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2020 Global AIDS Update ⁠— Seizing the Moment ⁠— Tackling Entrenched Inequalities to End Epidemics

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2020 Global AIDS Update ⁠— Seizing the Moment ⁠— Tackling Entrenched Inequalities to End Epidemics GLOBAL AIDS UPDATE | 2020 SEIZING THE MOMENT Tackling entrenched inequalities to end epidemics Cover photo credit: UNAIDS, iStock, GettyImages GLOBAL AIDS UPDATE | 2020 SEIZING THE MOMENT Tackling entrenched inequalities to end epidemics 2 GLOBAL AIDS UPDATE 2020 CON TENTS 6 Foreword 8 INTRODUCTION AND SUMMARY 10 Coming up short in a milestone year for HIV responses 13 Progress towards the 90–90–90 targets 17 Gaps expose entrenched inequalities 26 People-centred approaches to pandemics 33 Seizing the moment 40 ADVANCING TOWARDS THE THREE ZEROS 44 Zero new infections 01 47 Zero AIDS-related deaths 51 Zero discrimination 56 Maximizing the impact of HIV responses 61 Measuring HIV epidemic transitions 60 2020 COMMITMENTS 70 Gains in HIV testing and treatment 02 74 Region and country progress 79 Declines in condom use among young women 81 Combination prevention for key populations 85 Pre-exposure prophylaxis 85 Voluntary medical male circumcision 106 SYNERGIES BETWEEN PANDEMIC RESPONSES 112 Leveraging HIV leadership and lessons against a new pandemic threat 03 114 Adapting HIV services during the COVID-19 pandemic 118 Turning a crisis into an opportunity for multimonth dispensing of HIV medicines 121 Avoiding antiretroviral medicine stock-outs during the COVID-19 pandemic 123 Adapting services for key populations during the COVID-19 pandemic Contents 3 Credit: Doctors of the World 128 SECURING RIGHTS 133 Sexual and reproductive health and rights 04 136 Unequal gender norms undermine health rights 138 Gender-based violence 143 Challenges faced by adolescent girls and young women 144 Access to education 146 Working without pay or protections 148 Comprehensive approaches to empowerment and health 156 Laws and policies 172 SUSTAINABLE, PEOPLE-CENTRED APPROACHES 177 HIV responses and universal health coverage 05 179 Integrating HIV and other health services 195 Leaving no one behind 213 Investment and sustainability 215 HIV funding is losing momentum 218 HIV financing during global crises 222 No simple trade-offs 238 REGION PROFILES 240 Eastern and southern Africa 06 258 Western and central Africa 272 Asia and the Pacific 292 Latin America 306 Caribbean 322 Middle East and North Africa 338 Eastern Europe and central Asia 352 Western and central Europe and North America 362 ANNEX ON METHODS 364 Part 1. Methods for deriving UNAIDS HIV estimates 07 369 Part 2. Methods for deriving the 90–90–90 targets 375 Part 3. Data on key populations 377 Part 4. Subnational HIV estimates for sub-Saharan Africa 379 Part 5. Laws and policies scorecards 4 GLOBAL AIDS UPDATE 2020 5 SEIZING THE MOMENT — Like the HIV epidemic before it, the COVID-19 pandemic is exposing our world’s fragilities—including persistent economic and social inequalities and woefully inadequate investments in public health. In many parts of the world, COVID-19 is colliding with the ongoing HIV epidemic. As the latest UNAIDS report shows, the HIV epidemic remains enormous, unfinished business. Gender inequalities, gender-based violence and the criminalization and marginalization of vulnerable groups continue to drive HIV forward. This crisis is a wake-up call to do things differently. We need a recovery based on economic and social justice since response gaps in pandemics, whether HIV or COVID-19, lie along the fault lines of inequality. António Guterres United Nations Secretary-General 6 GLOBAL AIDS UPDATE 2020 FOREWORD — The COVID-19 pandemic has be reversed. Especially as there is changed our world immeasurably still so far to go to finish the job. over the past six months. Of the 38 million people living with I am proud that decades of HIV, 25.4 million people are now on experience in responding to HIV treatment. That means 12.6 million are being used in the response to people are still waiting. New HIV the coronavirus, and that activists infections have been reduced by all over the world are working hard 23% since 2010, thanks in large part to make sure that the disruption to a substantial decrease of 38% in to HIV services is minimized. This eastern and southern Africa. But HIV report profiles some activists, like infections have increased by 72% in Theary So from Cambodia who has eastern Europe and central Asia, by been living with HIV for 15 years. 22% in the Middle East and North Theary provides counselling services Africa and by 21% in Latin America. every day at the Khmer–Soviet Friendship Hospital in Phnom Penh, Globally, there were still 690 000 the country’s first HIV treatment site AIDS-related deaths in 2019 and that is now being used to respond 1.7 million new infections. Our 2020 to COVID-19. targets of reducing AIDS-related deaths to fewer than 500 000 and Our progress towards ending new HIV infections to fewer than 500 AIDS as a public health threat by 000 will be missed. 