Press Release

Funding from Donor Governments was nearly the same as a Decade Ago, Despite an Increase in the Number of People Living with HIV of 24 percent over that period

GENEVA/SAN FRANCISCO, 6 July 2020—A new report from KFF (Kaiser Family Foundation) and The Joint United Nations Programme on HIV/AIDS (UNAIDS) finds donor government disbursements to combat HIV in low- and middle-income countries totaled US$7.8 billion in 2019, a reduction from the US$8 Billion in 2018 and nearly the same as the funding levels of a decade ago.

Half of the 14 donor governments analyzed in the study decreased their spending on global HIV efforts from 2018 to 2019; six increased; and one held steady. Donor government funding supports HIV care and treatment, prevention and other services in low- and middle-income countries.

The decline in funding was driven primarily by a decrease in bilateral funding from the United States, due to, flat funding from Congress for several years and a shrinking funding pipeline for programs, as well as the timing of disbursements. The decline is also attributable to declining funding from other donors, though to a lesser extent. While donors increased multilateral contributions to The Global Fund to Fight AIDS, Tuberculosis, and Malaria, UNAIDS, and UNITAID by more than $100 million, these gains were not enough to offset declines in bilateral funding. Since 2010, funding from donor governments other than the U.S. has declined by more than US$1 billion largely due to decreased bilateral support for HIV.

Even with its decreased funding, the United States remains the world’s largest donor government to HIV, disbursing US$5.7 billion in 2019, and ranking first in funding relative to the size of its economy. The next largest donor is the United Kingdom (US$646 million), followed by France (US$287 million), the Netherlands (US$213 million) and Germany (US$180 million).

These data feed into the broader UNAIDS global report, which examines all sources of funding for HIV relief, including local governments, non-governmental organizations and the private sector, and compares it the resources need to achieve goals related to testing and treatment. UNAIDS estimates that resources needed by the end of 2020 are US$26.2 billion, compared to US$19.8 billion currently available, leaving a gap of several billion dollars. This gap has grown in recent years as the number of people living with HIV in low and middle income countries has increased by 25% over the past decade and the number of new HIV infections remains high.

“Every dollar not invested today contributes to AIDS-related deaths and new HIV infections,” said Winnie Byanyima, Executive Director of UNAIDS. “In a world characterized by massive inequalities we must ramp up investments for realizing the right to health. It's a shared responsibility, demanding more donor funding and domestic resources, including freeing up fiscal space through debt cancellation.” “Donor governments continue their move away from funding HIV programs in low and middle income countries, while the number of people living with HIV continues to grow,” said KFF Senior Vice President Jen Kates. “This situation is likely to become more precarious in 2020 and beyond, as the effects of COVID-19 hit donor government budgets and take an increasing toll on health and economies around the world.”

The new report, produced as a long-standing partnership between KFF and UNAIDS, provides the latest data available on donor government funding based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund, UNAIDS, and UNITAID.  “Donor government funding” refers to disbursements, or payments, made by donors.

The Kaiser Family Foundation

KFF is a non-profit organization focusing on national health issues, as well as the U.S. role in global health policy.

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.

Missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services.

GENEVA, 6 July 2020—A new report by UNAIDS shows remarkable, but highly unequal, progress, notably in expanding access to antiretroviral therapy. Because the achievements have not been shared equally within and between countries, the global HIV targets set for 2020 will not be reached. The report, Seizing the moment, warns that even the gains made could be lost and progress further stalled if we fail to act. It highlights just how urgent it is for countries to double down and act with greater urgency to reach the millions still left behind.

“Every day in the next decade decisive action is needed to get the world back on track to end the AIDS epidemic by 2030,” said Winnie Byanyima, the Executive Director of UNAIDS. “Millions of lives have been saved, particularly the lives of women in Africa. The progress made by many needs to be shared by all communities in all countries. Stigma and discrimination and widespread inequalities are major barriers to ending AIDS. Countries need to listen to the evidence and step up to their human rights responsibilities.”

Fourteen countries have achieved the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally supressed), including Eswatini, which has one of the highest HIV prevalence rates in the world, at 27% in 2019, and which has now surpassed the targets to achieve 95–95–95.

Millions of lives and new infections have been saved by the scale-up of antiretroviral therapy. However, 690 000 people died of AIDS-related illnesses last year and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment.

“We cannot rest on our successes, nor be discouraged by setbacks. We must ensure that no one is left behind. We must close the gaps. We are aiming for 100–100–100,” said Ambrose Dlamini, the Prime Minister of Eswatini.

