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 became infected with HIV l last year, roughly three times the global target, the United Nations reported. Wednesday.
About 650,000 people died of AIDS in 2021, roughly one every minute, according to UNAIDS, the organization’s HIV and AIDS program. Progress against the disease has faltered and global infections have remained stable since 2018.
The toll in 2021 was uneven, with 15-24 year olds, and young women in particular, bearing a disproportionate share of the burden. A new infection in a teenage girl or young woman occurred every two minutes, the program said.
In sub-Saharan Africa, young people accounted for 31 percent of new infections, and almost four out of five of them were among girls and young women. In El Salvador, HIV prevalence nearly doubled among men who have sex with men and increased eightfold among transgender people.
In Asia and the Pacific, new HIV infections were increasing where they had been decreasing. And about 160,000 children worldwide became infected, despite the availability of prevention methods.
“These numbers should represent more than just a wake-up call, this should represent an endpoint,” 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, Dr. Wallace said. “Groups that are oppressed in different parts of the world, or essentially lower in the social hierarchy, don’t have the same access,” he said.
An estimated 40 million people are living with HIV worldwide. About 10 million of them, including half of infected children, have no access to treatment.
Fortunately, many of those already on treatment continued to do so in 2021, thanks in part to innovative HIV programs in some countries. But the past two years have brought relentless waves of hardship, especially 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 teen pregnancies and gender-based violence soared. The pandemic sent poverty rates and fuel costs soaring.
The war in Ukraine has caused further increases in food prices and constraints on supply chains.
“When there’s an economic crisis, women, especially young women, will become more dependent on transactional sex as a source of income,” said Harsha Thirumurthy, an economist at the University of Pennsylvania. “It’s not exclusively, but generally, an economic story.”
In 2021, low-income countries’ debt service accounted for 171% of spending on health, education and social protection combined. Donor countries tightened their purse strings, 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 about $29 billion to address HIV by 2025, but will face a shortfall of about $8 billion.
“These numbers speak to political will,” UNAIDS Executive Director Winnie Byanyima said in a statement.
“Do we care about empowering and protecting our girls?” she added. “Do we want to stop child deaths from AIDS? Do we put saving lives ahead of criminalization? If we do that, we will have to reclaim the AIDS response.”
The response in some countries has been marked by the fact that people from marginalized communities are among those most at risk.
In Australia, Canada and the United States, new HIV infections are higher among black and indigenous communities compared to whites. Men who have sex with men, drug users and sex workers, who together account for about 70 percent of global infections, have about 30 times the risk of infection, compared to other people in the population.
Effective global policies should take these realities into account; it’s about “more than handing condoms and lube to people,” Dr. Wallace said.
In an ideal world, for example, young women would have free access to reproductive health services without stigma or judgment from their families, communities or places of worship. Dr. Thirumurthy suggested that cash transfer programs could be as essential as medical tools in curbing new infections among girls.
At a meeting in 2016, UN member countries set new targets for 2020: fewer than 500,000 new HIV infections per year, fewer than 500,000 AIDS-related deaths annually and the elimination of AIDS-related discrimination with HIV Nations did not achieve these goals.
The world is also unlikely to meet another target: a reduction to 370,000 new infections annually by 2025. The new report estimates that the actual number is likely to be three times higher.