Resources and funding

The funding gap for HIV responses is widening. Momentum established following global agreement on the Millennium Development Goals in 2000 has been lost in the Sustainable Development Goal era. Increases in resources for HIV responses in low- and middle-income countries halted in 2017, with funding decreasing by 7% between 2017 and 2019 (to US$ 18.6 billion in constant 2016 United States dollars).  

The total funding available in 2019 for HIV in these countries amounted to about 70% of the 2020 target set by the United Nations General Assembly.

In the light of the theme of this year’s World AIDS Day, global solidarity, shared responsibility, it’s interesting to note that domestic investments in HIV responses in low- and middle-income countries have grown by 50% since 2010. Financial support for those countries provided through the Global Fund to Fight AIDS, Tuberculosis and Malaria increased by 26% between 2010 and 2017, but then declined by 15% over the next two years, leaving a 7% total increase over the nine-year period. Bilateral funding provided to those countries by the United States Government increased by 50% between 2010 and 2017 before declining by 8% over the next two years, leaving a 38% total increase since 2010 (in constant 2016 United States dollars). Contributions from other international sources declined by 50% between 2010 and 2019. Resource availability is presented in constant 2016 United States dollars in order to be comparable with the target for 2020 adopted in the 2016 High-Level Meeting on Ending AIDS.

The World Health Organization (WHO), in coordination with UNAIDS, has updated its HIV Testing Services dashboard with new data for 2020, ahead of this year’s World AIDS Day.

The interactive dashboard gives users a wide range of information on HIV testing from countries worldwide on, for example, HIV prevalence, the number of people testing positive for HIV and the number of people testing for HIV for the first time or repeating a test. Data are given in charts and tables and are differentiated by age, sex and other characteristics.

“It is critical to have differentiated HIV testing data at this stage in the epidemic,” said Cheryl Johnson, WHO Technical Officer. “Having such data will help programmes to implement the World Health Organization’s guidelines so that they may reach the remaining people living with HIV who do not know their status. We look forward to working with countries on how they can use their data to guide efficient and effective HIV testing services.”

Countries need to have a range of testing approaches to reach people living with HIV who do not know their status and others at risk of acquiring HIV. The dashboard will help countries to develop the best mix of testing services—such as self-testing, index testing and various forms of community and facility-based testing services—suitable for their settings. Countries can also monitor the progress of the number of people who newly learn their HIV status.

“We are using data to intensify our efforts to reach the remaining people living with HIV who don’t know their status and to facilitate linkage to care by prioritizing and differentiating testing so we can reach underserved geographies and populations in Uganda. The dashboard is a useful tool to help guide decision-making and our national strategy moving forward,” said Geoffrey Taasi, Programme Officer, HIV Testing Services, Ministry of Health, Uganda.

The information on the dashboard is a mixture of WHO and UNAIDS data, national programme data, modelled estimates and population survey data—it also includes the implementation status of testing services and national policies. The data used were selected in consultation with representatives of ministries of health, research partners, local and international implementing partners and donors.

In addition to the website, the dashboard can be accessed through the WHO HTS Info app using a smartphone or tablet.

“Expansion of relevant HIV testing approaches is critical for Viet Nam to achieve the 90–90–90 targets. With support from the World Health Organization and other partners, we have successfully piloted community-based HIV testing, including lay provider testing and self-testing. We are now working to scale up these approaches nationwide,” said Nguyen Hoang Long, Director-General of the Viet Nam Authority of HIV/AIDS Control, Ministry of Health, Viet Nam.

Ukraine has announced that it is now funding 80% of its national HIV response’s HIV prevention, care and support programmes.

Under its 20–50–80 transition plan, which began in 2018, the government committed to increasing its share of the funding of HIV prevention, care and support programmes, which previously were fully funded by international donors, over three years. In the first year of the transition plan, the state was to finance 20% of those programmes, with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) providing 80%. In the second year, the ratio was to reach 50/50 and in the third year 80% of funding was to be provided by the state, with 20% from by the Global Fund. This level of funding, which comes from both national and local budgets and is for prevention, care and support programmes within the national HIV and tuberculosis (TB) response and for the procurement of HIV/TB-related services from community organizations, has now been achieved.

The transition plan was proposed by a group of public and community organizations led by 100% Life, formerly called the All-Ukrainian Network of People Living with HIV. Dmytro Sherembey, the Head of the Board of 100% Life, said that most of the funding of the country’s HIV response used to come from donors, primarily the Global Fund. The 20–50–80 formula provided a simple algorithm tied to an agreed timeframe and obliged the government to increase domestic funding, since under the plan donor financing would be stopped if the government failed to meet its obligations.