The world is far behind in preventing new HIV infections. Some 1.7 million people were newly infected with the virus, more than three times the global target. There has been progress in eastern and southern Africa, where new HIV infections have reduced by 38% since 2010. This is in stark contrast to eastern Europe and central Asia, which has seen a staggering 72% rise in new HIV infections since 2010. New HIV infections have also risen in the Middle East and North Africa, by 22%, and by 21% in Latin America.

Seizing the moment shows unequal progress, with too many vulnerable people and populations left behind. Around 62% of new HIV infections occurred among key populations and their sexual partners, including gay men and other men who have sex with men, sex workers, people who inject drugs and people in prison, despite them constituting a very small proportion of the general population.

Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers. Marginalized populations who fear judgement, violence or arrest struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention. Stigma against people living with HIV is still commonplace. At least 82 countries criminalize some form of HIV transmission, exposure or non-disclosure, sex work is criminalized in at least 103 countries and at least 108 countries criminalize the consumption or possession of drugs for personal use.

Women and girls in sub-Saharan Africa continue to be the most affected and accounted for 59% of all new HIV infections in the region in 2019, with 4500 adolescent girls and young women between 15 and 24 years old becoming infected with HIV every week. Young women accounted for 24% of new HIV infections in 2019, despite making up only 10% of the population in sub-Saharan Africa.

However, where HIV services are comprehensively provided, HIV transmission levels are reduced significantly. In Eswatini, Lesotho and South Africa, a high coverage of combination prevention options, including social and economic support for young women and high levels of treatment coverage and viral suppression for previously unreached populations, have narrowed inequality gaps and driven down the incidence of new HIV infections.

The COVID-19 pandemic has seriously impacted the AIDS response and could disrupt it more. A six-month complete disruption in HIV treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the next year (2020–2021), bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths.

“Those of us who survived HIV and fought for life and access to treatment and care cannot afford losing the gains that took so much effort to win. In some Latin American countries we are seeing how HIV resources, medicines, medical staff and equipment are being moved to the fight against COVID-19,” said Gracia Violeta Ross, President of the Bolivian Network of People Living with HIV. “Some good lessons and practices of the HIV response, such as meaningful participation and accountability, are being ignored. We will not allow HIV to be left behind.”

To fight the colliding epidemics of HIV and COVID-19, UNAIDS and partners are leading a global call for a People’s Vaccine for COVID-19, which has been signed by more than 150 world leaders and experts demanding that all vaccines, treatments and tests be patent-free, mass produced and distributed fairly and free for all.

UNAIDS is also urging countries to increase investments in both diseases. In 2019, funding for HIV fell by 7% from 2017, to US$ 18.6 billion. This setback means that funding is 30% short of the US$ 26.2 billion needed to effectively respond to HIV in 2020.

“We cannot have poor countries at the back of the queue. It should not depend on the money in your pocket or the colour of your skin to be protected against these deadly viruses,” said Ms Byanyima. “We cannot take money from one disease to treat another. Both HIV and COVID-19 must be fully funded if we are to avoid massive loss of life.”

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.

The UNAIDS Health Innovation Exchange’s global event, HIEx2020, will feature health-related innovations from around the world and facilitate discussions around innovation in health

GENEVA, 1 July 2020—The UNAIDS Health Innovation Exchange global event, HIEx2020, has opened, showcasing a virtual marketplace of more than 25 innovations for health from around the world. This year, the event, which is taking place ahead of the 2020 International AIDS Conference, has a special focus on COVID-19.

The innovations presented in the marketplace aim to respond to some of the most critical health challenges faced by countries and communities, particularly in low- and middle-income countries. Innovations range from products to detect counterfeit medicines and illicit substances to digital solutions such as telemedicine platforms that provide remote online medical services, mobile applications to promote the sexual health of young people and COVID-19 diagnostics.

“We need social innovations and to leverage technology to achieve better health outcomes. We need radical game-changers for adolescent girls and young women in sub-Saharan Africa to address persisting inequalities,” said Shannon Hader, Deputy Executive Director, Programme, UNAIDS. “The AIDS response has demonstrated that innovations driven by the passion of communities can transform health-care access and reach the most marginalized.”

One of the featured innovations uses ultraviolet-free LED lighting technology to kill viruses and bacteria, which has recently demonstrated high effectiveness on the new coronavirus that causes COVID-19.

The HIEx2020 programme will run over two days (1 and 2 July) and will feature key leaders in health and innovation. The programme of high-level events includes Lessons from COVID-19: Innovating to Future-Proof our Health Systems, Young People’s Access to Digital Health and Changing Healthcare through Innovations.

