HIV/AIDS is one of the deadliest diseases in the world, and a permanent cure has yet to be developed. As countries all over the globe face this problem, The United Nations Program on HIV/AIDS or UNAIDS announced their approach to getting rid of the disease in a span of 10 years.

The Geek Herald reports that the organization announced its 90-90-90 approach for 2020. 90-90-90 meaning having 90 percent of individuals who are infected properly diagnosed, 90 percent of those diagnosed treated, and 90 percent of those who are treated receiving viral suppression. Come 2030, UNAIDS plans to increase that rate to 95-95-95, with the hopes of ending the epidemic once and for all since then.

While the United States has achieved a goal close to UNAIDS, with a 79-78-86 rating, other countries where the disease is prevalent still have a long way to go. With those countries in mind, it is important that the disease should be made treatable and a solid cure found to get rid of the disease for good. This is why the organization plans to support those countries with very limited resources by providing HIV/AIDS testing and treatment programs that are not only accessible but also affordable.

If technological breakthroughs over the past hundred years are able to get rid of once-deadly diseases like the plague and smallpox, then the future is bright for further research into developing a cure for the disease. Scientists are all on a united front when it comes to beating this disease as more and more progress is made in terms of properly treating HIV/AIDS. A new study as reported by Medical Xpress, reveals that while research has gone on mainly on killing off infected cells, it may not be as necessary.

Explaining further, the researchers focused on the individuals who are HIV-positive but are also able to live without treatment. They found that these individuals had lymphocytes that only suppress the virus but do not kill the infected cells. Analyzing blood samples from these individuals, the researchers saw that they had HIV-specific CD8-T cells in their lymphoid tissue, and these specific cells were able to suppress the virus by an enhanced ribosomal function, and thus were better at determining proteins from amino acids.

This resulted in producing more varieties of cytokines, which are small protein molecules that play a big role in cell communication, and promoted the polyfunctionality of the cells.

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Yet it remains an enduring problem: a disease rooted in poverty and inequality, it’s an epidemic that disproportionately affects women and young girls, health workers say. 

Last year, 1.7 million people were newly infected with HIV, according to the Joint United Nations Programme on HIV/AIDS, known as UNAIDS.

But the prevalence is twice as high among young women aged 15 to 24 compared to men of the same age group.

In Gambia, South Africa, the Congo, and Gabon, HIV prevalence is three times higher among young women. In Angola, it is four times. And in eSwatini, a country with one of the highest prevalence rates in the world, young girls and women are five times more likely to be living with HIV compared to boys and young men.

There is concern that the HIV epidemic is falling from global public health agendas and, with it, financial investment.

Between 2017 and 2018, there was a $900 million decrease in HIV funding in low- and middle-income countries.

Jose Izazola, UNAIDS special adviser on resource tracking and finances, told The New Humanitarian this was driven primarily by: reduced disbursements from The Global Fund, a multilateral non-profit; reductions in contributions from donor governments such as the UK; and a stagnation in funding from the world’s largest donor – the United States.

Only about two percent of global funding for HIV is earmarked specifically for key populations such as girls and women – but that is changing.

An example is the DREAMs programme, a partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Bill and Melinda Gates Foundation, among other funders, to reduce new HIV infections in adolescent girls and young women in 10 sub-Saharan African countries. 

“For the first time, we do have comprehensive programmes,” Chewe Luo, the associate director of UNICEF’s HIV/AIDS section, told TNH. “The DREAMs programme of PEPFAR is attempting to address exactly what we are talking about.”

The problem in eSwatini

There are particular reasons why the small southern African country formerly known as Swaziland, now officially the Kingdom of eSwatini, has so many women with HIV.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children,” Albertina Zodwa Nyatsi, director of Swazi’s Africa Coalition on Tuberculosis chapter, told TNH on a trip around the northwestern countryside.

“Women have limited decision-making when it comes to family planning. Women cannot advocate for condom usage or they risk being viewed by their partner as a prostitute or as diseased,” said Nyatsi, who also founded Positive Women Together in Action, a support group for HIV-positive women.

“The first thing to know is eSwatini is a patriarchal society. Women are considered children.”

