by 2030 is in our hands.

However, for this promise to be fulfilled, we must act now.