Mariya Gabriel, the European Commissioner for Innovation, Research, Culture, Education and Youth, will deliver a keynote address focused on leveraging innovation and leadership for global health. “Innovation must be part of the health-care DNA, leaving no one behind,” said Ms Gabriel. “But no individual continent, country or institution can win this race on its own. It takes a global effort and political commitment.”

HIEx2020 will feature a special spotlight on solar energy for health through a high-level discussion with ministers of health and energy from several countries, which is organized in collaboration with the International Solar Alliance. Primary health facilities in several countries lack reliable power, which not only limits quality of services but also prevents the take-up of digital health tools for scaling up access to health care. 

“Solar energy can ensure better availability and quality of health services in areas where there is a challenge of access to energy,” said Upendra Tripathy, the Director-General of the International Solar Alliance. “We should work towards scaling up solar energy as an agent for transforming primary health care in developing countries.”

Innovations for COVID-19

The COVID-19 pandemic has brought to light the crucial importance of ensuring that health systems are resilient and that countries have the necessary technologies and capacities to respond effectively to health crises.

The UNAIDS Health Innovation Exchange has been an early supporter of tracking COVID-19-related innovations. As the COVID-19 pandemic was rapidly spreading in March 2020, UNAIDS and the UNAIDS Health Innovation Exchange teamed up with StartupBlink to launch a dynamic online map of COVID-19-related innovations. The map now has more than 30 000 monthly users and includes details of more than 1000 initiatives from around the world. As part of HIEx2020, the UNAIDS Health Innovation Exchange and StartupBlink will launch an in-depth analysis of the COVID-19 initiatives in an Innovation Ecosystem Report, which will measure and rank cities and countries globally in terms of innovation for COVID-19.

To visit HIEx2020 go to: https://event.healthinnovation.exchange/

UNAIDS Health Innovation Exchange

Launched by UNAIDS in Geneva, Switzerland, in May 2019, the UNAIDS Health Innovation Exchange identifies challenges faced by implementers and connects them with innovations that have high potential for impact, and links with investors to scale up the sustainable solutions. The UNAIDS Health Innovation Exchange builds upon the expertise of political leaders, health experts, technology and science leaders, innovators, investors, accelerators, communities and implementers in countries, and advocates for indigenous solutions, local production and multisectoral partnerships.

Note: inclusion in the UNAIDS Health Innovation Exchange marketplace does not equal endorsement of the innovation by UNAIDS or the UNAIDS Health Innovation Exchange.

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, 26 June 2020—The 46th meeting of the UNAIDS Programme Coordinating Board (PCB) has concluded in Geneva, Switzerland. The PCB, which met from 23 to 25 June 2020, was held for the very first time as a virtual meeting because of the COVID-19 pandemic. The PCB, chaired by the United States of America, had decided that it would be important to demonstrate that the intergovernmental process can continue to work effectively during the COVID-19 pandemic.

During the meeting, a series of crucial decisions were taken on the future of the HIV response and on the transformation of UNAIDS, while the interconnectedness between the twin pandemics of HIV and COVID-19 was discussed and reflected upon.

“I thank the Programme Coordinating Board for the trust it has given us to take forward our ambitious agenda,” said Winnie Byanyima, Executive Director of UNAIDS. “I am excited that further work towards a new global HIV strategy for an HIV response that incorporates the COVID-19 and post-COVID-19 realities, and for a fitter and more responsive UNAIDS, has been given the green light. I’m looking forward to putting this work into action.”

The three-day meeting opened with an overview given by Ms Byanyima on the HIV/COVID-19 landscape in mid-2020, which stressed that the HIV epidemic is urgent and very much unfinished business and that the world is off course to meet the 2020 HIV targets. She urged countries to leverage the decades of investment in the HIV response and to learn the lessons from a history of unequal access to HIV services and apply them to the fight against COVID-19, including by supporting a People’s Vaccine.

The critical nature of the next UNAIDS strategy—a strategy that it was acknowledged must be ambitious, visionary, data-driven, evidence-informed, well resourced and well received—was discussed by the participants. The PCB laid out a timeline of milestones for the development of the bold new strategy and decided that UNAIDS would present a report on the outcome of the ongoing review and consultations on the strategy for approval by the end of October 2020. A draft of the strategy will be discussed at the next PCB meeting, in December 2020.

The PCB also debated the transformation of UNAIDS. The PCB heard an update on the implementation of the Management Action Plan, which was set up to ensure a healthy, equitable and enabling workplace for all UNAIDS staff. It welcomed the progress made so far and called for faster progress, particularly on strengthening systems of internal justice and redress. The PCB working group on the recommendations of the Joint Inspection Unit (JIU) also gave an update on its work to ensure that the JIU’s recommendations are acted upon.

