MUNICH, 22 JULY 2024 – A new United Nations report released today shows that the HIV response in Eastern Europe and Central Asia is critically off track. Data in UNAIDS’ global report The Urgency of Now: AIDS at a Crossroads reveals that in this region, new HIV infections have risen by 20% and AIDS-related deaths have risen by 34%, since 2010. Only half of the 2.1 million people living with HIV in the region are accessing treatment, and only 42% of all people living with HIV in the region have suppressed viral load, the lowest rate globally. The report shows that it is still possible to end AIDS as a public health threat by 2030, but only if governments reform laws to protect everyone’s human rights and increase resources to ensure services are available for all.

“The promise to end AIDS is off track in Eastern Europe and Central Asia. But leaders can get on the path that ends AIDS. Programmes need to focus especially on people most affected by HIV, who are often the most marginalized and vulnerable. Community organizations need to be properly funded, supported and enabled to provide HIV services to people affected by HIV. The barriers of stigma and discrimination need to be broken down,” said Winnie Byanyima, UNAIDS Executive Director. 

The new data shows that in 2023, there were 140,000 new HIV infections across the region, with 93% occurring in Russia, Ukraine, Uzbekistan, and Kazakhstan. Eight out of 13 countries in the region reported increases in new infections.

Because stigma, discrimination and harmful punitive laws obstruct marginalised communities’ access to vital services, 94% of new infections were among people from key populations - including men who have sex with men, people who inject drugs, and sex workers - and the sexual partners of people from key populations. Only 58% of sex workers, 43% of gay men, 52% of people who inject drugs, and 65% of transgender people receive HIV prevention services. Only 12% of resources are dedicated to prevention programmes for key populations.

The criminalization of small amounts of drug possession for personal use, of sex work, and of HIV transmission and exposure, are driving the people most in need underground and out of reach of HIV services. All 16 countries in the region criminalize sex work, 13 criminalize the non-disclosure, exposure, or transmission of HIV, and 7 criminalize small amount of drug possession for personal use. Studies show criminalization increases HIV prevalence among key populations. Unless countries can ensure fear-free access to HIV prevention services for everyone, new infections will continue to grow.

“Restrictive legal environments and stigma are obstructing progress in the region,” said Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia and Asia Pacific. “Restrictive laws, along with aggressive policing and stigma, push people away from medical care. If people are pushed underground, the HIV response will not succeed.”

Powerful prevention technologies like PrEP are also not widely accessible for the same reason.  Criminalization fuels stigma, with many avoiding medical care due to discrimination. Nearly half of people surveyed who inject drugs in Kyrgyzstan and 32% of people living with HIV in Tajikistan reported avoiding medical care due to stigma and discrimination. UNAIDS data shows that people in key populations are experiencing high levels of violence.

"Supporting the leadership of communities is essential for reaching marginalised people providing vital outreach services. Without community leadership and the integration of community services into the health system, reaching these groups is too difficult," said Yelena Rastokina, lead of the ‘Answer-Kazakhstan’ Association.

Recent years have seen worrying restrictions of civic space and limits to communities’ involvement in public health initiatives, including those related to harm reduction, access to public health services for LGBTQ+ people, sex workers and other marginalised people. Restrictive systems at local, national, and regional levels are holding back communities’ contribution to public health.

Ganna Dovbach, Executive director of the Eurasian Harm Reduction Association, highlighted: “The shrinking of civic space and attacks on human rights threaten our response to HIV, which is based on community-led or civil society provided services. Addressing these interconnected issues is essential for a sustainable response to the AIDS epidemic in our region.”

The region’s HIV response has also been hurt by the war in Ukraine.

But despite the conflict, Ukraine remains committed to its HIV response. Through a strong coalition of the government, civil society, international organizations and donors, HIV services have been maintained, with 143,600 people receiving treatment in 2023. This collaboration has ensured vital supplies of antiretroviral and tuberculosis medicine, and opioid agonist therapy, contributing to uninterrupted HIV treatment and other services. As of January 2024, 7,900 Ukrainian refugees in other countries and 1,900 returnees were accessing antiretroviral therapy.

Many community organizations working on HIV in Ukraine refocused their efforts to addressing humanitarian issues and supporting community members while continuing national advocacy for access to HIV services and the protection of human rights.

With support from the UNAIDS and other donors ALLIANCE.GLOBAL oversees a network of five specialized shelters across the country, providing shelter, humanitarian aid, and access to specialised services, including HIV prevention and treatment, for key populations and LGBTQ+ people who are internally displaced.