Swazi women cannot take steps to prevent the spread of HIV, and when they receive their diagnosis, they are often blamed, socially isolated, or face stigma and violence.

As a result of gender inequality and cultural practices, an estimated 16 percent of Swazi girls and young women were living with HIV in 2018, a reflection of the broader burden of HIV on girls and women.

Early sexual debut and child marriage – cultural practices that are normalised in many countries across sub-Saharan Africa – put girls at high risk of contracting HIV.

In some countries, it is estimated that 25 percent of adolescents are sexually active before the age of 15, and 12 million girls under the age of 18 are married each year.

“Many of those gender inequalities mean that women have less power. Girls have less power,” said Sarah Hand, CEO of Avert, a UK-based charity focused on spreading information about HIV. 

“The cultural practices often mean that young girls, very young girls, are having sex early with male partners who are often themselves then in concurrent sexual partnerships.”

Lack of opportunities

Many challenges that young girls and women face stem from a lack of education and economic opportunities.

“We realise now, in terms of challenges among girls and young women, they go through multiple vulnerabilities as they grow,” said Luo.

“For example, we know that not keeping a girl in school increases risk of HIV acquisition because she is not empowered to negotiate for safer sex.”

“They go through multiple vulnerabilities as they grow.”

In eSwatini, only about 30 percent of adult women received some secondary education between 2010 and 2017. Limited education combined with widespread poverty creates an environment where transactional sex, often with multiple concurrent partners, and intergenerational sex are commonplace.

On top of that, gender-based violence, which is linked to higher rates of HIV transmission, is common. An estimated 48 percent of Swazi women experience sexual violence in their lifetime.

Harmful cultural practices such as polygamy and wife inheritance also persist and are frequently cited as factors contributing to high HIV rates.

In KaKhoza Township, an impoverished slum-like community in Manzini, eSwatini’s second largest city, TNH met with a support group for girls and young women living with HIV. Nearly every young woman was diagnosed with HIV in her late teens or early twenties – and only after seeking health services for pregnancy.

Gender-based violence

Stories of stigma and violence reverberated around the group.

“I was diagnosed with HIV when I went to the doctor for my pregnancy,” one girl, who asked not to be named, said. “When I told my partner, he beat me and forced me out of the home.

Today, she lives with her mother and her child in a one-room hut; she makes a small living selling fruits and vegetables in her town, but said her meagre income doesn’t even cover the medication for her baby.

“When the HIV came, my husband didn’t want to associate with me,” Dudu Manana, the support group’s leader said through a translator. “He sends a bit of money each month but doesn’t come to see me.” Like many HIV-positive women, Manana lives alone, socially isolated from her family and friends.

Stigma, violence, and the cultural expectation that Swazi women receive permission from their spouse or partner to access health services can prevent young girls and women from receiving proper medical treatment and social support.

“When you are diagnosed with HIV, you are seen as useless, depleted,” Tebeguni Nxumalo, a member of the Kakhoza support group said. “It is harder to become employed and you have to leave school.”

A grim employment outlook forces many young girls into the sex industry, said Florence, an HIV-positive sex worker living in Mbanane, the capital. “And then clients pay double for sex without a condom even when they know your HIV status,” she added.

Sex workers in eSwatini have the highest prevalence rate of HIV in the world, with 60 percent of sex workers living with the disease.

In eSwatini, antiretrovirals that suppress the virus are provided free of charge, but medications and diagnostic tests for illness caused by opportunistic pathogens are not, which drives up deaths from diseases such as tuberculosis and cryptococcal meningitis.

Food insecurity has been found to lower adherence to antiretroviral therapy.

“The [HIV] medicine makes you hungry, but there is no food,” said Hobsile Malambe, a resident in Mvembili, in the far north of eSwatini. “I wish they provided food, too.”

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The co-conveners of the Global HIV Prevention Coalition, UNAIDS and the United Nations Population Fund, have launched a new report on progress made in reducing new HIV infections across 28 countries that have been particularly affected by HIV. The report was launched at the High-Level Meeting of the Global HIV Prevention Coalition, held on 12 November on the sidelines of the Nairobi Summit on ICPD25.

