Demands for social transformation are building as the global HIV response reaches an important milestone. Four years ago, the United Nations (UN) General Assembly agreed that ending the AIDS epidemic by 2030 required an accelerated expansion of HIV services alongside rights-affirming and enabling environments for those services. Interim targets were agreed to be achieved by the end of 2020.
Significant progress has been achieved. Dozens of countries from a diverse range of geographic, economic and epidemic settings are on track or nearly on track to achieve many of these commitments, proving that bold targets can be met with sufficient political will, financial resources and community engagement. A common thread among these countries is determined political leadership on AIDS, strong community engagement, rights-based and multisectoral approaches, and the consistent use of scientific evidence to guide concerted action. These hallmarks of success are relevant not only for other countries’ responses to HIV—they are vital lessons for the world as it mobilizes against a new pandemic threat.
However, the sad truth is that successes in some countries and regions are tempered by failures in others. The global aggregate of country data reported to UNAIDS shows that the world has invested too few resources, provided too few people with services and failed to bend the curves of new HIV infections and AIDS-related deaths as significantly as was envisioned in the UNAIDS Fast-Track Strategy.
As a result, all global targets for 2020 will be missed.
The funding gap for HIV responses is widening. Momentum established by global agreement on the Millennium Development Goals (MDGs) in 2000 has been lost in the Sustainable Development Goal (SDGs) era. Increases in resources for HIV responses in low- and middle-income countries stalled in 2017, and funding decreased by 7% between 2017 and 2019.1 The total HIV funding available in these countries in 2019 amounted to about 70% of the 2020 target set by the UN General Assembly. Key enablers of effective HIV responses—equitable access to education and health care, and laws and justice systems that protect the rights of the most marginalized within society—remain neglected in dozens of countries across multiple regions.
This collective failure to invest sufficiently in comprehensive, rights-based HIV responses comes at a terrible price: from 2015 to 2020, there were 3.5 million more HIV infections and 820 000 more AIDS-related deaths than if the world was on track to meet its 2020 targets.
The blueprint for success is widely available. The world can do better.