Topics

Gathered in Amsterdam for the annual Fast-Track Cities conference between 25 ─ 27 September 2023, cities shared their various initiatives toward achieving key HIV targets.

In Nairobi, Kenya a situation analysis conducted at a granular level helped the county to better understand the gaps in the HIV response and to identify priority actions. The data showed that there was a lack of in health service points, especially for key populations and young people living in informal settlements. In addition, stigma and discrimination also keeps people away. Zipporah Achieng, a young person living with HIV navigating the dusty streets of Kibera, one of several informal settlements, can attest to this. “Before, life was not easy, the healthcare workers were not well trained, and when they saw youth coming to the hospital, they would start judging them, discriminating them.”

The Nairobi City County, with the support of the USAID-funded joint UNAIDS-IAPAC Fast-Track Cities project, developed activities to create awareness, address vulnerabilities, and reduce discrimination with a focus on young people. Informal settlements house up to 60% of Nairobi’s population despite covering less than 10% of the city. Over a period of five years, community members worked hand in hand with healthcare providers in the establishment of 30 friendly health centres for young people and men who have sex with men and sex workers. As a result, stigma against people living with HIV has been reduced while the uptake of HIV and other health services increased significantly during this time.  

Ms Achieng is now a peer educator. She goes out in the community sharing her experience and getting people to come to the clinic. “Now I know what is right and what is wrong, I’m happy because life has changed, life is sweet, there is medicine, there is support, and I’m just happy,” said Ms Achieng.

Nairobi's commitment to fast-tracking HIV services for young people and key populations not only contributed to the city's own public health goals but also set an inspiring example for other urban centres in the country.

Discussions about sex and HIV in Indonesia remain taboo and information limited. As a result, HIV-related knowledge is low, especially among young people. In 2018, UNAIDS created an online chatbot named Tanya Marlo and integrated it in the popular messaging application LINE. “Before Marlo, finding reliable information about HIV and sexual health was really hard. It was difficult to get the right information”, says Arisdo Gonzalez, a user of the online application.

Support provided by the Fast-Track Cities project allowed this pilot to grow into a key tool to reach young people and increase HIV prevention and testing.

Last year alone, 200 000 engagements were recorded on social media and on average 100 users are directed to counselling every month. “Tanya Marlo has been an absolute hit among young people in Indonesia,” said Tina Boonto, UNAIDS Country Director in Indonesia. “Young people feel that they can chat with Marlo anytime, anywhere, and in secret, nobody has to know about it.” To ensure its sustainability and further development, a community group, YKS, has taken over the management of the application.

Kyiv joined the Fast-Track Cities initiative in 2016 and had made remarkable progress towards key HIV targets until Russia declared war in Ukraine. Many feared that treatment, HIV services and outreach would disintegrate.  Thanks to emergency funds and the support of the Fast-Track Cities project, a number of interventions were put in place to help those in need, in particular members of key and vulnerable populations like people who inject drugs and LGBTIQ+ members. “Since the invasion, we have managed to maintain our test numbers, didn’t lose a single patient, and ensured continued access to antiretroviral therapy” said Dr. Vitali Kazeka, Director of the Kyiv AIDS center.

One of Kyiv's notable achievements is the establishment of shelters designed to cater to the unique needs of key populations affected by HIV. These shelters provide a safe and supportive environment while also ensuring access to essential healthcare services, counseling, harm reduction programmes, and education about HIV prevention. “The Fast-Track Cities project makes people living with HIV, and those from key population groups, feel like equal citizens of the city… They see that there are special initiatives that care about them and their future,” said Nataliia Salabai, UNAIDS Fast-Track Cities focal person in Kyiv.

Launched in December 2014, the Fast-Track Cities partnership has grown to more than 500 cities and municipalities that have committed to accelerate their local HIV, tuberculosis (TB), and viral hepatitis responses to achieve Sustainable Development Goal (SDG) 3.3 by 2030.

More than half of the world’s population currently live in cities and cities account for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases. The risk of contracting, and vulnerability to, HIV and TB infection is often higher in urban areas compared to rural areas, because of urban dynamics such as social networking, migration, unemployment and social and economic inequalities.