When discussing the UNAIDS Unified Budget, Results and Accountability Framework, the PCB recognized that UNAIDS delivers on its core mandate, leads in reaching the people who are being left the furthest behind and targets inequalities. UNAIDS’ strengthened work at the country level was welcomed.

Reports on performance monitoring of UNAIDS, UNAIDS’ finances and strategic human resources management issues were examined at the meeting. The PCB welcomed the reported accomplishments of the Joint Programme in strengthening joint and collaborative action at the country level but expressed concern about the forecast US$ 15 million shortfall against the core budget. The announcement by the Government of Germany that it had contributed a further €20 million to UNAIDS in 2020 was welcomed, however. The PCB also welcomed that the reports of the external and internal auditors were discussed in a distinct agenda item, where PCB members engaged with the auditors.

The planned thematic segment on cervical cancer that was due to be held on 25 June will now be held during the December PCB meeting.

Representatives of United Nations Member States, international organizations, civil society and nongovernmental organizations attended the three-day meeting, which was chaired by the United States of America, with Namibia serving as Vice-Chair and India as Rapporteur.

The report to the Board by the UNAIDS Executive Director and the PCB’s decisions can be found at https://www.unaids.org/en/whoweare/pcb/46.

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 June 2020—The Government of Germany has announced that, in addition to its annual core contribution of €5 million, it will contribute a further €20 million to UNAIDS in 2020 to strengthen the response to HIV during the COVID-19 pandemic. The Federal Minister of Health, Jens Spahn, made the announcement during a meeting with Winnie Byanyima, the UNAIDS Executive Director, in Geneva, Switzerland, during the 46th meeting of the UNAIDS Programme Coordinating Board.

“We commend UNAIDS’ work in the fight against COVID-19, which focuses on engaging communities, ensuring that vulnerable and key populations are reached with essential health services, including HIV services, protecting basic rights and mitigating the socioeconomic impacts of the epidemic,” said Mr Spahn. “With the additional funds, we encourage UNAIDS to continue this important work alongside the World Health Organization and other global health partners.”

The Government of Germany and parliamentarians, civil society and other partners in Germany have long shown commitment to the global HIV response and to global health and health security, with Germany pledging US$ 1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria at its last replenishment. A valued partner of UNAIDS, the Government of Germany is firmly committed to ending AIDS as a public health threat by 2030 and has invested significant resources to ensure that no one is left behind.

“UNAIDS welcomes this show of support by Germany. It is an encouraging recognition of the work undertaken by UNAIDS with countries and partners to respond to HIV during the COVID-19 pandemic. It is also a crucial recognition of the lessons and experiences gained over the past decades in the HIV response, which are now being used in the fight against COVID-19,” said Ms Byanyima. “I call upon others to follow Germany’s lead and continue to invest in the global HIV response.”

German’s increased support is a critical investment in saving lives and protecting the dignity of people living with or at risk of HIV. At a time when the world faces the colliding pandemics of HIV and COVID-19, Germany is continuing to demonstrate the need for shared responsibility and global solidarity. Modelling suggests that an unmitigated six-month interruption of HIV services due to COVID-19 could double AIDS-related deaths in sub-Saharan Africa, setting the clock on AIDS-related deaths in the region back to 2008, and could increase new paediatric HIV infections by up to 162%.

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, 24 June 2020—The 46th meeting of the UNAIDS Programme Coordinating Board commenced on 23 June 2020. Held for the first time as a virtual meeting, as a result of the COVID-19 pandemic, the meeting will see three days of discussion and reflection on the HIV response, the interconnectedness between the twin pandemics of HIV and COVID-19 and the work of the Secretariat and the Joint Programme.

In her opening address to the PCB meeting, Winnie Byanyima, the Executive Director of UNAIDS, presented an overview of the HIV/COVID-19 landscape in mid-2020 and told the online audience that the HIV epidemic is still urgent, unfinished business.

“Even before COVID-19 we were not on track to meet our targets for 2020. Now the COVID-19 crisis risks blowing us way off course,” warned Ms Byanyima. “As a Joint Programme, we must address the deeper challenges to recover from this crisis to beat both pandemics and foster safe, equitable and resilient societies,” she added.

Ms Byanyima urged countries to learn the lessons from a history of unequal access to HIV services and apply them to the fight against COVID-19. She noted that millions of people died from AIDS-related illnesses while there were medicines available that could have saved their lives—leaving access to medicines to pharmaceutical companies resulted in prices that were too high for people in developing countries.

