World AIDS Day (December 1) 2020 goes down as an important landmark — but for all the wrong reasons. Most countries are failing to reach the tough targets set for 2020 at the High-Level Meeting (HLM) on AIDS in 2016 on all fronts — prevention of new infections, reduction of AIDS-related mortality by providing anti-retroviral treatment and making a dent on AIDS-related stigma and discrimination. The latest report of UNAIDS released on the eve of World AIDS Day candidly admits, “Five years after a global commitment to Fast-Track the HIV response and end AIDS by 2030, the world is off track.” The momentum built during the first decade of the new millennium has all but been lost, most glaringly in prevention of new infections among adults and children alike. The tap of relentless spread of new infections continues to leak.
The situation in Asia-Pacific is more glaring. An incredible 98 per cent of new infections is occurring among the key populations: Men who have sex with men, transgenders, sex workers and clients, and people who inject drugs. This strategic information should have provided a great opportunity to prevent the spread of HIV by carefully focusing prevention programmes among these groups — the way it was done in the first decade. But they do not enjoy the priority any more as AIDS has fallen out of the political radar for almost a decade now.
Reasons for this sudden apathy of countries towards people vulnerable to HIV are not too difficult to find. Providing treatment to HIV-positive persons was never grudged by political leaders as it was a humanitarian gesture to save lives. Treatment scale-up over the last few years has been impressive, reaching a figure of 20 million by 2020. The 90-90-90 agenda of UNAIDS of bringing 90 per cent of HIV-positive persons for testing, treating 90 per cent of them and sero-converting a further 90 per cent of them was an imaginative step taken at a time when AIDS-related mortality was at its peak. The unexpected offshoot was that the prevention agenda had taken a back seat and many of the interventions focused on key populations have suffered funding crunch and got closed. Instead of running the AIDS control programmes on the twin tracks of prevention and treatment, countries shifted the balance to treatment at the expense of prevention. Instead of resource maximisation on both fronts, it was resource diversion that had occurred from prevention to treatment.
The second reason why the compelling alternative of keeping the focus on prevention of infections among key populations hasn’t got any mileage is because they not only are at the bottom of the social strata but at the bottom of political priorities as well. The joint UN programme on AIDS has also not helped in getting them back into the reckoning as the agenda of prevention was split between three or four co-sponsor agencies and not effectively coordinated by the secretariat. The UN HLM on AIDS, 2016 failed to even name the key population groups because of opposition from conservative groups of nations, which blocked such a move.
The colliding epidemics of Covid-19 and AIDS has added a new and serious dimension to an already aggravated problem. Apart from reduced access to existing services the key populations suffered denial of even the social support provided to other Covid-19 impacted people by the state governments.
The collective failure of member countries and UNAIDS in getting needed priority for prevention has resulted in almost all countries missing on the 2020 targets. This is not a discovery, as the writing was on the wall since the time the political resolution was adopted at HLM 2016.
The writer is a former Health Secretary, Government of India. Views expressed are personal