UNAIDS’ Global AIDS Update The Path that Ends AIDS underscores 2 main challenges faced by voluntary medical male circumcision (VMMC) programmes: diminished funding and low coverage among men in their twenties and older. Since VMMC was recommended by WHO and UNAIDS in 2007 as key to HIV prevention in high-prevalence settings, about 35 million men have accessed services across the 15 VMMC priority countries. While this shows good progress, the Global AIDS update highlights that VMMC coverage remains far from reaching the 90% global coverage target for impact in many subnational areas of priority countries. Additionally, funding has declined by almost half since 2020 from approximately US dollars 285 million to US dollars 147 million for the 15 countries funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). But questions have arisen about VMMC’s cost-effectiveness under growing coverage of other biomedical interventions, such as antiretroviral treatment.

“We need strong political leadership to scale up implementation of VMMC programmes; tackle the inequalities holding back progress; and ensure sufficient and sustainable funding” said Angeli Achrekar, UNAIDS Deputy Executive Director of Programmes. “Countries that are putting people and communities first in their policies and programmes are already leading the world on the journey to ending AIDS by 2030.”

Voluntary medical male circumcision is a simple, safe procedure that has proven to reduce the risk of HIV transmission by up to 60% in heterosexual men. But is it cost effective? For how long must policy makers continue to promote VMMC among adolescent boys and adult men across VMMC priority countries? This is what a group of researchers investigated.

Now published in The Lancet Global Health and using 5 existing mathematical HIV models, the researchers aimed to assess whether providing VMMC for the next 5 years would continue to be a cost-effective use of HIV programme resources in sub-Saharan Africa. The models applied assumptions based on HIV epidemiology in VMMC priority countries focusing on Malawi, South Africa, and Zimbabwe. The impact and cost-effectiveness were projected over 50 years to capture clients’ lifetime HIV exposure and infection.

Findings reveal that a continuation of VMMC was cost-effective even in regions with low HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 1 per 100 person-years in men aged 15–49 years, increasing to 95% with HIV incidence greater than 10 per 100 person-years They underscored VMMC’s importance in continuing to avert HIV infections and related healthcare costs over time.

While details of the results varied by country and model (see Box1), overall VMMC was shown to be highly cost-effective and even cost saving in nearly all countries and scenarios.

The authors concluded that despite the scale-up of antiretroviral therapy and low HIV incidence in some settings, the continuation of VMMC for at least the next 5 years is cost-effective in almost all settings considered in this study.

“Clearly, intensified efforts and commitments are needed to scale up VMMC while at the same time sustaining these services to reach men and boys,'' said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and STI Programmes. “The new Global AIDS report shows a widening gap for men that is important to recognize and address efficiently and effectively for their own health and to reduce new infections.’’

These analyses support a call to action on intensified efforts to reach men and boys in general and for continued funding for VMMC programmes. The discussion on VMMC sustainability is crucial. UNAIDS and WHO are urging countries to intensify their efforts in scaling up VMMC to global coverage targets (90%), at the same time address programme sustainability.

In the 2025 HIV Prevention Roadmap, VMMC remains a core component of combination HIV prevention under the pillar of men and boys. It is not only cost-effective, but also, cost-saving in many settings. Accordingly, continued progress towards male circumcision coverage targets in all the VMMC priority countries must be accelerated

NEW YORK/GENEVA, 21 September 2023—UNAIDS has designated the First Lady of Botswana, Neo Jane Masisi, as a UNAIDS champion for the empowerment and engagement of adolescent girls and young women. UNAIDS Executive Director, Winnie Byanyima, confirmed the appointment during a meeting with Mrs Masisi during the 78^th session of the United Nations General Assembly in New York.

“Her Excellency Mrs Masisi has a deep understanding of the structural barriers that are making adolescent girls and young women so vulnerable to HIV infection in Botswana and right across Africa,” said UNAIDS Executive Director, Winnie Byanyima. “Mrs Masisi is a fierce advocate for the rights of young women and girls and for the need to support them to stay in school, finish their education and receive the knowledge they need to help them thrive.”