Together, the 28 countries account for 75% of all new HIV infections globally—1.2 million of the 1.7 million new HIV infections among adults in 2018. The report, Implementation of the HIV prevention 2020 road map, shows that among the coalition countries new HIV infections among adults declined on average by 17% since 2010, slightly higher than the global decline of 13%, but far short of the 60% decline needed in 2018 to meet global HIV prevention targets.

“We are nearly 40 years into the HIV epidemic and it is unacceptable that governments and leadership are still shying away from sensitive issues,” said Winnie Byanyima, Executive Director of UNAIDS. “Investments in HIV prevention do not match the needs of our people; in some countries, even the basic commodities like condoms are not available, accessible or affordable in rural areas, for young people or key populations.”  

The report shows that some countries have made significant progress, with 12 countries reducing new adult HIV infections by 26% or more since 2010. They include countries with major epidemics, such as South Africa, with a 39% decline, the Democratic Republic of the Congo, with a 37% decline, Uganda, with a 36% decline, and Zimbabwe, with a 28% decline.

Some coalition countries, however, experienced concerning increases in new adult HIV infections, including Nigeria, where new adult HIV infections increased by 8%, and Pakistan, which is experiencing a rapidly growing HIV epidemic among key populations, where new adult HIV infections rose by a staggering 56%. On average, new HIV infections in non-coalition countries remained relatively stable between 2010 and 2018.

The report shows that while there has been some progress in developing programmes for adolescent girls and young women, the Global HIV Prevention Coalition estimates that in 2018 only 34% of the areas with high HIV prevalence had dedicated comprehensive HIV prevention programmes for women and girls—far short of the global target of reaching 90% of adolescent girls and women with these services by 2020. During the meeting, Nyasha Sithole, from the Athena Network, made a strong call for investment and engagement of adolescent girls and young women in HIV prevention and sexual and reproductive health programming.

The Global HIV Prevention Coalition was established in 2017 to galvanize greater commitment and investment in HIV prevention in order to achieve the 2020 prevention target of reducing new HIV infections among adults by 75% by 2020 (against the 2010 baseline). Its added value is clearly visible in a number of focus countries and beyond. Countries confirm that it has promoted a more systematic and structured approach to HIV prevention programming and built momentum in most of the 28 countries; however, much more needs to be done to meet global commitments.

“The coalition has been working as an important platform for countries to share their progress and experiences in HIV prevention, providing a very good opportunity for us to take joint actions to reduce new infections and curb the spread of the disease. This is the key to realize the Sustainable Development Goal target on ending AIDS by 2030,” said Yu Xuejun, Vice-Minister of Health of China and current Chair of the UNAIDS Programme Coordinating Board.

To accelerate progress in stopping new HIV infections, momentum urgently needs to be stepped up by increasing investment, addressing HIV-related stigma and discrimination, addressing the legal, policy and structural barriers to HIV prevention, especially for adolescent girls and young women, key populations and their sexual partners, and taking measures to expand community-based responses.

“I am convinced that community action is the key not only to HIV prevention, but prevention of all ill health. It is for this reason that we have made primary health care the focus of universal health coverage in Kenya,” said Sicily Kariuki, Cabinet Secretary of the Ministry of Health, Kenya.

By taking these critical steps and increasing efforts to address persistent gaps in programme coverage and ensuring that services and community programmes are available to everyone in need, significant progress can be made towards ending AIDS.

During the meeting, which was chaired by the Cabinet Secretary of the Ministry of Health of Kenya and the Minister of Health of Zambia, representatives of the coalition countries made bold commitments and pledges to scale up HIV prevention in their respective countries.

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The gap between the resources needed and those available is widening, as donors provide less funding, and domestic investments grow too slowly to compensate for inflation.

UNAIDS estimates that some $26.2 billion is needed by 2020 the 2018 amount available for the AIDS response was approximately $7.2 billion short of that figure.

‘Key populations’ at high risk

The report reveals that, from 2010 to 2018, the number of new HIV infections declined by 16 per cent, with around 1.7 million people infected in 2018. The drop is driven mostly by steady progress across most of eastern and southern Africa.