2030 was already off track before the COVID-19 outbreak. Now this Gender-based violence and crisis has the potential to blow us inequalities continue to drive the even further off course. Modelling epidemic. In sub-Saharan Africa, conducted on behalf of UNAIDS and young women and adolescent the World Health Organization has girls accounted for one in four shown that a six-month disruption new infections in 2019, despite to medical supplies could result in making up about 10% of the total an additional 500 000 AIDS-related population. deaths in sub-Saharan Africa alone by the end of 2021. It is estimated that globally 243 million women and girls (aged 15–49 We cannot allow the hard-fought years) have been subjected to sexual gains made in the HIV response to and/or physical violence perpetrated Forword 7 by an intimate partner in the past 12 months. Meanwhile, we know that women who experience such violence are 1.5 times more likely to acquire HIV than women who have not experienced violence. Among marginalized groups, a high prevalence of violence is also linked with higher rates of HIV infection. Credit: UNAIDS Female sex workers have a 30-times greater risk of acquiring HIV than the general population. of unequal access in dealing with HIV has been slipping down the We know how to treat HIV and how HIV. Millions died of AIDS-related international agenda for some years. to prevent people from becoming illnesses while there were medicines That is why I am calling on leaders infected. What we desperately need available that could have saved their to come forward to support a United is a different politics to guarantee lives. We must ensure that COVID-19 Nations General Assembly High- that everyone everywhere has the treatments and an eventual vaccine Level Meeting on Ending AIDS in right to health. against the coronavirus are made 2021 to address with urgency the available to everyone everywhere, outstanding issues that are holding This must include concerted efforts free at the point of use. A People’s us back from ending the epidemic to dismantle the injustices and Vaccine. as a public health threat by 2030. inequalities that put young women and girls, gay men and other men We need a multisectoral response to We must not drop the ball on HIV. who have sex with men, sex workers, HIV and other epidemics by making transgender people, people who sure, for example, that boys and girls The UNAIDS 2020 global report is a use drugs, prisoners and migrants complete secondary education, that call to action. It highlights the scale at greater risk of becoming infected people are no longer criminalized of the HIV epidemic and how it runs with HIV. for who they are or who they love, along the fault lines of inequalities. that there is a rights-based public We can and must close the gaps. The HIV prevention crisis must health approach to drug use. be tackled by granting everyone everywhere the right to health, Successful pandemic responses tearing down the barriers that stop must be rooted in human rights, be people receiving essential services. evidence-based, community-led In tackling COVID-19, we must learn and fully funded. We must learn the Winnie Byanyima the painful lessons from a history lesson once and for all. UNAIDS Executive Director 8 GLOBAL AIDS UPDATE 2020 INTRODUCTION AND SUMMARY — A deadly virus jumps the species approach. For COVID-19, the time Efforts to undo centuries of barrier and quietly spreads. Little is frame for debate and change has inequality have been slow and prone done at first. Denial, discrimination been compressed from years to to setbacks. The shackles of poverty, and discord undermine an effective weeks. racism and sexism have been too response. The poor and marginalized easy for the privileged to ignore. are the most exposed to infection As health systems mobilize, A ravenous hunger for economic and death, and the least able to communities lock down and growth has too frequently overcome cope with the broader impacts of the economies slide into recession, calls for action on climate change, disease. Resentment and frustration COVID-19 has reminded the world and for expanded access to health build. Emotions boil over. Protestors of uncomfortable truths. Women care and strengthened social safety march. are beset by violence in their own nets. homes. Girls outside of school When HIV emerged as a global are exposed to harmful practices, Simmering frustrations are again pandemic, change took years. When including early marriage. Regulations boiling over. Powerful men sexually the calls from activists and the coffins and policing measures ostensibly assaulting young women cannot be of the dead could no longer be aimed at maintaining law and tolerated. #MeToo. The killing of ignored, consensus was achieved, order are used to harass and harm unarmed black men by white police and global commitments were minority groups, the poor and the officers is not a reasonable use of made.
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