Mrs Masisi has already been working closely with UNAIDS for several years as an advocate for young people. In her new role, Mrs Masisi will champion Education Plus, an initiative launched by UNAIDS, UNESCO, UNICEF, UNFPA and UN Women to prevent HIV infections through free universal, quality secondary education for all girls and boys in Africa, reinforced through comprehensive empowerment programmes. Botswana joined the initiative in June.

In Botswana, young girls aged 15-19 years old are seven times more likely to become infected with HIV than their male counterparts. During the meeting the First Lady said that surveys showed that between 2015 and 2019 young women and girls accounted for 36% of all new infections in Botswana and 19 are boys and 43 girls become infected every week.    

“I will be serving with this special title at a crucial moment. The SDGs are just around the corner and it is the last sprint to end AIDS by 2030,” said Mrs Masisi. “We will be discussing some hard issues to protect our children and young people. But the good thing about our communities today is that they realise that these are not ordinary times, and they know that doors that were closed, mouths that were sealed—its time they were opened. I remain resolute in directing energies to supporting young people in my country.”

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.

NEW YORK/GENEVA, 19 September 2023—UNAIDS has named the First Lady of Sierra Leone, Fatima Maada Bio, as a UNAIDS champion for the empowerment and engagement of adolescent girls and young women in Sierra Leone. UNAIDS Executive Director, Winnie Byanyima, confirmed the appointment during a meeting with Mrs Maada Bio and her husband President Julius Maada Bio at the 78th session of the United Nations General Assembly taking place in New York.

“I am delighted to welcome Her Excellency Mrs Fatima Maada Bio to the UNAIDS family as a champion for adolescent girls and young women,” said Ms Byanyima. “The First Lady is a strong advocate for the empowerment of women and girls. I look forward to continuing to work together to end gender inequalities that drive HIV including sexual and gender-based violence, and to ensuring that our girls and young women have all the information and knowledge they need to lead healthy lives.”

Mrs Maada Bio is a leading advocate for the Hands Off Our Girls Campaign, a movement launched by President Maada Bio in December 2018 to ban early child marriage and end sexual violence against women and girls. In 2022, she spearheaded the adoption of the first ever World Day for the Prevention of, and Healing from Child Sexual Exploitation, Abuse and Violence, which is commemorated annually on 18 November.

Mrs Maada Bio is also a champion of Education Plus, an initiative launched by UNAIDS, UNESCO, UNICEF, UNFPA and UN Women to prevent HIV infections through free universal, quality secondary education for all girls and boys in Africa, reinforced through comprehensive empowerment programmes.

“My hope is for a future where all women have equal rights,” said Mrs Maada Bio. “Where women and men can sit at the same table and make decisions together, where women are given the space to lead. That is my hope because then we will know that real equality has arrived for us all.” 

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.

Thailand’s HIV response can provide important learning for other Southeast Asian countries, with the experience of having already reached 90-90-97 in the treatment cascade in 2022, on the way to the achieving the “triple 95s”. The country was first in the region to eliminate mother-to-child HIV transmission. AIDS-related deaths have declined by 65% since 2010. With support from Australia’s Department of Foreign Affairs and Trade (DFAT), UNAIDS helped organise for Thailand to share lessons it has learned in its HIV response with Indonesia through a south-to-south learning exchange mission of Indonesian delegates to Thailand.

On day one, the Indonesian Ministry of Health and Thai Ministry of Public Health delegates discussed the HIV epidemic, trends, and challenges in each country. They shared insights on HIV prevention, treatment and stigma reduction in the HIV response. The following day, the mission team visited community organisations— including the Service Worker in Group Foundation (SWING), a non-governmental organization working for sex worker rights, and the Rainbow Sky Association of Thailand (RSAT), an organization that offers sexual healthcare for men who have sex with men, migrants, people who use drugs, sex workers and transgender people.

Multidisciplinary care is provided in Thailand to people living with HIV and to key populations through community service providers, incorporating certified community counsellors, medical technicians and caseworkers at the community facilities, and through doctors, nurses, pharmacists and laboratory scientists through the telehealth system.