“It was not an easy decision. It would have been easier to just sign a grant with the Global Fund. But we understood that if the government did not increase its funding, about half a million people who use the services would be left with nothing,” said Mr Sherembey. Also, since the government is unable to provide a wide spectrum of HIV prevention, care and support services on its own, community organizations have stepped in. However, there was a worry that reduced funding for community organizations would result in their being unable to provide such services, resulting in hundreds of thousands of people being deprived of care.

A Strategic Group for the Implementation of the Transition Plan, which included the Public Health Centre of Ukraine’s Ministry of Health, 100% Life, UNAIDS, the ICF Alliance for Public Health, Renaissance and Deloitte, developed new mechanisms through which local community organizations could cooperate with local authorities. The Sumy and Poltava regions of Ukraine were the first to start financing HIV and TB programmes from domestic funding. In 2018, the equivalent of more than US$ 650 000 was allocated to the programmes from Ukraine’s state budget.

“The transition plan provides an opportunity to continuously strengthen links between government and nongovernmental organizations in the provision of quality services to people living with HIV and tuberculosis. Nongovernmental organizations are moving away from their former role of volunteer activists and are starting to carry out professional social work and are accountable for its results. And the state, in turn, purchases their services through the public procurement system,” said Igor Kuzin, the Acting Director of the Centre for Public Health of the Ministry of Health of Ukraine.

With the support of Ukraine’s Ministry of Finance, the implementation of the transition plan progressed. In 2019, about US$ 4 million was allocated, equal to 50% of funding, which reached 25 regions in Ukraine. In 2020, the cost to the government of treatment and other services is expected to be about US$ 12.5 million, which is 80% of funding for such programmes.

“Together with the Public Health Centre of Ukraine’s Ministry of Health, and international and civil society partners, we will carefully monitor and analyse the results of this new model of HIV service delivery in order to ensure its sustainability, effectiveness and consistency,” said Raman Hailevich, the UNAIDS Country Director for Ukraine.

The Russian Federation has donated a mobile clinic to Uzbekistan to provide primary health care for people in remote and hard-to-reach regions of the country, including testing for HIV, COVID-19 and other diseases.

The mobile clinic is equipped with the latest medical equipment and diagnostic systems, including for HIV and COVID-19, and is ready to provide people with access to integrated HIV testing and counselling and other forms of medical diagnostics and treatment.

“Thanks to this programme, the citizens of Uzbekistan living in different regions of the country will be able to receive timely information about the symptoms and ways of transmission of infectious diseases, which has become more important than ever,” said Botirjon Asadov, Uzbekistan Ambassador to the Russian Federation.

The clinic was donated as part of a technical assistance programme supported by the Russian Government that is being implemented by UNAIDS in partnership with the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) and the nongovernmental organization AIDS Infoshare.

The programme aims to strengthen health systems, ensure better epidemiological surveillance of HIV and promote the scale-up of HIV prevention programmes among populations at higher risk in Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan.

“Our work in today’s coronavirus pandemic is more relevant than ever. We continue our cooperation to fight COVID-19 and fully support the efforts of the Uzbek authorities to normalize the epidemic situation in the country as soon as possible, and assure that the Russian Federation is ready to provide the necessary assistance,” said Irina Bragina, Deputy Head of Rospotrebnadzor.

To date, 12 mobile clinics have been donated—four to Tajikistan, three to Armenia and five to Kyrgyzstan. Apart from the primary health-care services and a range of HIV screening services, the clinics provide tests for COVID-19, viral hepatitis and sexually transmitted infections and obstetrics, gynaecology, cardiology and urology care. All the mobile clinics offer services free of charge. So far, more than 1.6 million people have used the services provided by the clinics.

“Mobile clinics today not only continue providing primary health-care services, including HIV testing, but also have come to the forefront to combat a new threat—COVID-19,” said Aleksandr Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

As the Global Fund to fight AIDS, Tuberculosis and Malaria—one of the main donors for the HIV response in the last 20 years in Eastern Europe and Central Asia (EECA)—is moving away from funding the HIV response in EECA, the region is looking for ways to invest their available domestic resources in a much more cost-effective way.

“There are purely epidemiologic and economic arguments behind this transition,” said Dumitru Laticevschi, Regional Manager Eastern Europe and Central Asia Team, The Global Fund. “The economies here are considerably better for the same level of disease burden than the average in the world, that’s why it is expected that the region increasingly takes care of the epidemic by itself.”

The key challenge for the Global Fund, UNAIDS and other partners is to strengthen national responses and “to squeeze the problem to a size that is manageable for the governments to take over,” added Mr Laticevschi.

A series of HIV allocative efficiency studies conducted in 2014 in the region with support from the World Bank, UNAIDS Secretariat and some cosponsors, the Global Fund, USAID/PEPFAR and other partners, recommended countries to prioritize investment in the most cost-effective interventions to maximize health outcomes, including updating HIV testing and treatment protocols, reducing treatment costs, and optimizing service delivery. The studies were based on the Optima HIV mathematical modelling approach which has been applied in over 60 countries globally to help support HIV-related investment choices.

