As we mark the 30th anniversary of World AIDS Day, we need to come to grips with a devastating reality — the end of AIDS may fail to materialize. As global leaders gathered in Buenos Aires last week, AIDS did not appear to be on their radar, let alone the agenda.
Complacency, apathy, budget cuts, combined with climate change and political unrest — and the resulting disruption in treatment access and continuity of services — are moving us toward an HIV rebound.
In just three decades, our children will be living in a world where more than 200 million people are displaced by climate change and political unrest. Of note, the African countries most impacted by growing populations and climate change are also those most impacted by HIV. According to United Nations’ projections, Africa will account for 40 per cent of the world population by the end of the century, 80 years from now. But, it’s not just Africa that is suffering. A study published in The Lancet HIV found 74 countries experienced increases in rates of new infections between 2005 and 2015, including Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico and Russia.
At last week’s G20 forum in Buenos Aires, the world’s major economies came together to identify solutions for our planet’s most pressing challenges. HIV and AIDS has been a global challenge since the 1980s and we cannot afford to let it fall off the radar now. Treatment is not just a health issue and a human-rights issue, it’s an economic issue. The B.C. Centre for Excellence in HIV/AIDS has demonstrated, time and again, upfront investment in HIV treatment pays dividends down the road.
Alarmingly, even with potentially catastrophic scenarios at our doorstep involving climate change and political unrest, leading governments have stalled funding toward expanding access to treatment for ending AIDS. After widening access to HIV treatment in Africa from a baseline of 50,000 to 15 million, funding for the President’s Emergency Plan for AIDS Relief, the U.S. government’s global response to HIV/AIDS, has generally plateaued for the past decade. This, despite HIV treatment remaining unattainable within many health care settings in low- and middle-income countries.
Beyond cutbacks, indifference to a surge of discriminatory laws and policies in regions such as Eastern Europe and Central Asia are driving global increases in HIV. Governments are targeting vulnerable groups, including people who use drugs and the LGBTQ community. At the end of 2017, official estimates from Russia showed around 1 million people living with HIV and only about one third receiving treatment.
North America is experiencing pockets of HIV growth in areas in Western Canada and the Southern United States. Uneven access to effective, life-saving HIV treatment — due to marginalization, lack of insurance coverage or fear of criminalization — are sadly resulting in avoidable cases of HIV infection.
Just three years ago UNAIDS, the United Nations body tasked with addressing HIV/AIDS, announced an ambitious plan to end AIDS as an epidemic by 2030. As part of the plan, nations were called to meet the UNAIDS 90-90-90 target, which requires at least 90 per cent of all those living with HIV be diagnosed by 2020, at least 90 per cent of those to be on treatment and at least 90 per cent of those achieve viral suppression. Doing so, would have led to a 90-per-cent decrease in AIDS deaths and a 90-per-cent decrease in new HIV infections between 2010 and 2030.
Unfortunately, at the current pace, we are simply not going to reach the target. We will fail to see the end of AIDS as a pandemic by 2030.
Canadian leadership is critical. In less than a year, Canada will pass the baton to France as host of the Global Fund Replenishment Conference. In 2016, the federal government announced Canada’s pledge of $804 million to the Global Fund. That year, the conference raised $12.9 billion with the goal of ending AIDS, tuberculosis and malaria by 2030. While this funding amount is remarkable, it is not enough to bring treatment to all individuals living with HIV worldwide. Canada needs to support allies such as France and as they call on global partners to increase investment to end AIDS.
In the face of these existing and upcoming challenges to the end of AIDS, leading governments must re-double their efforts and international investments in 2019. Failing to do so will cost lives and money while causing unjust suffering. Meeting the 90-90-90 target will avoid all of that and will be cost-saving.
This is not a drill. We know what will end AIDS: increasing investment; expanding access to prevention, testing, treatment and support and reducing stigma. The G20 meeting this week would have been the ideal platform to demonstrate commitment to these achievable goals. Instead, it was a missed opportunity.
Dr. Julio Montaner is director of the B.C. Centre for Excellence in HIV/AIDS, Canada’s largest HIV research organization, and a professor of medicine at the University of B.C. Robert Hogg is an epidemiologist and demographer, a senior research scientist with the B.C. Centre for Excellence in HIV/AIDS and a professor in the Faculty of Health Sciences at Simon Fraser University.