In the same vein, Ms Byanyima reiterated her call for a People’s Vaccine for COVID-19, with an international agreement that any vaccines and treatments discovered for COVID-19 be made available to all countries. “Developing countries must not be priced out,” she said.

The Executive Director also spoke about the increasing relevance of UNAIDS during a new pandemic and how it has a unique combination of experience and expertise that can help ensure that investments in the COVID-19 response reflect the vital lessons learned from the HIV response.

Supporting HIV treatment and prevention, working on the front line with communities, supporting human rights and gender equality and campaigning against stigma and discrimination—these are part of UNAIDS’ core mandate, she told the meeting. UNAIDS will continue to deliver on that mandate and reach the people who are left the furthest behind, but will also move the global policy needle and tackle the inequalities that place people at greater risk of both HIV and COVID-19, she said.

Turning to the next global UNAIDS strategy, Ms Byanyima committed that the critical new strategy, designed to shape an improved HIV response, will reflect the widest possible input and engagement—from the PCB, its constituencies and the global AIDS community. She suggested that an ambitious draft strategy be presented to the 47th meeting of the PCB in December 2020, with a final version to be reviewed and adopted by the PCB in March 2021. 

Ms Byanyima updated the PCB on the internal transformation of UNAIDS, outlining how she will bring feminist leadership principles to help change the culture of the organization. A series of other steps—including a revised performance management system and an independent ethics function—that will ensure that the transformation continues to be on course were announced.

Ms Byanyima ended her address with a reminder of the huge returns that are seen from investing in UNAIDS. She said that it is vital that UNAIDS, along with funding sources such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief, be fully funded.

“As COVID-19 has shown, investments in HIV principles, approaches and infrastructure and expertise extend far beyond the AIDS response,” she said.

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 study shows that the impact on production and logistics caused by COVID-19 could have a significant effect on antiretroviral therapy supply worldwide, but steps taken now could lessen the damage done

GENEVA, 22 June 2020— A new analysis by UNAIDS has revealed the potential impacts that the COVID-19 pandemic could have in low- and middle-income countries around the world on supplies of the generic antiretroviral medicines used to treat HIV.

The UNAIDS survey discovered that the lockdowns and border closures imposed to stop COVID-19 are impacting both the production of medicines and their distribution, potentially leading to increases in their cost and to supply issues, including stock-outs over the next two months.

“It is vital that countries urgently make plans now to mitigate the possibility and impacts of higher costs and reduced availability of antiretroviral medicines,” said Winnie Byanyima, Executive Director of UNAIDS. “I call on countries and buyers of HIV medicines to act swiftly in order to ensure that everyone who is currently on treatment continues to be on it, saving lives and stopping new HIV infections.”

Since 24.5 million people were on antiretroviral therapy at the end of June 2019, millions of people could be at risk of harm—both to themselves and others owing to an increased risk of HIV transmission—if they cannot continue to access their treatment. A recent modelling exercise estimated that a six-month disruption of antiretroviral therapy in sub-Saharan Africa alone could lead to 500 000 additional AIDS-related deaths.

The production of antiretroviral medicines has been affected by several factors. Air and sea transport is being severely curtailed, hampering the distribution of the raw materials and other products, such as packaging material, that pharmaceutical companies need to manufacture the medicines. Physical distancing and lockdowns are also restricting the levels of human resources available in manufacturing facilities. The combined result of shortages of materials and workforces could lead to supply issues and pressure on prices in the coming months, with some of the regimens for first-line treatment and those for children projected to be the severest hit.     

An array of circumstances are conspiring to add pressure on the overall cost of finished antiretroviral medicines. Increased overhead and transport costs, the need for alternative sourcing of key starting materials and active pharmaceutical ingredients and currency fluctuations caused by the forecasted economic shock are combining to push up the cost of some antiretroviral regimens. It has been estimated that a 10–25% increase in these could result in an annual increase in the final cost of exported antiretroviral medicines from India alone of between US$ 100 million and US$ 225 million. Considering that in 2018 there was an HIV financing shortfall of more than US$ 7 billion, the world cannot afford an added burden on investments in the AIDS response.