Indonesia’s delegates on the visit highlighted that they had found helpful areas to improve community engagement in their national HIV programme, with a focus on effectively addressing the barriers and limitations in the HIV response that are interlaced with stigma and discrimination across Indonesia.

“We learned how Thailand prioritised zero discrimination, one of which is developing an e-learning curriculum for healthcare workers to minimise stigma and discrimination in healthcare facilities,” said Dr Endang Lukitosari, who heads the National AIDS Programme of Indonesia’s Ministry of Health.

Thailand’s delegates shared experiences from their community complaint support and crisis response system. Health workers, communities and clients can use QR codes at various locations to report rights violations, promoting accountability and coordination between health facilities and community organisations.

The Ministry of Public Health of Thailand noted that community workers are actively involved in the HIV response throughout a robust system of accreditation for both individual community health workers and community organisations. There are health insurance options for all users, including three that can be accessed by migrants. These initiatives help create an enabling environment, led by the government, to connect communities with marginalised groups and tackle issues such as loss to follow-up.

Indonesia’s delegates noted the significance of community mobilisation in the HIV response and envisaged that by putting community in the centre they would reach the most marginalised and underserved groups across different islands and highlands in Indonesia.

“Thailand's comprehensive service delivery inspired me, especially through the Ministry of Public Health's accreditation and certification system for communities. This cooperative mechanism across the government and community stakeholders is the one we haven’t sufficiently addressed in Indonesia. Perhaps by applying this approach, we can minimise the gaps in the treatment cascade by ensuring we leave no one behind”, said Irfani from GWL-INA, Indonesia’s network of men who have sex with men and transgender people.

Over the five days, Indonesian delegates explored public HIV service centres and treatment facilities in Bangkok, Thailand and learned about how efforts of communities and government in HIV prevention and control could be streamlined and coordinated by enhancing the continuum of care and minimising loss to follow up. Notably, Thailand emphasised integrated, One-Stop, services as pivotal for a successful HIV response. Indonesia’s delegates sought a pathway for sustainability in the HIV programme through lessons from the continuity of HIV treatment services in Bangkok, which connects clients with community clinics and public health facilities through referral system and telehealth.

Delegates agreed that this learning mission highlighted key features in efforts to reduce stigma and discrimination, mobilise communities in HIV response, and improve access to quality healthcare by tackling barriers. In addition, the mission underscored efforts to support the delivery of client-centred services for key populations. The debriefing concluded with a commitment to continue the technical partnership on HIV between the two countries.

"I believe Indonesia can do it," said Krittayawan Boonto, UNAIDS Country Director of Indonesia. "Indonesia is in a similar situation to the one Thailand faced a few years ago. Thailand's strategies contributed to getting closer to their goals. I see potential in Indonesia to accelerate progress towards triple 95s. I hope these learnings from Thailand mission can advance the HIV response in Indonesia. UNAIDS Indonesia will keep supporting efforts to end AIDS by 2030."

UNAIDS Executive Director, Winnie Byanyima, joined women’s coalitions, government officials, development partners and community groups from across East and Southern Africa to launch the HIV Prevention Choice Manifesto. Led by the African Women Prevention Community Accountability Board and supported by the International Community of Women Living with HIV (ICW) East Africa and Advocacy for Prevention of HIV and AIDS (APHA), the Choice Manifesto advocates for choice in the HIV prevention options available for women and a commitment to expanding access to long-acting HIV health technologies. Further, these options should be people centred, women-centred and women-led.

In her keynote remarks Ms Byanyima focused on three key areas to making women-centred, people-centred prevention approaches work:

• tackling inequalities for girls and women;
• addressing unequal access to health technologies;
• and putting communities & women in the lead.

Ms Byanyima signed the Choice Manifesto on behalf of UNAIDS and committed to supporting and amplifying the voices of African women and confirmed that UNAIDS will continue to convene partners and government to find solutions.

