Inequalities, stigma and lack of funds are holding back the end of the AIDS epidemic, warn United Nations

The increase in inequalities and the worsening of financial restrictions have worsened the fight against the AIDS epidemic in Brazil and in the world, leading to the growth of new infections and making the goal of the disease ceasing to represent a public health threat by 2030 more distant.

The alert comes from a new report by Unaids (United Nations Program on HIV/AIDS), launched this Tuesday (29), on the eve of World AIDS Day, on December 1st.

In Brazil, inequalities impact the response to HIV in different ways, with the black population being the most affected. Data from the Ministry of Health between 2010 and 2010 show a drop of 9.8% in the proportion of AIDS cases among white people. Among blacks, there was an increase of 12.9%.

In the same period, a similar disparity was observed in relation to deaths due to AIDS-related illnesses: a 10.6% reduction in the proportion of deaths among white people and a 10.4% increase among black people.

“It is an unacceptable situation, which demonstrates the direct impact of inequalities and structural racism on the lives of thousands of people who have every right to benefit from advances in the response to HIV and AIDS”, says Claudia Velasquez, director and representative of the UNAIDS in Brazil.

Barriers to accessing HIV services also represent stigma, discrimination and criminalization of key populations, transvestites and transgender people, gay men and men who have sex with men, sex workers, people deprived of liberty and drug users. injectable drugs.

“Brazil is an example in the response to HIV, but inequalities continue to have a negative impact and create barriers that prevent access to services for vulnerable people”, explains Velasquez.

According to her, it is common for inequalities to intersect. For example, a trans person, black, living with HIV and living on the streets will have great difficulty accessing health services and following treatment.

“Recognizing the intersection of inequalities is a key element of a comprehensive approach to the HIV response. Failure to make progress to stop HIV infection in key populations undermines the entire response to the AIDS pandemic and helps explain the slowdown in progress [em relação à resposta]🇧🇷

For Unaids, Brazil must pay special attention to young people, considering the different urban, rural and peripheral environments, in addition to quilombola and indigenous communities. Data from the Ministry of Health indicate that new HIV infections have grown precisely among the young population, between 15 and 24 years old.

Unaids also advocates that there should be more education and communication actions on STIs (sexually transmitted infections) and on the prevention, diagnosis and treatment of HIV and AIDS specifically for young people, with emphasis on those in conditions of greater vulnerability.

Recently, the Ministry of Health decided to extend pre-exposure prophylaxis, PrEP, to young people at higher risk of HIV infection from 15 years of age.

Another challenge faced in Brazil is financing. The Jair Bolsonaro (PL) government withdrew BRL 407 million for the prevention, control and treatment of AIDS/HIV from the 2023 Budget compared to what was allocated in 2022. Organizations have asked the president-elect, Luiz Inácio Lula da Silva (PT ), the reversal of cuts.

The report reinforces that inequalities and harmful gender norms are also delaying the end of the AIDS pandemic in the world. In regions with a high incidence of HIV, for example, women subjected to domestic violence face a 50% greater chance of being infected with HIV.

In a press release, Winnie Byanyima, executive director of UNAIDS, says that in 33 countries only 41% of married women aged between 15 and 24 could make their own decisions about sexual health, according to an analysis carried out between 2015 and 2021 .

According to the report, girls who stay in school through high school have reduced their risk of HIV infection by up to 50%. When this is reinforced with initiatives to support empowerment, the risks are further reduced.

“The only effective way to end AIDS, achieve sustainable development goals and ensure health, rights and shared prosperity is through a feminist approach”, says Byanyima.

According to her, leaders need to ensure that all girls are in school, are protected from violence, which is often normalized in society, including through the permission of underage marriages, and have economic paths that guarantee them a promising future.

Another effect of inequalities on the response to HIV and AIDS highlighted by the report is that of toxic masculinity, by discouraging men from seeking health care.

While 80% of women living with HIV had access to treatment in 2021, the proportion of men is 70%.

There are also disparities in access to treatment between adults and children. While more than three-quarters of adults living with HIV are on antiretroviral therapy, just over half of HIV-positive children take the drugs, the report says.

In 2021, children accounted for just 4% of all people living with HIV, yet accounted for 15% of all AIDS-related deaths.

The UNAIDS report indicates that the fiscal space for health investments in low- and middle-income countries needs to be expanded, including through substantial debt cancellation and progressive taxation.

“It is necessary to guarantee equal access to rights, services, access to the best science and medicine. Equity no longer only benefits people in vulnerable situations. The truth is that it benefits everyone”, says Winnie Byanyima.