UNAIDS and partners are working to mitigate the impact. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is providing immediate funding of up to US$ 1 billion to help countries to respond to COVID-19 and is expanding the use of its procurement platform to non-Global Fund recipients. The United States President’s Emergency Plan for AIDS Relief is promoting continuity of HIV care, implementing new strategies, such as telemedicine, and allowing some programme flexibility in reporting requirements, staffing and funding re-allocation. The World Health Organization is compiling, exchanging and analysing information on HIV services that have been impacted and is liaising with manufacturers of antiretroviral medicines for emergency supply and with countries to switch to available quality alternative products and on possible mitigation measures. UNAIDS has been coordinating efforts to address the procurement and supply management challenges of antiretroviral therapy caused by the COVID-19 response.

However, a series of policy recommendations on the coordinated action that should be taken by governments and suppliers in order to resolve these issues map out how to minimize the impacts on supply chains and prices. By managing effectively current and future stocks of antiretroviral medicines, supply can be continued for all who need treatment.

The UNAIDS analysis collected information from the eight generic manufacturers of antiretroviral medicines in India that together account for more than 80% of generic antiretroviral medicine production worldwide. Government departments in seven other countries that produce generic antiretroviral medicines and that account for most of the production of generic antiretroviral medicines in low- and middle-income countries domestically were also surveyed.

More than 140 world leaders, experts and elders have made an unprecedented call for guarantees that COVID-19 vaccines, diagnostics, tests and treatments will be provided free of charge to everyone, everywhere

GENEVA, 14 MAY 2020—More than 140 world leaders and experts, including the President of South Africa and Chair of the African Union, Cyril Ramaphosa, the Prime Minister of Pakistan, Imran Khan, the President of the Republic of Senegal, Macky Sall and the President of the Republic of Ghana, Nana Addo Dankwa Akufo-Addo have signed an open letter calling on all governments to unite behind a people’s vaccine against COVID-19. The call was made just days before health ministers meet virtually for the World Health Assembly on 18 May.

The letter, which marks the most ambitious position yet set out by world leaders on a COVID-19 vaccine, demands that all vaccines, treatments and tests be patent-free, mass produced, distributed fairly and made available to all people, in all countries, free of charge.

Other signatories include the former President of Liberia, Ellen Johnson Sirleaf, the former Prime Minister of the United Kingdom, Gordon Brown, the former President of Mexico, Ernesto Zedillo, the former United Nations Development Programme Administrator and former Prime Minister of New Zealand, Helen Clark.

They join notable economists, health advocates and others, from the Chair of the Elders and the former President of Ireland, Mary Robinson, Nobel Laureate, Joseph Stiglitz, to Moussa Faki, Chairperson of the African Union Commission, Dr John Nkengasong, Director of African Centres for Disease Control and Prevention, and Dainius Puras, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

“Billions of people today await a vaccine that is our best hope of ending this pandemic,” said Cyril Ramaphosa, President of South Africa. “As the countries of Africa, we are resolute that the COVID-19 vaccine must be patent-free, rapidly made and distributed, and free for all. All the science must be shared between governments. Nobody should be pushed to the back of the vaccine queue because of where they live or what they earn.”

“We must work together to beat this virus. We must pool all the knowledge, experience and resources at our disposal for the good of all humanity,” said Imran Khan, Prime Minister of Pakistan. “No leader can rest easy until every individual in every nation is able to rapidly access a vaccine free of charge.”

The letter, coordinated by UNAIDS and Oxfam, warns that the world cannot afford monopolies and competition to stand in the way of the universal need to save lives.

“This is an unprecedented crisis and it requires an unprecedented response,” said former President of Liberia, Ellen Johnson Sirleaf. “Learning the lessons from the fight against Ebola, governments must remove all the barriers to the development and rapid roll out of vaccines and treatments. No interest is more important than the universal need to save lives"

The leaders recognize that progress is being made and that many countries and international organizations are cooperating multilaterally on research and development, funding and access, including the welcome US$ 8 billion pledged on 4 May at the European Union’s international pledging marathon.

However, as many countries and companies are proceeding with unprecedented speed to develop an effective vaccine, the leaders are calling for concrete commitments to ensure that it is made affordable and available to all in the quickest possible time. These include:

• A mandatory worldwide pooling of patents and sharing of all COVID-19-related knowledge, data and technologies in order to ensure that any nation can produce or buy affordable doses of vaccines, treatments and tests.
• The rapid establishment of an equitable global manufacturing and distribution plan for all vaccines, treatments and tests that is fully funded by rich nations and which guarantees transparent “at true cost prices” and supplies in accordance with need rather than the ability to pay.
  • This would include urgent action to massively increase manufacturing capacity to produce the vaccines in sufficient quantities and train and recruit millions of health workers to distribute them.
• A guarantee that COVID-19 vaccines, treatments and tests are provided free of charge to everyone, everywhere, with priority given to frontline workers, vulnerable people and poor countries with the least capacity to save lives.