Medical student Anaïs Maillat, 21, joined METIS (Movement of The Students Against Inequalities in Health Access) for a simple reason. The children’s beaming smiles drew her in.

As a member organization of the International Federation of Medical Students Association (IFMSA), the Swiss Medical Students Association (SWIMSA) Switzerland, launched the program CALWHA which works with children and adolescents living with HIV and AIDS in Tanzania.

Ms. Maillat focused on the Mwanza region where the rate of HIV infection is higher than the national average as its project coordinator.

“Our project is currently helping more than 400 children living with HIV and AIDS,” she said. “We organize activity days in hospitals where children and adolescents get check-ups, medicine, a meal, educational activities, and a safe space to play,” she added.

Activity days are held on three Saturdays of each month for children and adolescents aged 0 – 19 years old to improve clinic attendance and treatment adherence. “For many children, the hospital is far, so parents miss work, which has a cost,” Ms. Maillat explained. The project pays for people’s transportation to the hospital and that help allows many children to stay on treatment, according to CALWHA.

Like Ms. Maillat, medical students worldwide are taking an active role in the HIV response in their native countries.

Ana Laura Nascimento, a 21-year-old medical student and member of IFMSA Brazil, became an advocate for sexual and reproductive health rights through Pense Positivo, a project that organizes HIV awareness activities for houseless individuals and sex workers.  

During her school years, Ms. Nascimento said she realized there was a clear demand to educate her peers about sex due to sexually transmitted infection (STI) outbreaks. “We organized Testar é Saber (“testing is knowing”), a campaign to encourage students to get tested for HIV, syphilis, hepatitis B and C,” she said.

That led to information sessions at the university including doctors, public health professionals, and the municipality. As a result, the school now offers testing events twice a year.

Ms. Nascimento went on to lead and become a member of IFMSA Brazil’s National Officers for Sexual and Reproductive Health (NORA).

In Malaysia, another NORA leader, Joseph Hamzah Anwar, is a 25-year-old medical student and a member of Society of MMA Medical Students. He became an outreach worker for People Like Us Hang Out (PLUHO) - an LGBTQ organization based in Kuala Lumpur, Malaysia that focuses on mental health.

“I met doctors who are not sensitized to issues that HIV comes with and this discourages clients from seeking treatment,” he said. In his view, the younger generation of doctors need to be aware and knowledgeable, so people stay on HIV treatment and live their lives like any other person.

As members of IFMSA, these future doctors have been organizing activities with communities as part of the organization’s aim to strengthen its involvement in the HIV response.  They also seek to educate the public about HIV and AIDS and reduce stigma and discrimination in all healthcare facilities.

Representing more than a million medical students as their members, IFMSA also contributes to the Global Partnership to End All Forms of HIV-Related Stigma and Discrimination and holds a leadership role in The PACT, a global coalition of youth-led organizations advocating for sexual and reproductive health rights.  

On August 24, IFMSA, with the International Pharmaceutical Students’ Federation (IPSF) launched a Declaration of Commitment to HIV and AIDS. The Declaration will guide IFMSA and IPSF in their future efforts to contribute to the AIDS response.

All three future doctors hope that the declaration will encourage others to join the global youth movement to end AIDS. “With the activities outlined in the declaration, I believe we are on the right track to end AIDS by 2030,” Mr. Anwar said.

“I truly believe that young people have the potential to unite to end AIDS,” Ms. Maillat said. “We are the generation of unity. Let’s do this. You and me.”

UNAIDS offers lessons from the AIDS pandemic on the Intergovernmental Negotiating Body Pandemic Accord Bureau text

GENEVA, 24 July 2023—The Joint United Nations Programme on HIV/AIDS (UNAIDS) offers lessons learnt from the HIV/AIDS pandemic to strengthen and sharpen the bureau text of the Pandemic Accord to ensure a truly robust response to current pandemics, and to prevent, prepare for and respond to pandemics of the future.

UNAIDS and the global response to AIDS have unique experience and insight over the past forty years in responding to pandemics. The global AIDS response has shown how effective a pandemic response can be which it outlined recently in its Global AIDS Update 2023 – The Path that Ends AIDS.

