On World AIDS Day we celebrate progress but continued uncertainty

On this World AIDS Day, experts are praising recent progress in the fight against the four-decade-old global HIV epidemic. Indeed, the goal of eliminating HIV/AIDS as a major public health threat by 2030 remains a possibility. But these same experts acknowledge that recent progress could be lost. Increased LGBTQ discrimination in countries around the world, service disruptions due to regional conflicts, and uncertainty over continued U.S. support for the President’s emergency AIDS relief plan are among the top concerns.

Recent developments in HIV treatment and prevention

Recent decades have seen dramatic developments in the treatment and prevention of HIV/AIDS. Highly active antiretroviral therapy, introduced nearly thirty years ago, changed the paradigm for people infected with the virus. Instead of dying of AIDS, they could live with HIV. And access to these life-saving medicines became more accessible to people around the world when then-President George W. Bush took the initiative PEPFAR.

HAART is so effective that the amount of virus in the blood of an HIV-infected person may become undetectable. And several large studies have shown that someone with an undetectable viral load cannot sexually transmit the virus. Undetectable equals untransmittable. U=U. In other words: treatment is a method of prevention.

These same medications can also protect a person from becoming infected if exposed to the virus. When taken regularly, pre-exposure prophylaxis medications such as Truvada and Descovy provide significant protection to uninfected people. According to the CDCPrEP can reduce the risk of sexual transmission by 99% and the risk of infection in people who inject drugs by 74%.

Ending the HIV epidemic by 2030

With programs like PEPFAR and medical interventions like U=U and PrEP, ending the HIV epidemic is a very real possibility. HIV/AIDS will not go away. No one is saying this will happen. But the number of new infections can be reduced to such an extent that we can move beyond the crisis phase of the epidemic. In the US, for example, public health officials hope the number of new infections can be reduced to around 3,000 per year, a tenfold drop from current levels.

But public health researchers also note that ending the HIV epidemic by 2030 won’t be easy. Many structural barriers still remain. And these barriers can only get worse.

Persistent stigma, discrimination and criminalization

Stigma, discrimination and criminalization remain major obstacles to ending the HIV epidemic. As Helen Clark, the former Prime Minister of New Zealand, noted at the International AIDS Conference in July: “The HIV/AIDS pandemic is rooted in inequality and marginalization.” As part of their plan to end HIV/AIDS, in 2021 UNAIDS has launched the 10-10-10 goals. Less than 10% of countries have policies that limit or deny access to HIV services, less than 10% of people living with HIV experience stigma and discrimination, and less than 10% of girls, women, people living with HIV and others key population groups experience gender-based violence or inequality. These objectives are not being achieved. Even in the US, the data is disturbing. According to the Human Rights Campaign, more than 20% of hate crimes in the US are associated with anti-LGBTQ stigma. And 34 states have HIV criminalization laws, many of which are outdated and inconsistent with current data.

Uncertainty about US support for PEPFAR

Founded by President George W. Bush in 2003, PEPFAR has reshaped the global HIV/AIDS landscape. By providing much-needed assistance to countries hardest hit by HIV/AIDS, PEPFAR has saved millions of lives. Recently written in The hillNathaniel Weixel noted, “It is widely regarded as one of the most successful global health programs in American history.”

But its future is doubtful.

In March 2024, Congress granted a one-year extension of PEPFAR funding. This is the first time since the program’s creation 20 years ago that Congress has not approved a five-year reauthorization. This program cannot survive a one-year extension. The initiatives supported by PEPFAR are not short-lived. Ending HIV/AIDS requires long-term projects, a long-term vision and guaranteed long-term financing. Uncertainties associated with temporary funding can cripple many programs. These funding uncertainties could lead to tragic losses in our efforts to end HIV/AIDS.

On this World AIDS Day, we can be grateful for the progress that has been made. The HIV/AIDS landscape has improved dramatically, both in the US and globally. But HIV/AIDS is not over yet. Much still needs to be done. As former New Zealand Prime Minister Clark noted at the end of her speech at the International AIDS Conference: “It is clear that we are not living in the best of times. But we cannot give up on the challenges we face, such as ending AIDS. Lives and well-being literally depend on it.” Today we have the tools to end HIV/AIDS. We need the political will.