Why are people still dying needlessly from AIDS? Politics, not science, is to blame

This is a question recently posed to us by one of our young people. Youth4Health Network. Our answer is simple and sad, but the reason is not medical.

as we observe world aids day on sundayDecember 1st The biggest hurdle remaining in the fight against HIV/AIDS in our region, and indeed in many parts of the world, is political. A restrictive and intolerant environment. Stigma, discrimination, and even criminalization of HIV infection. Inconsistent uptake of evidence-based recommended interventions.

Today, we have all the medicines, tools, and technology to eradicate AIDS. Testing positive for HIV is no longer a death sentence. Dramatic improvements in antiretroviral therapy (ART) are enabling people living with HIV to live long, healthy lives, especially if diagnosed early and kept on antiviral drugs.

surely, More people than ever are receiving lifesaving drugs. New diagnostic algorithms enable same-day diagnosis. Testing can be done in a community setting or at home. And don't forget, there are very effective preventative measures, such as pre-exposure prophylaxis, PrEP, and especially condoms.

We need to depoliticize the HIV response

Although our HIV toolbox is enriched, progress in uptake remains uneven and unequal. Prevention, testing, and treatment are not yet available to everyone. This is clear when you look at the numbers.

The WHO European Region covers 53 countries in Europe and Central Asia. The number of new HIV infections in 2024 increased by 7% compared to 2010. One in two people who test positive for HIV across the region will have a delayed diagnosis.

Half of all people with HIV in Eastern Europe and Central Asia are still not on ARTonly 42% have their virus suppressed. This means that you can no longer transmit the virus.

To completely eliminate AIDS, we must overcome stubborn hurdles and take action.

First, countries need to depoliticize their HIV response.

Across Europe and Central Asia, discrimination remains against key populations such as sex workers, men who have sex with men, transgender people, people who inject drugs, and people living with HIV in general. Too many countries are taking a regressive approach. . Sexual health and sexuality remain taboo in many countries. In this respect, some countries are making progress, albeit slowly, while others are actually retreating over time in reactionary political trends and patterns.

HIV-related stigma is a problem almost everywhere

But don't get me wrong. HIV-related stigma is a problem in every country and society to some degree. We need to ensure that HIV-related policies are compassionate, not punitive. We must treat people at risk of, living with or affected by HIV with kindness and dignity in health care settings and wider society. . We need to create safe spaces where people can access services and normalize testing, no matter who they are or where they are.

Education and public awareness ultimately remain our greatest weapon against prejudice, including comprehensive age-appropriate sex education that provides young people with the foundations of empathy, life, and love. .

Second, countries and development partners need to invest in the HIV response to take advantage of new innovations.

In July, UNAIDS reported that the global AIDS pandemic could be ended by 2030 if leaders specifically strengthen resources for HIV prevention. Prioritizing a combined prevention approach can reduce new infections.

Achieve “95 goals”

We must also keep our foot on the accelerator to achieve the 95 Goals across the WHO European Region. Developed by UNAIDS as an indicator for the 2030 Sustainable Development Goals, UN Political Declaration on AIDS 202195-95-95 means:

• 95% of people living with HIV know their status.
• 95% of people diagnosed with HIV are on sustained ART.
• 95% of people on ART have viral suppression.

With new tools and models like PrEP, self-testing, and the latest generation of ART, we can't overcome a 40-year-old epidemic with old tools and models alone, like unrealistic messages about abstinence and relying solely on condoms. . Only by acting differently can we stay ahead of the curve.

Third, we need to get information, prevention, and testing to people. And treatment.

The fact that most HIV diagnoses are made too late shows that testing strategies need to change and reach people much earlier. Any early diagnosis can help prevent serious disease and further infection. This means that key people in particular need to be confident that information, prevention and testing are available in a safe environment. The shocking truth is that medical settings and health care workers often display the worst forms of HIV-related stigma and discrimination, scaring people away from accessing life-saving services. We need to ensure that we run awareness campaigns that counter these deep-rooted misconceptions.

human right to health

After all, access to HIV prevention, treatment, and care services are all part of the human right to health. Everyone should have access to the health care services they need, when and where they need it. Our society has the medicines and tools needed to eradicate AIDS. Now we need to take advantage of them and ensure that everyone benefits.

In early 2025, the WHO Regional Office for Europe will consult with euro area countries on joint efforts to achieve the 95 goals. Our continued efforts to fight HIV/AIDS will not stand alone, but will be integrated into the broader control of infectious diseases, including other sexually transmitted diseases.

From climate change to growing resistance to life-saving antibiotics, we have multiple public health crises knocking on our door and demanding our attention. These are huge, difficult challenges with no easy answers, compared to HIV, where we know exactly what needs to be done.

But do we have the political will needed to double down on the HIV response? How can we destigmatize the health sector? How can we best invest in diagnosis and treatment to better reach key populations and connect them to the continuum of care they need?

Within the next ten years, the AIDS pandemic should be a thing of the past. Future generations won't have to worry about it. We must work harder than ever for a region and a world where the question remains, “Why are people still dying of AIDS?” After all, HIV itself is similarly confined to the history books.

Hans Kluge is WHO's Regional Director for Europe. Rob Butler is Director of Infectious Diseases, Environment and Health at WHO/Europe.

Image credits: Marcus Rose/IAS, WHO/Europe Region , UNAIDS 2024 Update, UNAIDS, – Elena Kovalenko-UNAIDS.