However, the picture looks very different – and far less positive – in other regions, which have seen a rising number of cases In eastern Europe and central Asia, AIDS-related deaths have risen by five per cent and, in the Middle East and North Africa, by nine per cent, since 2010.Key populations — which include people who inject drugs, gay men and other men who have sex with men, transgender people, sex workers and prisoners—now account for more than half of new HIV infections globally.

In eastern Europe and central Asia and in the Middle East and North Africa, that figure rises dramatically to around 95 per cent, which highlights that key populations are still being marginalized and being left behind in the response to HIV.

We urgently need increased political leadership to end AIDS, said Gunilla Carlsson, acting Executive Director of UNAIDS. This starts with investing adequately and smartly, and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, and take a human rights-based approach to reaching people most affected by HIV.

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The Joint UN programme on AIDS, commonly known as UNAIDS, is facing one of the worst challenges afflicting the global AIDS response — this time an existential threat questioning its very relevance. The UN Secretary-General, António Guterres, is expected to appoint a new executive director after the departure of Michel Sidibé in May 2019 on the recommendation of the programme coordinating board which manages the organisation. There are strong contenders from Africa and the U.S. in the reckoning among those who have been shortlisted.

A pivotal role

At such a crucial time, it is disturbing to hear voices again questioning the relevance of UNAIDS for the global response.

There are suggestions that AIDS should go back to the World Health Organisation (WHO) where it originally belonged to some 25 years ago. And that the new executive director should be equipped with an exit strategy to wind up the organisation.

Since its establishment in 1994, UNAIDS has been able to successfully mobilise world opinion to mount an exceptional response to an epidemic which has consumed over 20 million lives with still no effective treatment or cure. The UN General Assembly Special Session (UNGASS) 2001 was a game changer with the adoption of a political resolution that itself was exceptional in many ways. The creation of a Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the slashing of prices of AIDS drugs by Indian generics have brought treatment within the reach of many countries. Today some 22 million people are under antiretroviral therapy (ART) and preventing mother-to-child transmission of HIV has become an achievable goal by 2020. The organisation has provided leadership to many countries which in 10 years (2001-2010) could halt the epidemic and reverse the trend.

The epidemic is still alive

However, at a time when it should be leading the global response to end AIDS as a public health threat, the organisation has started to falter in its strategy. First came the extremely optimistic messaging blitz that the world was going to see the end of AIDS very soon. This is far from true. Regions such as eastern Europe and Central Asia and West Asia are nowhere near reaching that goal, with many countries such as Russia witnessing a raging epidemic among drug users and men who have sex with men (MSM) communities. With the top leadership in UNAIDS exhorting countries to bring AIDS “out of isolation” and integrate with health systems, the political leadership in many countries have thought that AIDS is no more a challenge.

Second has been the thinking that the AIDS epidemic can simply be treated away by saturating anti retroviral (ARV) coverage. Nothing could be farther from the truth. It is forgotten that AIDS affects the poor, the marginalised and criminalised communities disproportionately as they face challenges in accessing the ‘test and treat’ programmes. The ever increasing number of young people who are joining the ranks of vulnerable populations do not get prevention messages like in the past. National programmes do not any more consider condoms, sexual education and drug harm reduction as central to the prevention of HIV transmission that results from unprotected sex and drug use. Funding for non-governmental organisations and community-based organisations working on prevention has virtually dried up.

Third has been the weakening of country leadership of UNAIDS in many high-prevalence countries. Senior country-level positions are, in many instances, held by people who do not possess the core competence to constructively engage political leadership to undertake legal reforms and provide access to services to marginalised populations.

Weakening activism

But the biggest setback has been the lost voice of vulnerable communities which was the main driving force of AIDS response in the decade after UNGASS. Activism surrounding AIDS has suddenly fizzled out emboldening many countries, especially in Africa, to further stigmatise and discriminate by enacting new laws that criminalise vulnerable sections of society.

To add to its woes, the charges against one of the senior most staff and his exit from the organisation have seriously compromised UNAIDS at a time when the global response needs its leadership the most. The new executive director will have an unenviable task of not just restoring the credibility and relevance of the organisation but strengthening its presence at country level and making it more meaningful to the communities which look to it for leadership. The new executive director has to work relentlessly to place prevention of the epidemic and empowering communities at the centre of global response.

