On the occasion of World Aids Day the ‘Parliamentarians for the 2030 Agenda’ organized a lunch-time conversation on the impact of criminalisation of HIV and key populations on the HIV-response. Evidence shows that an overly broad criminalisation of HIV non-disclosure, exposure or transmission with no intent to harm, undermines public health. Why is that? ​

40 years ago the first people dying of aids were registered. At a seminar with the Parliamentarians for the 2030 Agenda, Prof. Marie Laga (ITM) explained how the epidemic grew at an alarming speed in the 1990s and 2000s. As it hit countries in Southern Africa, life-expectancy in countries such as Zimbabwe, Botswana, Zambia and South Africa dropped below the level of the 1960s. Things started to change when in 1996 anti-retroviral treatment (ART) became available for people in the wealthy North. However, the drugs were unaffordable for patients living in the South. It was only thanks to activists’ campaigns that political recognition and action came about, and brought about fundamental change with the creation of international coordination through UNAIDS, and increased funding through the Global Fund and PEPFAR. This led to a rapid scale-up of people’s access to ART, standing at 2% in 2001 and amounting to 73% today. However, with 1.5 million new infections in 2020, we are not seeing ‘the end of aids’ yet and HIV prevention remains the biggest challenge. 

UNAIDS’ recent report finds that worldwide goals for 2020 have not been reached, despite past years’ efforts. More people know their HIV-status, more people have access to medicines and more people have an undetectable viral load thanks to treatment. Yet, the efforts to prevent new infections have been less successful. The number of new infections among adults has hardly dropped in the past 4 years. Not a single region reached the goal to decrease new infections by 75% compared to 2016.  

A high-level meeting (HLM) on AIDS under the theme - End Inequalities. End AIDS - was convened from 8 to 10 June 2021, in New York. The HLM made a comprehensive review of the progress on the commitments made in the 2016 Political Declaration towards ending the AIDS epidemic by 2030 and had to set out priorities for the coming years.

Reducing inequalities lies at the heart of UNAIDS’ 2021-2026 new Global AIDS Strategy. It aims to assist and guide every country and community in reaching UNAIDS goals of zero new HIV-infections, zero discrimination and zero AIDS-related deaths. A comprehensive framework of actions has been outlined to tackle inequalities and protect human rights in the HIV response. The gaps for HIV prevention, testing, treatment and support can be closed by reducing inequalities. The Strategy’s vision for reducing inequalities and laying the foundation to reach the 2030 targets builds on its three Strategic Priorities: (1) Maximise equitable and equal access to HIV services and solutions; (2) Break down barriers to achieving HIV outcomes;(3) Fully resource efficient HIV responses and integrate HIV in systems for health, social protection, and humanitarian and pandemic responses.

Sensoa International's annual audit of the expenditures by the Belgian Directorate General for Development Cooperation and Humanitarian Aid (DGD) shows that spending on health and reproductive health in 2019 was at its lowest level in four years. DGD spent a total of 11.08% of its budget on health and reproductive health in 2019, whereas support halted at 13.29% in 2017 and 12.84% in 2016. 

Particularly worrying is DGD's declining support for HIV prevention and treatment, for which the budget was cut in half during the previous government term. Support has been falling since 2017, with substantially less attention for HIV in Belgium’s bilateral cooperation and less support for multilateral organisations that take the lead in the global 'HIV response', such as UNAIDS and the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM). Multilateral support did increase in 2019, but not enough to turn the tide. 

Guttmacher’s recently published 2019 “Adding it Up” report captures the shortages in sexual and reproductive health services in low and middle income countries (LMIC). The research institute calculated what it would take to bridge the gap.

The European Medicines Agency (EMA) published a positive opinion on the use of the dapivirine vaginal ring for women ages 18 and older in developing countries to reduce their risk of HIV-1 infection. The monthly ring is the first long-acting HIV prevention product and is designed to help address women’s unmet need for new prevention methods given the persistently high rates of HIV they face, especially in sub-Saharan Africa. 

Gains made in preventing mother-to-child transmission of HIV could be reversed, with new HIV infections among children up by as much as 162% and setting the clock on AIDS-related deaths back to 2008, a modelling group convened by the World Health Organization and UNAIDS estimated. If no efforts are made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500,000 extra deaths from AIDS-related illnesses in sub-Saharan Africa in 2020–2021.

• The 'community' which is fighting for sexual and reproductive rights has years of experience in the fight against that other pandemic, hiv. Important lessons can be drawn from this.

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​UNAIDS broke it down:

• The response to the crisis must always be based on a Human Rights approach. 
• More vulnerable groups should be identified in a non-stigmatising way
• Efforts should focus on those groups that would otherwise easily be excluded from care.
• Health workers should thus be equipped with information and knowledge about the needs of the most vulnerable sections, such as women, people living in poverty, people living with an illness, people in rural areas, people with disabilities, people in detention, people living in slums or other informal settlements and the homeless.
• Vulnerable sections of the population should be recognized themselves as health workers as they care family members, peer outreach, etc. In other words, they are also on the frontline of the epidemic. Their security and protection must therefore also be a priority.