HIV infections remain high, UN reports

While the world’s attention was focused on the Covid pandemic and the war in Ukraine, the fight against an older enemy lost crucial ground: More than 1.5 million people contracted HIV in the past year, about three times that number as the global target, the United Nations reported Wednesday.

According to UNAIDS, the organization’s program on HIV and AIDS, around 650,000 people died from AIDS in 2021, about one every minute. Progress in controlling the disease has stalled, and global infections have remained stable since 2018.

The 2021 toll has been uneven, with people aged 15 to 24 — and young women in particular — bearing a disproportionate share of the burden. Every two minutes, a new infection occurred in an adolescent girl or young woman, the program said.

In sub-Saharan Africa, young people accounted for 31 percent of new infections, and nearly four in five of those were girls and young women. In El Salvador, HIV prevalence has nearly doubled among men who have sex with men and has increased eight-fold among transgender people.

In Asia and the Pacific, new HIV infections rose where they had declined. And despite the availability of prevention methods, about 160,000 children became infected worldwide.

“These numbers should represent more than just an alarm — this should represent a point,” said Stephaun Wallace, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.

In most countries, including the United States, only privileged groups tend to have consistent access to HIV prevention and treatment, said Dr. Wallace. “Groups that are oppressed in different parts of the world or that are much lower in the social hierarchy don’t get equal access,” he said.

An estimated 40 million people are living with HIV worldwide. About 10 million of them, including about half of the infected children, do not have access to treatment.

Fortunately, many of those already treated have continued treatment in 2021, thanks in part to innovative HIV programs in some countries. But the past two years have brought unrelenting waves of hardship, particularly in low- and middle-income countries, that have disrupted HIV prevention and diagnosis

Millions of girls were out of school as the coronavirus spread, and teenage pregnancy and gender-based violence rose sharply. The pandemic sent poverty rates and fuel costs skyrocketing.

The war in Ukraine has led to further increases in food prices and restrictions in supply chains.

“If there is an economic crisis, women — especially young women — will be more reliant on transactional sex as a source of income,” said Harsha Thirumurthy, an economist at the University of Pennsylvania. “It’s not exclusively, but broadly, an economic story.”

In 2021, paying off debt for low-income countries accounted for 171 percent of spending on health care, education and social protection combined. Donor countries tightened their budgets, and HIV funding from countries other than the United States fell 57 percent over the past decade, according to the report.

Low- and middle-income countries will need an estimated $29 billion to fight HIV by 2025, but will face a deficit of about $8 billion.

“These numbers are about political will,” said Winnie Byanyima, Executive Director of UNAIDS, in a statement.

“Are we concerned about empowering and protecting our girls?” she added. “Do we want to stop the AIDS deaths in children? Do we put saving lives before criminalization? If we do that, we have to get the fight against AIDS going again.”

The response in some countries has been influenced by the fact that people in marginalized communities are among the most vulnerable.

In Australia, Canada and the United States, new HIV infections are higher among Black and Indigenous communities than among Whites. Men who have sex with men, drug users and sex workers — who together account for about 70 percent of the world’s infections — are about 30 times more likely to be infected than others in the population.

Effective global policy should take these realities into account; it’s about “more than handing out condoms and lube,” said Dr. Wallace.

For example, in an ideal world, young women would have unrestricted access to reproductive health services without stigma or judgment from their families, communities, or places of worship. dr Thirumurthy suggested cash transfer programs could be as important as medical tools to slow new infections in girls.

At a meeting in 2016, UN member countries set new goals for 2020: fewer than 500,000 new HIV infections annually, fewer than 500,000 AIDS-related deaths annually and the elimination of HIV-related discrimination. The nations have not achieved these goals.

The world is also unlikely to meet another goal: a reduction to 370,000 new infections annually by 2025. The new report estimates the real figure is likely to be three times that number.

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