Recently, a new wave of the allocative studies was concluded in 11 countries of the region (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Romania, Tajikistan, Ukraine, and Uzbekistan). Individual reports with a set of recommendations for each country, as well as a regional report with aggregated results from the eleven-country analysis are available here.

“We provided the technical support for these analyses,” said Sherrie Kelly, Team Lead HIV, TB, and Malaria Applications, Burnet Institute who supported the 2014 and 2019 studies in EECA. “We have the models in place and work with the national teams. The countries are the owners of the projects, data, and results. We are just the mathematical modelers.”

The modeling is informed by demographic, epidemiological, behavioural and other data, as well as expenditure estimates provided by national teams and available in the literature. The epidemic model is overlaid with a programmatic costing component and a resource optimization algorithm. Results are intensively discussed and validated by national teams and key stakeholders from respective countries. The UNAIDS Secretariat facilitated the entire process to ensure the capacity of national partners to facilitate optimized health spending was strengthened.

“We hope that the recommendations from the study will help our national partners to adjust National Strategic Plans and to focus on the most efficient, cost-saving interventions with maximum health outcomes and will not only save money, but will save people’s lives,” said Alexander Goliusov, UNAIDS Regional Director in EECA a.i..

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.

UNAIDS Executive Director Winnie Byanyima’s statement on the economic response to COVID-19 during an online event held on 16 April 2020 cosponsored by the Global Development Policy Center and the United Nations Conference on Trade and Development

COVID-19 is killing people. However, the scale and the consequences of the pandemic are man-made.

It was not inevitable that there would be thousands of lives lost and millions of livelihoods destroyed. Those losses are the result of the extreme inequality that is hardwired into our global economy.

The steepness of the mortality curves, the depth of the economic losses and the social upheavals in different countries are the consequences of our policy choices, a function of the economic model that we have created.

COVID-19 has pushed the world into a recession. The International Monetary Fund is reporting that the great lockdown is going to be worse than the global financial crisis of 2008. According to the International Labour Organization, COVID-19 is expected to wipe out the equivalent of 195 million full-time jobs.

As we know from the HIV epidemic, epidemics wreak havoc in an unequal world. They feed off existing inequalities and hit the most vulnerable and marginalized the hardest—those who have no access to health care, who have no social safety net, who have no right to sick leave or who have no water with which to wash their hands. The people whose right to health is denied are those who are hit first and hit the hardest.

When governments prioritize privatized health-care systems over publicly funded universal health care they are making a choice, they are saying that the right to health becomes a privilege for the few who can afford it. When an epidemic hits, that choice translates into a decision about who will live and who will die. Those with the privilege of access to health care live, those without, die.

Governments must invest in universal social protection. In poor communities around the world, we are hearing: “If we cannot work, we will die of hunger before we get sick from the coronavirus.” This is a choice no one should have to make. This health crisis is rapidly becoming a food crisis.

Across our economy, we see business models that rely on workforces that are not protected. Models that exploit workers and suppliers, that do not support or protect them.

The climate crisis is another consequence of our rigged economic model, exploitative of the ecosystems on which we depend. And again, it is the poorest, those least responsible for the exploitation, who are the hardest hit. Right now in the Pacific, people are not only struggling against COVID-19 but are recovering from the aftermath of Cyclone Harold.

None of this is an accident. It is by design. Earlier, I said that we are living with man-made choices, and in many ways they are MAN-made. It is men who still dominate corporate boardrooms and the corridors of political power, while it is women who take the biggest burden of caring for others—women who must look after sick relatives in a pandemic or who walk further to find drinking water.

But the story is not all bleak. We are seeing some silver linings; some lessons are being learned. We are seeing more awareness of the importance of health and social protection. This means that if we are to recover, we must reset—we can’t go back to where we were.

We are seeing some countries imposing what they are calling solidarity taxes on big businesses and on wealthy individuals. We are hearing about cancellation of student debt, health fees being waived, including user fees, and more support for carers. This is a new agenda.

However, we are seeing other countries moving in a different direction—tax cuts for the rich, bailouts for big companies, without any guarantee that those bailouts are going to translate into support for the workers and suppliers on the ground. So, we are seeing different signals.

Health spending and social protection must be increased. This could be the basis for the rebuilding, not so that it’s not just a patch-up with bailouts.

We must come out of this crisis differently, with a determination to change the economic model. We need a Global Green New Deal, where the stimulus is invested in people and in the planet.

A new economic model that expands universal health coverage and universal social protection to all, that boosts decent work and pays decent wages, where the rewards are distributed across the whole supply chain and every stakeholder benefits equitably. And a model in line with the Paris Agreement on climate change.

We have a chance to make different choices and I am praying that world leaders will decide to make different choices.

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.