While COVID-19 increased HIV vulnerability and disrupted HIV service access for millions of people around the world, the AIDS response, systems, infrastructure and governance model also helped countries respond to both HIV and COVID-19. UNAIDS has a critical interest in protecting the gains in the HIV response, preventing future pandemics and health emergencies which impact people living with and affected by HIV and which could set back efforts to end AIDS by 2030.

Drawing on the more than a quarter-century as a global leader of the fight to end AIDS as a public health threat, UNAIDS offers the following lessons learned for strengthening the current bureau text of the Pandemic Accord:

General language

The current draft could be amended to incorporate much clearer, stronger language on the obligations of high-income countries (HICs) to ensure worldwide access to pandemic products and to proactively provide financial and technical support to enable pandemic responses in low- and middle-income countries (LMICs). The frequent use of “as appropriate” language could be replaced by clear language that conveys the obligation of states to act. In the current draft, much of the burden for prevention and surveillance falls on LMICs, without communicating clear obligations of HICs to assist and support LMICs. It could also have text that commits all countries to prioritise health and medical research.

Human rights and equity

While the draft identifies human rights and equity as core principles of pandemic preparedness, the draft could clarify language regarding the member states’ commitment to protect human rights and ensure equity in all aspects of pandemic prevention, preparedness and response (PPR). The accord could: reconsider the definition of “persons in vulnerable situations” (Art. 1); explicitly reference States obligations to protect and fulfil human rights within its “general principles” (Art. 3.1); mainstream concern for equity throughout provisions of the accord; emphasize formal and substantive equality, alongside non-discrimination, as general principles (Art. 3.1)

Equitable access

With respect to equitable access to pandemic-related products, the bureau draft uses language that suggests that recommended actions are advisory rather than obligatory. UNAIDS recommends that the draft :

• Clearly commit countries that possess pandemic-related medical technologies and knowhow to share it with LMICs in a timely and meaningful manner, including requirements in funding and purchasing agreements for institutions and companies in HICs to share intellectual property rights, technologies and knowhow with researchers and capable manufacturers in LMICs.
• Commit to provide robust financial and technical support for collaborative research between institutions in the North and South to build R&D capacity in LMICs – not only for pandemics and not only for manufacturing, but to enable LMICs to contribute to progress in science and technology for all of humanity.
• Countries to make full use of TRIPS flexibilities to address public health needs during a health emergency.
• Commit all states to waive intellectual property provisions for all pandemic-related products during pandemic and recovery periods.
• Commit Member States to provide political leadership and robust financial and technical support to build strong, flexible medical manufacturing capacity in LMICs before the next pandemic emerges. With future pandemics, surge support will be essential to adapt this capacity in LMICs to manufacture pandemic-relevant products.
• If and when demand for pandemic-relevant products outstrips supply during future pandemics, all Member States must commit to abide by WHO product allocation prioritization recommendations to ensure equitable access, with particular attention to the most vulnerable populations.

Access and benefit sharing

Although the draft specifies obligations among LMICs for actions pertaining to surveillance and the timely sharing of pathogens and data, the draft should be revised to commit Member States to ensure equitable access, including sharing the benefits and profits from the sale of these pathogens. Draw lessons from the Ebola where pathogens from Africa were shared but the medicines were stockpiled in the north leaving people in Africa waiting for charitable donations. The Accord should build on the precedence of the Pandemic Influenza Preparedness agreement (PIP) which facilitates sharing of pathogens and benefits both in terms of vaccines and profit.

Common but differentiated responsibility

While PPR is a shared responsibility of Member States, the draft could make clear that the nature and extent of responsibilities are differentiated based on each country’s financial and technological resources and capacities. As the effects of epidemics are felt most heavily in poor and vulnerable populations, countries that are home to these populations require additional assistance.

Inclusion of community and civil society

Community-led responses play critical roles in reaching marginalized communities with essential health messages and services during a pandemic – as both HIV and COVID-19 have shown – but communities remain under-resourced and inadequately integrated as key partners in national PPR efforts. The Pandemic Accord must acknowledge the central role of community-led responses and commit member states to include communities and civil society in decision-making, planning, preparation, implementation and monitoring.

