At a session at the International AIDS Society (IAS) Conference on HIV Science, the participants discussed the new AIDS targets for 2025, which are included in the UNAIDS Global AIDS Strategy 2021–2026 and the 2021 United Nations Political Declaration on AIDS.

The session aimed to make the 2025 targets known more widely among the attendees of the conference. The panel was moderated by Luisa Frescura and introduced by Shannon Hader, the UNAIDS Deputy Executive Director of Programmes. The panel included Adele Benzaken, the Co-Chair of the target-setting process, Aleny Couto, Mandisa Dukashe, Birgit Poniatowski, Erik Lamontagne, Peter Ghys and José A. Izazola.

The different targets, including targets for services, integration and societal enablers, were discussed, framed within the Sustainable Development Goals, and the financial resources needed to achieve them in low- and middle-income countries were highlighted.

The global 2025 targets for the AIDS response are more granular than the targets for 2020. They recognize that societal, service and system enablers are needed to reach the high levels of service coverage and impact needed, while emphasizing the importance of integrating the HIV response to achieve universal health coverage and the Sustainable Development Goals.

The session heard that recommendations for prevention services are given in accordance with the specific needs of populations or groups and their risk of acquiring HIV, with a particular focus given to key populations. The participants also heard that testing and treatment services need to be scaled up in each and every subgroup in order to avoid them being left behind and hidden in the general average of coverage.

The participants noted that the ambitious targets are achievable and clearly show the way to reach a sustainable response to HIV globally.

Quotes

Forty years since the first AIDS cases were reported and just weeks before the United Nations General Assembly High-Level Meeting on AIDS, the United Nations Secretary-General has released a new report with recommendations and targets to get the world back on track to end AIDS

NEW YORK, 30 April 2021—The United Nations Secretary-General, António Guterres, has warned that despite intensive action and progress made against HIV in some places and population groups, HIV epidemics continue to expand in others and issued a set of 10 key recommendations.* If followed by all countries, this will end the AIDS pandemic as a public health threat by 2030 as part of the Sustainable Development Goals. In a new report, Addressing inequalities and getting back on track to end AIDS by 2030, the United Nations Secretary-General urges the world to address the inequalities that are slowing progress. 

“It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” said Mr Guterres in the report. “Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved for people living with HIV, communities and countries.”

The global targets set out in the General Assembly’s 2016 Political Declaration on Ending AIDS were missed by a long way, allowing the AIDS pandemic to grow in many regions and countries. The staggering 1.7 million new HIV infections that occurred in 2019 are more than three times higher than the 2020 target of less than 500 000 new infections. In addition, the 690 000 AIDS-related deaths in 2019 far exceed the 2020 target of reducing deaths to fewer than 500 000 a year.

“Ending AIDS as a public health threat by 2030 is still within reach—many countries are showing that rapid progress against HIV is possible when evidence-informed strategies and human rights-based approaches are adopted,” said UNAIDS Executive Director Winnie Byanyima. “But it requires bold political leadership to challenge and address the social injustices and inequalities that continue to make certain groups of people and entire communities highly vulnerable to HIV infection.”

The report notes that COVID-19 has caused additional setbacks. The United Nations Secretary-General warned that COVID-19 is not an excuse for missing AIDS targets, but rather a stark warning to the countries that they can no longer afford to underinvest in pandemic preparedness and responses.

At the same time, the COVID-19 pandemic has underscored the many spill-over benefits of HIV investments in health and development. Community-led service delivery pioneered by the HIV response is helping to overcome the extraordinary impediments created by COVID-19.

The set of 10 recommendations to get the world back on track include: addressing inequalities and reaching all people living with or at risk of HIV infection to reduce the annual new HIV infections to under 370 000 and annual AIDS-related deaths to under 250 000 by 2025; prioritizing HIV prevention to ensure that 95% of people at risk of HIV infection have access to effective HIV prevention options by 2025; and eliminating new HIV infections among children.

The report underscores that addressing social and structural factors that perpetuate inequalities is key. It highlights, for example, how gender inequality, underpinned by harmful gender norms, restricts women’s use of HIV and sexual and reproductive health services by perpetuating gender-based violence and limiting decision-making power, including the ability of women and girls to refuse unwanted sex, negotiate safer sex and mitigate HIV risk.

It also shows how vulnerable, marginalized and criminalized communities, such as gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, prisoners and migrants, also remain at higher risk of HIV infection than the general population because they are not receiving essential information and HIV treatment, prevention and care services.

The United Nations Secretary-General describes how communities of people living with, at risk of and affected by HIV are the backbone of the HIV response. Initiatives led by people living with HIV, women, key populations, young people and other affected communities have identified and addressed key inequalities and service gaps, advocated for the rights of their constituents and expanded the reach, scale and quality of health services.

