“The world has promised to end AIDS by 2030. We are off track,” said United Nations Secretary-General António Guterres in a message for World AIDS Day on December 1.
Inequalities stand in the way of ending the AIDS pandemic, and in particular gender inequalities, which are compounded by the patriarchy and violence against women.
As of 2021, AIDS has claimed 650,000 lives and 1.5 million people have become infected with HIV. To date, UNAIDS estimates that more than 38 million people worldwide are living with HIV.
“The world will not be able to defeat AIDS while reinforcing patriarchy,” said Winnie Byanyima, Executive Director of UNAIDS at the release of the organisation’s report, ‘Dangerous Inequalities.’
“We need to address the intersecting inequalities women face. In areas of high HIV burden, women subjected to intimate partner violence face up to a 50% higher chance of acquiring HIV,” she adds.
Harmful masculinity
By interrupting the dynamics of male dominance, policies can reduce girls’ vulnerability to HIV.
Harmful masculinities are also discouraging men from seeking care. While 80% of women living with HIV had access to treatment by 2021, only 70% of men were on treatment. Advancing gender equality will benefit everyone.
African women most vulnerable
The effects of gender inequality on women’s HIV risks are particularly pronounced in sub-Saharan Africa, where women accounted for 63% of new HIV infections in 2021.
Across 33 countries from 2015 to 2021, only 41% of married women aged 15 to 24 could make their own sexual health decisions. “The only effective route map to ending AIDS, achieving the sustainable development goals and ensuring health, rights and shared prosperity, is a feminist route map.”
Adolescent girls and young women (aged 15 to 24) are three times more likely to contract HIV than adolescent boys and young men in the same age group in sub-Saharan Africa.
Schooling is a key factor
One study showed that enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV infection by up to 50%.
When reinforced with a package of empowerment support, the risks to girls are further reduced. Leaders must ensure all girls are in school, and protected from violence which is often normalised, including through underage marriage. The girls must also have economic opportunities that guarantee them a hopeful future.
Inequalities between the ages
The fight against AIDS is also hampered by inequalities in access to treatment between adults and children, the UNAIDS report shows.
More than three-quarters of adults living with HIV are on treatment, but just over half of children living with HIV are on the lifesaving medicine.
In 2021, children accounted for only 4% of all people living with HIV, but 15% of all AIDS-related deaths.
UNICEF warns that progress on HIV prevention and treatment for children, adolescents and pregnant women has virtually flatlined over the past three years, with many regions still not reaching pre-COVID-19 service coverage.
Inequalities in law
Worldwide, more than 68 countries still criminalise same sex sexual relations. Gay men and other men who have sex with men living in African countries with the most repressive laws are more than three times less likely to know their HIV status. Sex workers living in countries where sex work is criminalised are seven times more likely to be living with HIV.
Lack of funding
At a time when international solidarity is most needed, too many high-income countries are cutting back on aid for global health. In 2021, funding available for HIV programmes in low- and middle-income countries was US$ 8 billion short. Increasing donor support is vital to getting the AIDS response back on track.
Mr. Guterres is calling for “more availability, quality and suitability of services for HIV treatment, testing and prevention.”
Budgets must prioritise the health and well-being of all people, especially vulnerable populations who are most affected by HIV-related inequities. Ending AIDS is far less expensive than not ending AIDS.