With 1.7 million new infections and one million deaths occurring every year, we can’t afford to drop the ball half way. The commitment to end AIDS by 2030 is ambitious but not impossible to achieve. What we need is a re-energised UNAIDS with a strong and fearless leadership from a person of high integrity and commitment along with a sincere effort to remove the deadwood from the organisation. Any thought of winding it up or giving the mandate back to WHO would be suicidal at this moment.

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Newswise — Chris Beyrer, MD, MPH, a longtime faculty member at the Johns Hopkins Bloomberg School of Public Health, globally recognized AIDS researcher and advocate, and former president of the International AIDS Society (IAS), is among five finalists to lead the Joint United Nations Programme on HIV/AIDS.

Beyrer has been at the forefront of AIDS advocacy and research since the start of his career. An outspoken advocate and champion of human rights, Beyrer has extensive experience conducting international collaborative research and training programs in HIV/AIDS and other infectious disease epidemiology, HIV preventive interventions, including vaccine clinical trials and preparedness studies, and in health and migration and health and human rights. His work spans Africa, Asia and throughout Central Asia and Eastern Europe.

Approximately 36.9 million people are currently living with HIV, and tens of millions of people have died of AIDS-related causes since the beginning of the epidemic. While significant progress has been made on HIV, with global deaths decreasing significantly in the past decade and longer life expectancies for patients who receive treatment, several regions are experiencing sharp increases in new infections and are struggling to expand both prevention and treatment.

“Chris brings extraordinary insights to the fight against HIV as a researcher, an advocate and a human being,” says Bloomberg School Dean Ellen J. MacKenzie, PhD, ScM. “Chris is a natural leader whose decades of experience in science and advocacy for human rights make him an inspired choice for this position.”

In addition to serving as president of the IAS from 2014 to 2016, Beyrer has held numerous high-level positions. He served as co-chair of the Epidemiology and Natural History Planning Group of the Office of AIDS Research at the National Institutes of Health. He also serves on scientific advisory committees for UNAIDS and the World Health Organization. He served on the Scientific Advisory Board for the President’s Emergency Plan for AIDS Relief (PEPFAR) from 2011 to 2014. Beyrer was elected to the Institute of Medicine of the U.S. National Academy of Sciences in 2014. He is the author of over 320 scientific papers, six books and numerous other publications.

Beyrer received his MD from SUNY Health Sciences Center at Brooklyn in 1988 and a master of public health from the Bloomberg School, then the Johns Hopkins School of Hygiene and Public Health, in 1991. He joined Johns Hopkins in 1992, to serve as field director for Hopkins HIV research in Thailand. Beyrer is a professor of Epidemiology, International Health, and Health, Behavior and Society at the Bloomberg School and also professor of Nursing and Medicine. He is the founding director of the Center for Public Health and Human Rights. He is associate director of the Hopkins Center for AIDS Research and an associate director of the Center for Global Health. In 2016, Beyrer was installed as the Desmond M. Tutu Professor in Public Health and Human Rights at the Bloomberg School.

“Chris has earned the deep respect of those who have fought and are fighting to save so many lives in the HIV/AIDS epidemic,” says Joshua Sharfstein, MD, vice dean for Public Health Practice and Community Engagement at the Bloomberg School. “He can bring together advocates, scientists, and policymakers in the U.S. and around the world in support of a vision of eliminating this terrible disease.”

UNAIDS, founded in 1995, works to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS encompasses 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and collaborates with partners across the world towards the Sustainable Development Goal of ending the AIDS epidemic by 2030.

The outgoing UNAIDS executive director, Michel Sidibé, has served since January 2009. He was appointed the Minister of Health and Social Affairs of Mali in May.

The UNAIDS’ 44th Programme Coordinating Board (PCB) was presented with a short list of candidates for the executive director position in late June. The PCB search committee chair was next to send the committee’s report to the Committee of Cosponsoring Organizations, which will make a recommendation to the United Nations Secretary-General. The UN Secretary-General will make the final decision about the appointment of the next executive director of UNAIDS.

The full list of finalists for the UNAIDS executive director position has been reported in several news outlets.

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