Despite the war, ALLIANCE.GLOBAL together with other community-led organisations continue advocating for laws that better protect LGBTQ+ people from intolerance and from hate crimes, to enhance access to public health services, including HIV-related services.

UNAIDS new report calls on leaders to develop sustainable plans for the HIV response to2030 and beyond. These plans should include enabling legal environments, support for community-led response and a boost in domestic funding. Repealing laws and norms that prevent people from accessing services is crucial.

“Ensuring access to services and treatment for all is how we end AIDS,” said Mr Murphy.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 10 July 2024— UNAIDS has welcomed the release of Gilead Sciences’ trial results on the injectable long-acting HIV medicine Lenacapavir for HIV prevention. The result “provides hope of accelerating efforts to end AIDS”, UNAIDS says, “but only if Gilead ensures that all people who need it can have access to this game-changing medicine.”

The recent trial of the medicine among cis-gender women in Uganda and South Africa was so successful that it was halted early. Twice-yearly injections of Lenacapavir showed overwhelming efficacy for preventing HIV infections compared to standard oral preventative HIV medicines, known as pre-exposure prophylaxis (PrEP). Additional trials are ongoing in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.

UNAIDS has welcomed the “exciting development,” and urged the company to allow generic production of Lenacapavir to all low- and middle-income countries by negotiating voluntary licensing agreements through the Medicines Patent Pool (MPP). The MPP is a UN-backed programme with extensive experience negotiating generics agreements between originators and generic pharmaceutical companies.

Gilead has not yet announced its plans for low and middle-income countries. However, UNAIDS is concerned that Gilead’s latest statement regarding its access strategy for low and middle-income countries mentions only “high incidence countries and resource limited countries” and makes no specific mention of upper-middle-income countries or the Medicines Patent Pool. Upper middle-income countries account for 41% of new HIV infections and 37% of all people living with HIV. These countries are home to millions who cannot afford the prices Gilead charges high-income countries.

“The success of Gilead’s recent Lenacapavir trial is an exciting development. While we still await regulatory approvals, normative guidance and results from the other ongoing trials, this news offers hope that we can enable everyone who would benefit, including especially the most marginalised communities, to have access to the help they need. Enabling equitable global access to new technologies can help get the world on track to end AIDS as a public health threat by 2030,” said Winnie Byanyima, Executive Director of UNAIDS. "However, it is concerning that Gilead’s latest announcement seems to mention neither upper-middle income countries, where people cannot afford anything like Lenacapavir’s current $42,250 price tag, nor a commitment to work with the UN-backed Medicines Patent Pool. Without these safeguards, it cannot be assured that this game-changing medicine will reach all those who need it."

Notes

Data in this press release comes from UNAIDS 2023 Epidemiological estimates (aidsinfo.unaids.org)

The UNAIDS Executive Director joined more than 300 experts and activists calling for a generic version of Lenacapavir to be licensed to all low and middle-income countries through the MPP, in a letter coordinated by the People’s Medicines Alliance: https://peoplesmedicines.org/wp-content/uploads/2024/05/Gilead-Open-Letter_May-2024.pdf

The AIDS Vaccine Advocacy Coalition provides an overview of the Lenacapavir for PrEP trials: https://avac.org/resource/infographic/an-overview-of-lenacapavir-for-prep-trials/ 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Girls’ education as a tool to prevent HIV infection has been centered at the 1st African Union Pan-African Conference on Girls’ and Women’s Education in Africa. This followed African leaders designating education as the 2024 African Union theme of the year.

At a high-level side event hosted by the Education Plus Initiative on the first day of conference held at the African Union Commission in Addis Ababa, Ethiopia, leaders, girls’ and women’s networks and advocates called for greater investments in girls’ education.

“Some people claim that providing girls with secondary education is too expensive. Such claims fail to consider the exponentially higher cost of not educating them,” said UNAIDS Executive Director, Winnie Byanyima. “We can get all our girls and boys to complete secondary education; that should be our legacy."

UNICEF calculates that 34 million girls in sub-Saharan Africa are out of secondary school. According to the Global Education Monitoring (GEM) Report 2023, in all regions in Africa, there are more girls out of school at the secondary level than boys, with gender disparities worsening as children move up to higher levels of education in favour of boys over girls. In sub-Saharan Africa, less than half of adolescent girls complete secondary education, their percentage standing at 42% and there has been no progress at all in closing this gap in the past 20 years.  Sub-Saharan Africa is the region furthest from parity at the expense of girls, with no progress since 2011 at the lower secondary level and since 2014 in upper secondary.

