Photo: Shutterstock. By Leonie Broekstra

The Global AIDS Policy Partnership (GAPP), a coalition of over 70 advocacy and implementing organizations committed to expanding and improving global HIV/AIDS programming, commends the convening bodies of the U.N. High-Level Meeting on HIV’s efforts to convene meetings that provide a platform for civil society voices. Despite the unusual circumstances brought about by the COVID-19 pandemic, centering of civil society voices is vital to the success of the High Level Meeting in June. To that end, what follows represents the view of GAPP members as to what must be addressed in the U.N. Declaration on HIV and AIDS.

Many of the substantial global gains in the fight to end the HIV epidemic by 2030 are now threatened by the COVID-19 pandemic and the resulting economic insecurity, unstable resources, and disrupted enabling environments. Without action, we risk a harmful escalation in new HIV infections as well as negative impacts on the lives of people living with HIV. Furthermore, the substantive resources that have been dedicated to fighting HIV/AIDS for the past four decades will have been squandered without aggressive and immediate action.

COVID-19 has caused significant disruptions in HIV prevention and treatment.[1] As HIV testing rates fell by 40%, a vast number of individuals who are HIV positive remain unaware of their status, increasing the risk of new infections . The reasons behind this data is complex. Due to stay-at-home orders, travel disruptions, and fear of COVID infection, many people avoided, or were unable to get to health centers for testing and treatment . Many women and girls, among those at highest risk for contracting HIV, lost their primary method of contact outside the home, in the informal economy or at school.

Even before the pandemic, global HIV prevention goals were unacceptably off-target. Now, progress is further derailed. Among other things, we are seeing slowing rates of voluntary male medical circumcision, pre-exposure prophylaxis (PrEP) initiations, and core interventions to reduce incidence in key and priority populations.

Global investment for health system strengthening is key to addressing future epidemics and has taken on new urgency in light of the COVID-19 epidemic. The structural framework developed as part of HIV programming in many countries has proven invaluable in addressing the current crisis as well as other infectious diseases such as Ebola and tuberculosis. However, as funds and attention are diverted away from HIV/AIDS to address other crises, we risk further delaying progress against the epidemic.

All this makes clear that, even as the world struggles to contain COVID-19, this is not a time to shift our focus away from HIV/AIDS.

Therefore, GAPP Members believe that the Declaration at the U.N. High Level Meeting must:

  • Clearly affirm that the HIV epidemic continues to be a significant worldwide risk.
  • Reaffirm the global commitment to ending AIDS as a public health threat by 2030. This commitment requires expanded and targeted services, including the urgent restoration of health infrastructure diverted to COVID-19, to ensure people living with and affected by HIV are not left behind.
  • Acknowledge the gaps in the response—including, but not limited to, those resulting from the effects of COVID-19.
  • Provide clear direction on how these gaps must be addressed, and move forcefully to ameliorate them.
  • Make clear that, while the needed platforms for epidemic preparedness and global health system strengthening are critical, they must be built on HIV platforms only in ways that enable the expanded programming required to end the AIDS epidemic by 2030.
  • Address three pillars of prevention policy: 1) significant, rapid scaling up of evidence-based HIV prevention interventions; 2) rapid introduction of new HIV interventions as they are approved for use; and 3) support for an enabling environment for prevention for all key and priority populations.

    As the 2030 deadline looms, the end of the HIV epidemic is in sight. Achieving this goal will take the full commitment of all stakeholders—national and multinational bodies as well as the private sector and civil society—to go the extra mile to reach the most underserved. A world without HIV requires equal access to services for all, regardless of gender, sexuality, age, or geographic location. The GAPP urges U.N. Member States to safeguard international gains made on eradicating HIV by centering equity in negotiations of the U.N. Declaration.

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