In the report, Mr Guterres applauds UNAIDS’ recently adopted Global AIDS Strategy 2021–2026: End Inequalities, End AIDS. “The lessons from the countries, cities and communities that successfully fast-tracked their HIV responses over the last five years are at the heart of the UNAIDS Global AIDS Strategy 2021–2026,” said Mr Guterres. “The global AIDS community and UNAIDS have used an inequalities lens to develop the strategy, with new targets that are ambitious, granular and tailored to reach the furthest behind first.”

The report comes 25 years after the creation of UNAIDS and describes how COVID-19 has exposed social inequalities and health system weaknesses. The United Nations Secretary-General says that the world should leverage the experience from responding to the AIDS pandemic to strengthen health systems across the world and improve pandemic preparedness. He also calls for enhanced global solidarity to close the HIV resource gap and increase annual HIV investments in low- and middle-income countries to US$ 29 billion by 2025. 

*The 10 recommendations in the United Nations Secretary-General’s report:

1.      Reduce and end the acute and intersecting inequalities that are obstructing progress to end AIDS.
2.      Prioritize HIV prevention and ensure that 95% of people at risk of HIV infection have access to and use appropriate, prioritized, person-centred and effective combination prevention options by 2025.
3.      Close gaps in HIV testing, treatment and viral suppression that are limiting the impact of HIV responses and achieve by 2025 the 95–95–95 testing and treatment targets within all subpopulations, age groups and geographic settings, including children living with HIV.
4.      Eliminate vertical HIV transmission and end paediatric AIDS.
5.      Put gender equality and the human rights of women and girls in all their diversity at the forefront of efforts to mitigate the risk and impact of HIV.
6.      Implement the GIPA (Greater Involvement of People Living with HIV/AIDS) principle and empower communities of people living with HIV, women, adolescents and young people and key populations to play their critical HIV response roles.
7.      Respect, protect and fulfil the human rights of people living with, at risk of and affected by HIV and ensure by 2025 that less than 10% of people living with HIV and key populations experience stigma and discrimination.
8.      Enhance global solidarity to close the HIV response resource gap and increase annual HIV investments in low- and middle-income countries to US$29 billion by 2025.
9.      Accelerate progress towards universal health coverage and strong primary health care systems, build forward better and fairer from COVID-19 and humanitarian crises, and strengthen global health security and future pandemic preparedness.
10.  Leverage the 25 years of experience, expertise and mandate of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in building multisectoral, multi-stakeholder and rights-based collaborative action to end AIDS and deliver health for all as global public good.

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, 25 February 2021—UNAIDS welcomes the United Nations General Assembly decision for a high-level meeting on HIV and AIDS to take place from 8 to 10 June 2021. The high-level meeting will review the progress made in reducing the impact of HIV since the last United Nations General Assembly high-level meeting on HIV and AIDS in 2016 and the General Assembly expects to adopt a new political declaration to guide the future direction of the response. The high-level meeting will take place as the world marks 40 years since the first case of AIDS was reported and 25 years of UNAIDS.

“World leaders must seize the opportunity offered by this new United Nations General Assembly high-level meeting on HIV and AIDS to maintain their focus and commitment on ending AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development,” said Winnie Byanyima, UNAIDS Executive Director. “The AIDS epidemic is unfinished business and must be ended for everyone everywhere, including for young women and adolescent girls and for other groups of people disproportionately affected by HIV. The right to health belongs to all of us.”

Progress towards ending the AIDS epidemic as a public health threat by 2030 as part of the Sustainable Development Goals has been highly uneven and the global goals for 2020 adopted in the 2016 United Nations Political Declaration on Ending AIDS were not met. Stigma and discrimination, the marginalization and criminalization of entire communities and a lack of access to health, education and other essential services continue to fuel the epidemic. Women and girls in sub-Saharan Africa and key populations (gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and people in prison) and their partners globally continue to be disproportionately affected by the HIV epidemic.

UNAIDS is currently developing a new global AIDS strategy for 2021–2026 through a process that is inclusive of all stakeholders in the AIDS response. The final draft strategy will be considered for adoption by the UNAIDS Programme Coordinating Board in March 2021. The new global AIDS strategy will include new targets to ensure that no one is left behind in ending AIDS, wherever they live and whoever they are. By achieving these targets, the number of people newly infected with HIV would fall to 370 000 by 2025, and the number of people dying from AIDS-related illnesses would be reduced to 250 000 in 2025.

Even the gains already made against HIV are threatened by the disruptions caused by the COVID-19 pandemic. The high-level meeting creates an opportunity to ensure that the world bolsters the resiliency of the HIV response to date, commits to rapid recovery post-COVID-19 and applies the lessons learned from the colliding epidemics of HIV and COVID-19 to create more resilient societies and health systems that are ready to meet future health challenges.

