READING BETWEEN THE LINES
Four Hidden Messages from the UNAIDS Global AIDS Update 2019: A Community Briefing
On 16 July 2019, UNAIDS published its Global AIDS Update, entitled “Communities at the Centre: Defending Rights, Breaking Barriers, Reaching People with HIV Services”.
The 316-page report provides a detailed analysis of epidemic trends, human rights- and gender-related barriers to access, quality of care, and the investment landscape. At times, key messages are buried in the pages. This community briefing highlights 4 hidden messages in the report. ICASO has drawn out these messages so that community-led advocacy can home in on the most urgent priorities for the global response.
Hidden message #1: The proportion of new HIV infections that occur among key populations and their partners is increasing. In 2018, 54% of new HIV infections occurred among key populations and their partners – up from 44% in 2015. Since 2015, the estimated proportion of new HIV infections has risen by 50% among people who inject drugs (from 8% in 2015 to 12% in 2018), and by 42% among gay men and other men who have sex with men (from 12% in 2015 to 17% in 2018). While the 2019 Global AIDS Update presents global and regional data for 2018, a comparison to 2015 data underscores the alarming increase over the past three years (Figure 1). Far greater urgency is needed to scale-up service coverage of comprehensive community-led HIV prevention packages for key populations.
Figure 1. Distribution of new HIV infections by population, global (2015 vs. 2018)[i]
Hidden message #2: Upper-middle income and high-income countries in Latin America are experiencing resurgent HIV epidemics. HIV epidemics in Brazil, Costa Rica and Venezuela have grown by more than 20% since 2010. Chile’s has grown by 34%. Post-donor transition, there is limited political will in some of these places to sustain the response. Though published on UNAIDS’ website, data on Venezuela’s epidemic is absent from the Global AIDS Update. This data is needed to support community advocacy with regional and global partners, who must continue supporting an emergency HIV response in Venezuela despite the country’s aid eligibility status.
Figure 2. Percentage change in new HIV infections, by country, Latin America, 2010–2018
Hidden message #3: Community-led
action improves the HIV response. The numerous case studies of
“communities in action” provide nuance and depth to the data-dense report. The
upshot is: community engagement makes HIV responses more effective. Successful challenges to anti-homosexuality laws spearheaded by networks of people
living with HIV and LGBT communities have removed human rights-related barriers
in Colombia and Botswana. Participatory research partnerships have yielded robust
HIV prevalence estimates of transgender women in three South African cities for
the first time. Community-led service delivery has increased condom use and
reduced HIV and STI rates among female sex workers in India. Examples of
effective community-led advocacy, research and service delivery are more than
just feel-good stories; they are catalyzing impact against the disease.
Hidden message #4: Countries are chronically underspending on HIV prevention interventions. The report highlights gaps, by region, between available HIV resources and those that are needed. In many countries, much of this gap is characterized by woefully inadequate spending on HIV prevention interventions. UNAIDS’ HIV Financial Dashboard stores data on HIV prevention spending, yet, progress towards achieving the commitment to ensure that financial resources for prevention constitute a quarter of AIDS spending is not reported in the Update. In Brazil, in 2017, just $18.2 million was spent on HIV prevention interventions, out of $770.9 million total HIV expenditure. In Angola, it was $1.1 million out of $20.1 million in the same year. Advocacy for increased HIV prevention spending is direly needed.
Figure 3. Expenditure on HIV Prevention, as a Proportion of Total HIV Expenditure
Advocacy Opportunities
- Urge policy-makers and funding partners to scale-up comprehensive HIV prevention programming for key populations and their partners. These programs should be delivered by community-led organizations for maximum impact.
- Hold governments in high income and upper middle income Latin American countries accountable for alarming increases in new HIV infections. Especially in countries like Brazil, Chile, Costa Rica and Venezuela – where there is limited or no donor programming remaining – Ministries of Health must not let the epidemic resurge. They must fund HIV prevention programs with domestic resources, including those led by civil society and community groups.
- Document and share evidence of impact from community-led action. These are powerful stories that can mobilize increased resources, improve the legal and policy environment, and catalyze sustainable change.
- Demand that a quarter of spending go towards HIV prevention. In order to achieve the Fast-Track targets, spending on HIV prevention must increase. With limited increases in total funding in recent years, technical and allocative efficiencies need to be sought to free up funds for preventing new infections.
[1] 2015 data source is page 9 of the UNAIDS 2017 Global AIDS Update. 2018 data source is page 28 of the UNAIDS 2019 Global AIDS Update.