“Faced with this crisis, we cannot carry on business as usual. The health of each of us depends on the health of all of us,” said Helen Clark, former Prime Minister of New Zealand. “The COVID-19 vaccine must not belong to anyone and must be free for everyone. Diplomatic platitudes are not enough—we need legal guarantees, and we need them now.”

“Market solutions are not optimal to fight a pandemic,” said Nelson Barbosa, former Finance Minister of Brazil. “A public health care system, including free vaccination and treatment when that becomes available, is essential to deal with the problem, as shown by the Brazilian experience with compulsory licensing of antiretroviral drugs in the case of HIV.”

Uniting behind a people’s vaccine against COVID-19—open letter and full list of signatories

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Gains made in preventing mother-to-child transmission of HIV could be reversed, with new HIV infections among children up by as much as 162%

GENEVA, 11 May 2020—A modelling group convened by the World Health Organization and UNAIDS has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021. In 2018, an estimated 470 000 people died of AIDS-related deaths in the region.

There are many different reasons that could cause services to be interrupted—this modelling exercise makes it clear that communities and partners need to take action now as the impact of a six-month disruption of antiretroviral therapy could effectively set the clock on AIDS-related deaths back to 2008, when more than 950 000 AIDS-related deaths were observed in the region. And people would continue to die from the disruption in large numbers for at least another five years, with an annual average excess in deaths of 40% over the next half a decade. In addition, HIV service disruptions could also have some impact on HIV incidence in the next year.

“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

“We must read this as a wake-up call to countries to identify ways to sustain all vital health services. For HIV, some countries are already taking important steps, for example ensuring that people can collect bulk packs of treatment, and other essential commodities, including self-testing kits, from drop-off points, which relieves pressure on health services and the health workforce. We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them,” added Dr Tedros.

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018. Those people now risk having their treatment interrupted because HIV services are closed or are unable to supply antiretroviral therapy because of disruptions to the supply chain or because services simply become overwhelmed due to competing needs to support the COVID-19 response.

“The COVID-19 pandemic must not be an excuse to divert investment from HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.”

When treatment is adhered to, a person’s HIV viral load drops to an undetectable level, keeping that person healthy and preventing onward transmission of the virus. When a person is unable to take antiretroviral therapy regularly, the viral load increases, impacting the person’s health, which can ultimately lead to death. Even relatively short-term interruptions to treatment can have a significant negative impact on a person’s health and potential to transmit HIV.

This research brought together five teams of modellers using different mathematical models to analyse the effects of various possible disruptions to HIV testing, prevention and treatment services caused by COVID-19.

Each model looked at the potential impact of treatment disruptions of three months or six months on AIDS mortality and HIV incidence in sub-Saharan Africa. In the six-month disruption scenario, estimates of excess AIDS-related deaths in one year ranged from 471 000 to 673 000, making it inevitable that the world will miss the global 2020 target of fewer than 500 000 AIDS-related deaths worldwide.

Shorter disruptions of three months would see a reduced but still significant impact on HIV deaths. More sporadic interruptions of antiretroviral therapy supply would lead to sporadic adherence to treatment, leading to the spread of HIV drug resistance, with long-term consequences for future treatment success in the region.

Disrupted services could also reverse gains made in preventing mother-to-child transmission of HIV. Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, owing to the high coverage of HIV services for mothers and their children in the region. Curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 83% in Mozambique, 106% in Zimbabwe, 139% in Uganda and 162% in Malawi.

Other significant effects of the COVID-19 pandemic on the AIDS response in sub-Saharan Africa that could lead to additional mortality include reduced quality clinical care owing to health facilities becoming overstretched and a suspension of viral load testing, reduced adherence counselling and drug regimen switches. Each model also considered the extent to which a disruption to prevention services, including suspension of voluntary medical male circumcision, interruption of condom availability and suspension of HIV testing, would impact HIV incidence in the region.

The research highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic. It will be important for countries to prioritize shoring up supply chains and ensuring that people already on treatment are able to stay on treatment, including by adopting or reinforcing policies such as multimonth dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems.

“Every death is a tragedy,” added Ms Byanyima. “We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths. I urge governments to ensure that every man, women and child living with HIV gets regular supplies of antiretroviral therapy—something that’s literally a life-saver.”

Sources:

Jewell B, Mudimu E, Stover J, et al for the HIV Modelling consortium, Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple models. Pre-print, https://doi.org/10.6084/m9.figshare.12279914.v1, https://doi.org/10.6084/m9.figshare.12279932.v1.