“The AIDS response has taught us that global solidarity is critical to making sustained progress against the impact of health threats like COVID-19,” said Ms Byanyima. “There must be concerted international efforts to reduce inequalities between countries and within them to strengthen the world’s capacity to absorb and defeat future global health challenges that put lives and livelihoods at risk everywhere.”

UNAIDS expresses its appreciation for the hard work of the high-level meeting co-facilitators, the permanent missions to the United Nations of Australia and Namibia, in the adoption of the resolution as well as to the President of the General Assembly for leading the process.

Given the constraints imposed by measures taken to contain the COVID-19 pandemic, it has not yet been decided if the high-level meeting will be in-person, virtual or a hybrid of the two. In line with the resolution, UNAIDS encourages the highest level of participation of United Nations Member States and the inclusion of civil society organizations and people living with or at risk of HIV in delegations to the high-level meeting. UNAIDS also looks forward to the multistakeholder hearing as a key opportunity to hear the voices of people living with, at risk of and affected by HIV, including key populations.

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.

UNAIDS stakeholders met virtually to engage in the development of the next strategy for the global AIDS response

GENEVA, 18 September 2020—With only 10 years left to deliver the Sustainable Development Goals, including the target of ending the AIDS epidemic as a public health threat by 2030, UNAIDS is developing its next global AIDS strategy. The next strategy, which is scheduled to be adopted by the UNAIDS Programme Coordinating Board by March 2021, will be a road map for all countries and partners in the global AIDS response to get back on track to reach the goal of ending AIDS.

The first phase of the development of the new strategy took place from May to August 2020, during which UNAIDS held broad consultations and conducted a review of the current UNAIDS 2016–2021 Strategy and its implementation. More than 10 000 stakeholders were consulted through a global online survey, interviews with key informants, focus group discussions and workshops. The UNAIDS evidence review raises critical questions about what is working and how to sustain or scale up what is working, where we are falling behind and how to overcome the gaps and obstacles for the next global AIDS strategy in order to remain ambitious, visionary and evidence-informed.

On 16 September 2020, UNAIDS held a multistakeholder consultation on the next global AIDS strategy online, with more than 170 representatives of Member States, civil society, nongovernmental organizations, the private sector and academia taking part, along with representatives of all 11 UNAIDS Cosponsors.

“We cannot assume that solidarity in the global AIDS response will be maintained,” said Winnie Byanyima, Executive Director of UNAIDS. “We do not plan to reopen discussions on the issues that could take us back. We want to focus on how to make progress across the areas and issues for which we are already off-track  and we need to advance to reinvigorate progress, enhance urgency in the HIV response and strengthen global solidarity.” 

The evidence review and the strategy consultations that UNAIDS has conducted to date indicate that the priorities in the current UNAIDS strategy remain relevant, but progress and results need to be accelerated across all countries, contexts and populations. Some issues that were discussed during the consultation included: political leadership and financing; partnerships and accountability; COVID-19; key populations; adolescent girls and young women; community-led responses; eliminating stigma, discrimination and punitive laws; regional specificity; HIV and universal health coverage; multisectorality; and inequalities.

The multistakeholder consultation explored these 11 issues in more detail, generating inputs on how to amplify game-changers, how to move from commitment to action and how to measure and monitor action to drive accountability.

Government representatives emphasized the importance of having the voice of countries, at the government and community levels, at the forefront in the development of the new strategy. Civil society representatives highlighted the need to further strengthen youth empowerment and leadership, an area noted as a major shortcoming in the current strategy, in order to seize the potential of communication, education and capacity-building for the next generation. Representatives of international organizations reinforced the critical importance of the next UNAIDS strategy to maintain and enhance community engagement, including in closer coordination with the new strategy being developed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The UNAIDS strategy development process now transitions into the next phase, with updates to be considered during briefings and meeting of the UNAIDS Programme Coordinating Board. A detailed annotated outline of the next UNAIDS strategy, which will integrate new global HIV targets for 2025 and resource needs estimates, will be presented to the 47th meeting of the Programme Coordinating Board in December 2020. The next UNAIDS global AIDS strategy will provide a critical link to inform the preparations for the next United Nations General Assembly high-level meeting on AIDS.

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.

Opening a session at the 2020 International AIDS Conference on UNAIDS’ next global AIDS strategy, UNAIDS Executive Director Winnie Byanyima presented a bold plan to put the global response to HIV back on track.

“Earlier this week, I raised the alarm that the world will miss the global HIV targets by 2020. The new UNAIDS strategy will be the road map to get the global response back on track to end the AIDS epidemic by 2030,” said Ms Byanyima. “The next UNAIDS strategy must address head-on the areas where we are still lagging, like combination prevention and human rights of key populations, and address the multiple vulnerabilities of adolescent girls and young women in sub-Saharan Africa.”

