Science and Equity Must Go Hand-in-Hand to End AIDS

A volunteer takes pictures with her mobile phone of others lighting candles in the shape of a red ribbon during an awareness event on the eve of World AIDS Day in Siliguri, West Bengal, India, on November 30, 2021.
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A volunteer takes pictures of an awareness event organized on the eve of World AIDS Day in Siliguri, West Bengal, India, Nov. 30, 2021. Image: Diptendu DUTTA/AFP via Getty

2022 will mark the COVID-19 pandemic’s third year. 

Since the early days of SARS-CoV-2, there have been calls to apply hard-won lessons learned from the fight against another global health crisis: HIV/AIDS. But what good are these lessons if we have yet to solve the very crisis we hope to learn from? 

Because 2022 will also mark the fifth decade of the AIDS pandemic, and we are losing ground. 

On this World AIDS Day, ending the inequalities that hinder access to lifesaving medicines and health technologies is critical to regaining what we’ve lost against a disease that has claimed more than 36 million lives and counting. 

There has been progress, marked by dramatic scientific advances and the introduction of new, game-changing treatment and prevention methods: the first long-acting injectable antiretroviral treatment regimen approved this year in the US and UK for adults living with HIV, the 20+ HIV vaccines in clinical trials, and exploration of integrating a new vaccine with existing prevention tools—including, perhaps soon, the first long-acting injectable pre-exposure prophylaxis option.

But science alone is not enough. Inequalities will cripple disease responses no matter how many life-saving innovations are developed. We’ve seen this happen before—but we cannot afford to repeat history.

In the early days of HIV, high costs and opposition to manufacturing in the places where the need was greatest put antiretroviral drugs out of reach for people outside of high-income countries. And despite rising availability and affordability of HIV treatments that has helped prevent an estimated 
16.2 million AIDS-related deaths since 2001, devastating disparities in access to prevention tools persist today, with just ~1 million PrEP users across 78 countries. 

This same situation is playing out with COVID-19 as low-income countries struggle to access the doses needed to vaccinate their populations, while vaccine manufacturing remains mostly concentrated in wealthy nations—further jeopardizing the global pandemic response, as the recent emergence of the Omicron variant of concern demonstrates. The development of new antiretroviral pill treatments also raises equity concerns. 

In the case of both COVID-19 and HIV/AIDS, effective and quality preventative, diagnostic and therapeutic tools all exist—but equitable and affordable access remains elusive.

Ironically, the HIV response can learn from the COVID-19 response. We must continue to adapt HIV service delivery to reach those most in need, for example through adopting digital health interventions that proved successful during COVID-19.

In India, the electronic Vaccine Intelligence Network, developed to help ensure equitable availability of immunizations with support from UNDP in partnership with the Ministry of Health and Family Welfare and Gavi, has trained nearly 49,000 government personnel in digital vaccine and cold chain management. In Bhutan, the innovative digital Bhutan Vaccine System supported by UNDP has helped ensure real-time data for an equitable, effective, safe and efficient rollout. UNDP has also released guidance on the human rights-based and ethical use of digital technologies in HIV and other health programs.

Comprehensive health systems strengthening grounded in equity is critical to ensuring ethical and effective service delivery, and it requires sustained investments from countries. Community leadership and human rights-based approaches, informed by meaningful civil society cooperation, must be central for these systems to better tailor care and outreach to the unique realities faced by different groups in different places. The peer-to-peer approach used by ZIOM21 in Kyrgyzstan to provide key populations with HIV prevention, treatment, care and support services provides an encouraging example of how to achieve these goals. 

Global collaboration and partnership, underpinned by community leadership and representation, are key to breaking historical patterns of inequality. And existing partnerships, such as the Global Fund, require continued and increased support.

The new 2021-2026 Global AIDS Strategy makes explicit calls to address inequalities that allow HIV/AIDS to continue, and, in many cases, worsen. We have the tools, experience and decades of lessons to draw from to fix what’s broken and end AIDS as a public health threat by 2030—after all, the history of the HIV response is, at its core, about bringing science and affected communities together. The success of efforts made at the community, country and global level depends on not repeating life-costing mistakes, and meaningfully applying these lessons to end inequalities, end pandemics, and ensure no one is left behind. 

 

Mandeep Dhaliwal, MD, is the director of HIV, Health and Development at the United Nations Development Programme.

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