For UNAIDS, respect for human rights is essential in the fight against HIV

For UNAIDS respect for human rights is essential in the

The United Nations AIDS program releases a report highlighting the importance of human rights in eradicating the epidemic. Discrimination, inequalities in access to care and economic crises are still slowing progress, reminding us of the urgency of global solidarity.

On the occasion of World AIDS Day, the last report of the United Nations program on AIDS (UNAIDS), published on November 26, provides an observation that is as optimistic as it is alarming about progress in the fight against HIV on a global scale. While notable progress has been made in some countries, notably in Africa sub-Saharan region, epicenter of the epidemic, HIV in 28 countries, particularly in Eastern Europe and the Middle East. While the goal remains to end AIDS as a public health threat by 2030, many obstacles persist. Between inequalities in access to care and discrimination, the report entitled “Let us follow the path of rights” highlights the need to guarantee human rights to eradicate this epidemic.

A worrying delay in meeting objectives

Despite significant progress in the fight against HIV since its discovery in 1983, no vaccine has yet been developed against this virus which affects nearly 40 million people worldwide. Last year, 1.3 million people worldwide became newly infected with HIV. If this figure is down 60% compared to the peak in 1995, it is very far from the global objective set in 2025 which is not to exceed 370,000. In 2023, 630,000 people will have died due to AIDS , far from the peak of 2.1 million in 2004, but well above the UNAIDS objective for next year of 250,000. However, according to Winnie Byanyima, executive director of UNAIDS, the HIV response has progressed so far that ending AIDS as a public health threat is achievable by 2030 » despite falling behind on objectives.

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While 2023 remains the year with the lowest new infections, the number of cases is increasing in 28 countries, mainly in Eastern Europe and the Middle East. According to Douglas Mendes, a former Belize Court of Appeal judge and human rights activist in Trinidad and Tobago, this situation is exacerbated by discriminatory legislation towards marginalized people. “ Laws that criminalize same-sex sexual relations hinder efforts to effectively combat the AIDS pandemic. These laws cost lives. They often prevent people from accessing HIV prevention, testing and treatment services, and they violate the inalienable rights and freedoms that belong to every person. When it comes to consenting adults, the state has no business in a person’s bedroom » he denounces. In Eastern Europe and the Middle East, where conservative far-right ideas and religious fundamentalism are gaining ground, homosexuals and sex workers, targets of these ideologies, are most at risk from a exposure to HIV.

Between stigma and discrimination, HIV a social disease

While antiretroviral therapy (ART) – a medical treatment for people living with HIV that reduces viral load in the blood to undetectable levels, reducing complications and limiting transmission – has transformed HIV from a deadly disease into a manageable chronic condition for many people, social inequalities and stigma remain major barriers.

The UNAIDS report reveals that key populations, such as sex workers, men who have sex with men (MSM), and transgender people, are still largely excluded from health services in many countries, due to the criminalization of their behaviors, but also persistent prejudices in the medical community. Monsignor Thabo Makgoba, Archbishop of Cape Town (South Africa), expresses his indignation at this reality. “ When discriminatory laws punish LGBTQ+ people, they keep them away from life-saving care. These laws are a form of institutional violence “, he declares. According to him, it is imperative that religious institutions and civil society engage in the defense of human rights and fight against stigmatization, particularly within Christian communities, where social disapproval is often still strong towards homosexual people.

ART and pre-exposure prophylaxis (PrEP) – a method of drug prevention that significantly reduces the risk of contracting HIV for people who are HIV-negative but at high risk of infection – would allow millions of people to live without complications with HIV. But today, AIDS is above all a social illness, where those affected live in shame and sometimes fear. The UNAIDS report highlights the need to dismantle prejudices and societal barriers that hinder access to health for these populations. “ Solidarity and inclusiveness must guide our actions », insists the archbishop, emphasizing that the protection of human rights is crucial for the establishment of effective and equitable health policies.

Research is evolving, but at what cost?

If UNAIDS insists on better integration of human rights in all public health policies, the end of the HIV epidemic will only be possible if each person, whatever their social, economic or sexual status, has access to prevention and treatment services.

Faced with these challenges, the UN program is calling for faster action to expand access to treatments like ART and PrEP. In the summer of 2024, during the International AIDS Conference in Munich, the presentation of Lenacapavir has revived a lot of hope in the field of PrEP. Unlike the current treatment taken daily orally, Lenacapavir is an injectable treatment taken twice a year, developed by the American pharmaceutical giant Gilead. However, the report deplores the slowness of pharmaceutical companies in making it accessible on a global scale. The lack of boldness by businesses and governments to share technology and ensure universal access is also holding back progress.

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Indeed, Asia Russell of the NGO Health GAP denounces in a column published by Médecins sans frontièresGilead’s extensive history of hindering global access to medicines, excluding middle-income countries from voluntary licensing agreements and arbitrarily restricting licensees. » By analyzing production costs, Dr. Andrew Hill demonstrated that the cost of producing Lenacapavir could be reduced to approximately $35-40 per patient annually. Currently, Gilead sets the cost at $42,250 for the first year. A prohibitive price, which excludes a large proportion of people at high risk of infection.

An economic crisis that is slowing down progress

UNAIDS highlights a determining factor: the debt crisis. In 2023, more than 60 developing countries experienced unsustainable debt levels, impacting their investments in public health. In a interview for RFI in 2022, Winnie Byanyima affirms: “ The countries of East, Southern, West and Central Africa have many needs, in particular, because they are very indebted. There’s this pressure on their budgets, and they’re going to need all of our help to keep their HIV programs running. “.

This economic crisis has profoundly reduced funding dedicated to the fight against HIV, worsening disparities. In 2023, allocated resources decreased by 8% compared to 2020, to reach 19.8 billion dollars, far from the 29.3 billion needed by 2025. Furthermore, funding is decreasing all over the world.

In this context, Thabo Makgoba calls for global solidarity. “ We must fight together, defending the human rights of everyone, everywhere. » Whether it concerns political decision-makers or pharmaceutical giants, international cooperation remains essential to combat this scourge which has lasted for more than 40 years.

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