The session was an opportunity for the participants to engage in a discussion with UNAIDS on the key principles and issues that should underpin the next UNAIDS global AIDS strategy.

Deborah Birx, the United States Global AIDS Coordinator and White House Coronavirus Response Coordinator, stressed the need to “bring data, communities and governments together to address the issues people are confronted with every day.”

The participants agreed on the need for the strategy to address the core vulnerabilities that put people at risk, including harmful traditional gender norms, accessing livelihoods and education and reducing the exclusion and marginalization of key populations.

“Health is not only about health. Health is also about social justice. It's not enough to provide sex workers with condoms without addressing all the factors that prevent them from using them,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV and Chair of the Global Fund Strategy Committee.

To close the gaps, there is a need to apply evidence to design programmes that adapt to the different epidemics and contexts. “We do have the tools to make an impact, but we need to move that to local level. We need to look at more customized solutions,” said Quarraisha Abdool Karim, from the Centre for the AIDS Programme of Research in South Africa.

There was a clear call for communities to be at the centre of the response in order to drive change. At the same time, the participants flagged the need to invest in communities to empower them to claim their leadership role, to hold everyone accountable, to help design and deliver people-centred, rights-based responses to HIV, tuberculosis and COVID-19 and to reach the hard to reach populations.

“How can we have people power when we don’t even have funding,” said Lucy Wanjiku, from the Kenya Positive Young Women Voices.

“Communities must be at the centre of the response. This means being funded, being part of decision-making and opening civic spaces for them to hold us all accountable,” added Ludo Bok, Manager of the Health and Development Group, United Nations Development Programme.

The speakers called for a serious reflection on what must be changed and a collective commitment to change the way we respond to HIV. The participants agreed on the need to focus the conversation on health as a basic right, on health as a social construct. HIV treatment and prevention cannot be delivered if there remain gaps to accessing knowledge, education, health care, harm reduction, sexual and reproductive health, secured livelihoods, economic opportunities, protection from violence and access to justice.

“I feel a renewed sense of urgency. We cannot continue to do the same things and expect a different outcome,” said Ms Byanyima. “People are expecting this strategy to set an urgent new direction for the global AIDS response—for the UNAIDS Joint Programme, for ending AIDS in every country and in every community.”

Since the 2020 HIV targets are soon to elapse, UNAIDS is leading a three-year process to develop new targets for 2025 and to estimate the epidemiological impact and the resources needed for the HIV response from 2021 to 2030.

At the 2020 International AIDS Conference, a session chaired by Anton Pozniak, the President of the International AIDS Society, presented the process and main results from the consultations that have informed it, as well as the next steps. It is expected that the targets will inspire countries to develop ambitious national strategic plans and inform discussions in preparation for the United Nations high-level meeting on AIDS in 2021. 

“This 2025 target-setting exercise sets itself apart from previous rounds of this work in that it includes a stronger focus on the need for social enablers to achieve targets for the AIDS response, as well as consideration for the integration of HIV services,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme.

Paul De Lay, the Co-Chair of the Steering Committee of the 2025 target-setting process, highlighted that the objective is to focus on what will be needed in 2025 in order to achieve the 2030 goal of ending AIDS as a global public health threat. He stressed the broad participation and transparency of the process, which has included representation from governments, civil society, key populations, academia and others.

A representative of Avenir Health presented the model to be used in the estimation of the impact of the targets. The model includes data on population sizes, the estimated impact of each service included and the effectiveness and sustainability of the interventions.

The session heard presentations from the three co-chairs of the technical consultations on testing and treatment, primary prevention and addressing social enablers.

Wafa El-Sadr, from ICAP at Columbia University, said that according to the results of the technical consultation on testing and treatment, in order to leave no one behind the targets should be the same for all subpopulations, including key populations. There should also be specific targets for men and women adjusted by age group and specifically for children younger than 13 years of age. Pregnant women should have testing and treatment targets higher than 95%.

On primary prevention, Quarraisha Abdool Karim, from the Centre for the AIDS Programme of Research in South Africa, indicated that, globally, new HIV infections have declined, but the rate of the decline was far too slow to reach the 2020 target. HIV prevention requires a context-specific combination approach that includes behaviour, biomedicine and an enabling environment for service access and uptake, and the set of targets for 2025 should call for countries to address structural barriers to services. According to her, most parts of the world are not living up to their commitments to scale up primary prevention services, and so the 2025 targets must include a strong statement on HIV prevention.

On social enablers, the session heard that the response to HIV must be people-centred and be based on the principle of inclusion and participation, highlighting the need for community-led responses.

The target-setting process will feed into the new UNAIDS global AIDS strategy currently being developed.