Sustainable investments in health systems and infrastructure

Sustainable, resilient, well-resourced, equitable, human rights-based and people-centred health systems are essential to PPR and to efforts to achieve Universal Health Coverage. The HIV response has shown clearly how it is possible to leverage HIV investments to build stronger, inclusive, sustainable health and social service systems that respond to both HIV and other health threats. Drawing on previously recommended language on differentiated responsibilities based on national financial and technical capacity, the draft could clearly commit countries to invest major new public financing in health systems – ensuring a well-trained, well-remunerated health workforce (including community health workers); strengthening primary health care; ensuring access to health technologies (including those that are locally produced); and strengthening and effectively using health information systems.

Multisectoral governance

HIV has pioneered inclusive, accountable, participatory health governance across multiple sectors and with community, but there is a risk that PPR governance will be devised as a technocratic, top-down enterprise that does not include the central contributions of communities and civil society. The draft could insist that PPR governance mechanisms be fully inclusive of key stakeholders and integrated at national and regional levels to deal with current pandemics and future health crises. Language on whole-of-government and whole-of-society approaches should be strengthened.

Conclusion

Pandemics continue to exact enormous costs on societies across the world – an estimated 630,000 people died of AIDS-related causes in 2022, and long COVID will has lasting effects on human health and well-being and health infrastructure. In responses to HIV and COVID-19, too many countries and communities have been left to fend for themselves. Responding effectively to current and future pandemics requires the global community to summon the principles of solidarity, equity and people-centred action at the heart of the 2030 Agenda for Sustainable Development. Through learning by doing over decades, the HIV response has shown how it is possible to respond effectively to a pandemic. UNAIDS strongly encourages countries to take on board UNAIDS lessons learned when negotiating revisions to the bureau draft of the Pandemic Accord.

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.

Partners call for urgent action to reverse an explosion in inequalities which are endangering us all

18 July 2023—The Centre for International Cooperation at the University of New York, Development Finance International, Oxfam and UNAIDS are calling for urgent action to save Sustainable Development Goal (SDG) 10: Reduced Inequality.

COVID-19 caused the largest rise in income inequality in three decades, as poorer countries lacked financing to support the incomes of the poor or to confront the COVID-19 and AIDS pandemics. During the COVID-19 pandemic and global inflation crisis, inequality of income, wealth and health outcomes rose sharply. Without seriously tackling inequality, we will not end AIDS by 2030 (SDG 3.3), and the SDGs on poverty, gender and education will be strongly compromised.  

In his 2023 SDG Progress Report, the United Nations Secretary-General announced that SDG10 is one of the worst performing SDGs. Action has never been more urgent on this goal.

For SDG10 to be successful in reducing inequality, it is vital that the international community takes concerted action during the current review of the SDGs which will culminate at the United Nations (UN) General Assembly SDG Summit taking place on 18-19 September 2023.

Action includes better monitoring the inequality of income and wealth within and between countries. This requires using indicators which are used by all member states and institutions including the UN or the World Bank, these indicators are called the Gini coefficient and the Palma ratio.

The official start to the call to action will take place during a high-level meeting on 18 July at the UN in New York, with representatives from government and civil society. H.E. the President of Namibia, Hage Gottfried Geingob, and H.E. the President of Sierra Leone Julius Maada Bio, have expressed their support and willingness to co-sponsor this call to action to Save SDG10 and fight inequality.

In addition, more than 230 leading global economists, political leaders and inequality experts, including former UN Secretary General Ban Ki Moon, Nobel prize laureate Joseph Stiglitz, Thomas Piketty, Jayati Ghosh, Helen Clark and Jose-Antonio Ocampo, are sending an open letter to the UN Secretary-General and the World Bank President urging them to include the incomes and wealth of the rich in monitoring inequality by using Gini and Palma, and to ensure trends in inequality are monitored annually in all countries. This will allow the world to see the true picture of growing extreme inequality, and to strengthen its efforts to promote anti-inequality policies.

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.