As COVID-19 pushes the Caribbean AIDS response even further off track and the 2020 targets are missed, UNAIDS is urging the region to step up action around HIV testing and prevention.
GENEVA/KINGSTON, 29 November 2020—In a new report, Prevailing against pandemics by putting people at the centre, UNAIDS is calling on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.
The global AIDS response was off track before the COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks. Modelling of the pandemic’s long-term impact on the HIV response shows that globally there could be at least 123 000 additional new HIV infections and 69 000 additional AIDS-related deaths between 2020 and 2022. “The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Winnie Byanyima, Executive Director of UNAIDS. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS.
To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.” New targets for getting back on track High-performing countries have created a path for others to follow. UNAIDS has worked with its partners to distil those lessons into a set of proposed targets for 2025 that take a people-centred approach. The targets focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They put people at the centre, especially the people most at risk and the marginalized—young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.
New HIV service delivery targets aim at achieving a 95% coverage for each sub-population of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics. The 2025 targets also require ensuring a conducive environment for an effective HIV response and include ambitious antidiscrimination targets so that less than 10% of countries have punitive laws and policies, less than 10% of people living with and affected by HIV experience stigma and discrimination and less than 10% experience gender inequality and violence. Prevailing against pandemics Insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact.
COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis. “No country can defeat these pandemics on its own,” said Ms Byanyima. “A challenge of this magnitude can only be defeated by forging global solidarity, accepting a shared responsibility and mobilizing a response that leaves no one behind. We can do this by sharing the load and working together.” There are bright spots: the leadership, infrastructure and lessons of the HIV response are being leveraged to fight COVID-19. The HIV response has helped to ensure the continuity of services in the face of extraordinary challenges.
The response by communities against COVID-19 has shown what can be achieved by working together. In addition, the world must learn from the mistakes of the HIV response, when millions in developing countries died waiting for treatment. Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services. Everyone has a right to health, which is why UNAIDS has been a leading advocate for a People’s Vaccine against COVID-19. Promising COVID-19 vaccines are emerging, but we must ensure that they are not the privilege of the rich. Therefore, UNAIDS and partners are calling on pharmaceutical companies to openly share their technology and know-how and to waive their intellectual property rights so that the world can produce successful vaccines at the huge scale and speed required to protect everyone.
The Caribbean will not meet the Fast Track targets set for the end of 2020 There were an estimated 330,000 people living with HIV in the region at the end of 2019. Overall Caribbean adult HIV prevalence was 1.1% last year. In 2019 77% of people living with HIV in the Caribbean knew their status. This compares to the worldwide average of 81%. Eighty-one percent (81%) of diagnosed Caribbean people were on treatment last year. Eighty percent (80%) of those on antiretroviral therapy were virally suppressed. The global average was significantly higher at 88%. Some countries have achieved elements of the 90–90–90 targets (90% of people living with HIV aware of their HIV status, 90% of diagnosed people on antiretroviral treatment and 90% of those on treatment virally supressed). Barbados has reached the target for testing while Guyana has exceeded it with 94% of people living with HIV diagnosed.
Haiti has gotten 98% of diagnosed people on treatment. Suriname and Trinidad and Tobago have achieved viral suppression among at least 90% of people living with HIV who are on treatment. “This shows that within the region there is the capacity to deploy the people, policies and programmes to end AIDS,” said UNAIDS Caribbean Sub-regional Office Director, Dr. James Guwani. Last year there were 6,900 AIDS-related deaths in the Caribbean. Deaths due to AIDS decreased by 37% since 2010. Total antiretroviral treatment coverage for the region was 63%–71% for women and 56% for men. New HIV infections decreased 29% in the region since 2010. One-third of new HIV infections in the Caribbean in 2019 were among young people ages 15 – 24. While most Caribbean countries have been able to sustain HIV treatment access during COVID-19, there are concerns that other branches of the AIDS response have suffered.
“We need innovative strategies to ensure we do not lose ground around HIV testing and prevention because of COVID19,” said Dr. Guwani. UNAIDS is collaborating with the Pan American Health Organization (PAHO), Pan Caribbean Partnership against HIV/AIDS (PANCAP), President’s Emergency Fund for AIDS Relief (PEPFAR) and Caribbean Med labs Foundation (CMLF) on an advocacy strategy in support of HIV self-testing. The initiative will be launched on the Monday 30 November, the eve of World AIDS Day
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