Gender is a key factor linked to disparities in enrolment, retention, completion, and learning outcomes through social conditioning, gender-based differences in parental expectations and education-related investments, child marriages and early childbearing, female genital mutilation, child labour, gender-based violence, period poverty and discrimination.

More than forty years into the HIV response, Africa remains an epicenter of the AIDS epidemic with adolescent girls and young women being disproportionately affected. Every week 3100 adolescent girls and young women acquired HIV in sub-Saharan Africa. Every three minutes, an adolescent girl or young woman aged 15-24 years acquired HIV in 2022 in sub-Saharan Africa.  Adolescent girls and young women aged 15-24 years in the region were more than three times as likely to acquire HIV than their male peers in 2022.

UN agencies, African Union representatives, government ministers, and young women leaders called for accelerated actions to translate commitments to action through leveraging girls' education for gender equality and preventing HIV, child marriage, teenage pregnancies, violence, gender-related stigma and discrimination in Africa.

Speakers emphasized the connection between health and education. Ministers spoke about key policy reforms and best practices aimed at promoting girls' education, including creating safe and inclusive school environments, strategies to get girls into secondary school, and the readmission policy that addresses high dropout rates due to pregnancy.  UN co-leads emphasised the need for improved collection of data disaggregated by sex and other relevant population characteristics to better understand educational participation, progression, and learning, and using gender-sensitive data for policymaking and planning. 

Other issues highlighted included the integration of digital literacy programs into the secondary education and vocational training curriculum to facilitate smooth transitions from school to employment; integrate gender equality into all aspects of the education system, including curriculum-based comprehensive sexuality education  and life skills, address gender-based violence  within schools and discriminatory laws and practices, and access to information, non-discriminatory HIV and sexual and reproductive health services access.

Young women leaders spoke on the role of partnerships and young women's leadership. Participants highlighted the upcoming 30th anniversary of the Beijing Declaration as an opportunity moment to accelerate accountability and commitments, as well as the CSW Resolution 60/2, Women, the Girl Child and HIV and AIDS as significant mechanisms to address political and resource gaps so no woman or girl is behind in the HIV response.

Education Plus is a rights-based, gender-responsive action agenda to ensure adolescent girls and young women have equal access to quality secondary education, alongside key education and health services and support for their economic autonomy and empowerment.  Co-led by five UN agencies, the initiative builds on existing frameworks like the Transforming Education Summit, the Continental Education Strategy for Africa (CESA) and the Dakar Education for All (EFA) Declaration to push for access and completion of education for women and girls in Africa.

Quotes

On 19 June 2024, the United Nations General Assembly convened to evaluate the progress made in the response to the AIDS epidemic. The yearly session provided a platform for Member States to reflect on achievements, confront persistent barriers, and chart a course forward towards ending AIDS by 2030. The UN Secretary-General’s progress report formed the basis of the debate. 

Member States celebrated the significant achievements towards ending AIDS, while highlighting ongoing challenges that must be overcome to reach the promise of ending AIDS as a public health threat by 2030.   

The commitment to the 95-95-95 targets and the progress made in eliminating vertical transmission of HIV, especially through the use of decentralized community-based services, were highlighted as pivotal to the success of the HIV response.  

Many member states stressed the crucial role that promoting a human rights-centered approach has had in the fight against HIV. They highlighted the significance of comprehensive multi-sectoral responses, including education on sexuality and robust support for sexual and reproductive health and rights. They pointed to the harm of actions that undermine gender equality and LGBTQI+ rights. They emphasized the shared duty of every country to protect everyone’s human rights.  

The need for continued global solidarity and enhanced multilateral cooperation was emphasized as key to tackling the remaining challenges. Calls for increased domestic and international funding were echoed, noting that sustained investment is crucial to maintaining progress and for expanding access to innovative prevention and treatment options.  

The UN General Assembly annual review served as a poignant reminder of the collective responsibility to uphold the rights and dignity of all people affected by HIV. 

Inspired by the lessons learnt from the AIDS response, the upcoming Summit of the Future scheduled for September 2024 will explore how common challenges can be overcome. 

Against a backdrop of geopolitical shifts and economic uncertainties, the HIV response serves as a beacon of how multilateral solidarity saves and transforms lives.