Hogan B, Jewell B, Sherrard-Smith E, et al. The potential impact of the COVID-19 epidemic on HIV, TB and malaria in low- and middle-income countries. Imperial College London (01-05-2020). doi: https://doi.org/10.25561/78670.

Stover J, Chagoma N, Taramusi I,  et al. Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic: Analysis using the Goals Model. Pre-print. medRxiv 2020.05.04.20090399; doi: https://doi.org/10.1101/2020.05.04.20090399

WHO

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.

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.

Overstretched health systems, lockdowns, loss of livelihoods and fewer employment opportunities could increase unprotected sex, sexual violence and exploitation, transactional sex and sex work, leading to an increase in new HIV infections

GENEVA, 6 May 2020—Despite the global progress made in HIV prevention, with new HIV infections falling by 40% since the peak in 1997, hard-won gains are in danger of being reversed by the COVID-19 pandemic sweeping around the world.

In the light of the COVID-19 pandemic, UNAIDS is urging countries to remain steadfast in their HIV prevention efforts and ensure that people can continue to access the services they need to stay HIV-free, discrimination-free and violence-free and to be able to enjoy their sexual and reproductive health and rights.

“COVID-19 is impacting almost every country and community, but the global HIV epidemic hasn’t gone away,” said Winnie Byanyima, UNAIDS Executive Director. “People are still having sex. People are still using drugs. During the COVID-19 pandemic, everyone must be given the tools they need to be safe and to protect themselves from HIV. Human rights are a cornerstone of HIV prevention and must be a cornerstone of the COVID-19 response.”

Three new documents on HIV prevention published by UNAIDS and partners in the Global HIV Prevention Coalition look at how to maintain and prioritize HIV prevention services in the context of COVID-19. They look at the critical measures needed to keep the most vulnerable alive and healthy, including the measures required to prevent and address violence against women and children, to keep the supply of critical commodities available and to sustain the livelihoods of the world’s poorest.

The documents explain that the range of options to prevent HIV—condoms, both male and female, lubricants, sterile needles and syringes and opiate substitution therapy for people who inject drugs, pre-exposure prophylaxis and post-exposure prophylaxis and treatment as prevention—are just as valid now as ever. Innovative ways of getting HIV prevention commodities to the people who need them must be found—dispensing longer-term quantities of prevention supplies, allowing distribution centres to remain open during lockdowns and protecting community distribution points are but a few possibilities.

In addition to hampering HIV prevention and treatment services, UNAIDS is concerned that the COVID-19 epidemic may increase the vulnerability of people to HIV. The widespread loss of livelihoods and fewer employment opportunities could mean that transactional sex, sex work and sexual exploitation will increase, putting people at increased risk of contracting HIV unless they have the means to protect themselves.

As well as HIV prevention commodities, the sustained availability of services and support programmes for the prevention of HIV, prevention of gender-based violence and promotion of sexual and reproductive health and rights as essential services is critical. HIV counselling and testing services, the screening and treatment of sexually transmitted infections, continuity of access to sexual and reproductive health services, peer and other community outreach services, psychosocial support services, drop-in centres for key and vulnerable populations, comprehensive sexuality education and sexual violence protection are all vital to preserving the HIV prevention response. The lockdowns imposed during the COVID-19 response have resulted in alarming increases in reports of domestic and intimate partner violence against women and violence outside the home, necessitating urgent reinforcement of prevention, protection and support services for gender-based and sexual violence.

Since social distancing and lockdowns have all but stopped face-to-face service delivery, UNAIDS is urging the introduction of innovative means through which people can access services. Physical meetings can be made safer by using appointment systems that do not allow too many people in a facility at the same time, while holding meetings and education sessions virtually and the use of telephone hotlines and SMS services all have a role to play to both keep people safe from the new coronavirus and to allow them to continue getting the help they need to stay free from HIV. HIV self-testing is a safer way to carry out HIV testing that reduces contact with other people and reduces the service burden on health facilities.

Community organizations and networks have long been essential for the AIDS response, owing to the central role they play in raising awareness, providing information, dispelling myths and countering misinformation and service delivery for marginalized and vulnerable populations. Now more than ever, community-led actors should be supported to innovate, deliver and be recognized as essential service providers for both the HIV and COVID-19 responses.

Forty years in responding to HIV have provided valuable lessons, notably that the COVID-19 pandemic will not affect everyone equally and that the most marginalized, including key populations, will be the most affected. Across the three new documents, UNAIDS urges countries to take a human rights approach and prioritize the needs of the most marginalized populations during COVID-19, including maintaining critical HIV prevention services.

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.