The global report of UNAIDS, ‘The Urgency of now: AIDS at crossroads’, released on the eve of the International AIDS Conference (IAC) in Munich, concluded that “the global AIDS response is currently off track”. At the current rate of progress, it is highly unlikely that the ambitious targets set for either 2025 or 2030 will be achieved. The UNAIDS highlighted two conditionalities for turning the tide and achieving the goals — countries must scale up resources for AIDS programmes substantially and protect human rights of people infected with and vulnerable to HIV. But the data provided by UNAIDS did not give rise to such optimism.

World over, 1.3 million people still get newly infected, 50 per cent of them in Africa. Global deaths at 6,30,000 account for 50 per cent of the new infections. The glaring failure was on prevention of new infections with a coverage of a lowly 39-50 per cent against the goal to cover 95 per cent of those who are vulnerable. Eastern Europe and Central Asia, Middle East and Northern Africa and Latin America still report increasing rates of new infections. Africa performed better where new infections registered a decline of 50 per cent. In Asia-Pacific, new infections declined by 14 per cent but the decline virtually plateaued in the last 10 years. The tap of new infections is still leaking profusely all over the globe.

Collective failure

It is not difficult to understand the reasons for this collective failure of countries to rein in the AIDS pandemic. Logically, prevention programmes should saturate the key populations (KPs) — such as sex workers, gay populations, people who inject drugs, transgenders and those who practice high risk behaviour — with proven strategies of prevention. On the contrary, the report states that proportion of new infections among KPs has increased from 45 per cent in 2010 to 55 per cent in 2023. In Asia-Pacific, 79 per cent of new infections occurred among KPs in 2023. Normatively, prevention programmes should get an allocation of 20 per cent of total resources but got a measly 2.6 per cent of the spending.

The global report, however, except for providing generic statements like optimisation of resources and protecting human rights, does not dig deep into what went wrong. The first 10 years after the UN General Assembly Special Session, 2001, on AIDS witnessed an unprecedented response, both in prevention and treatment. And several countries could halt and reverse the epidemic in that decade of action, especially in the Asia-Pacific region. But the response stalled in its tracks, with political leadership losing interest in AIDS programmes. Success had given rise to complacency.

In Asian countries such as India, Thailand and Bangladesh, social contracting of community-based organisations and NGOs was adopted as a strategy to directly reach resources for prevention programmes. But over the years, interest in such programmes has waned and funds got stuck in bureaucratic muddle.

The report has also not gone into the reasons for failed implementation of programmes even with the limited resources made available. In the earlier decade, governance of AIDS programmes followed the Three Ones principle with national AIDS committees pivoting focused AIDS programmes. This strategy was later watered down trying to bring the AIDS response out of isolation. The present report advocates main-streaming of AIDS responses without trying to identify the key elements of the programmes, such as treatment which can be integrated and maintaining that KP-related prevention programmes still needing focused implementation.

The global AIDS response partially succeeded in preventing AIDS-related deaths but is failing on many other fronts. Implementation failure is the most important of them and often goes missing in global reports on AIDS, such as the present one.

The writer is former Special Envoy of the UN Secretary General on AIDS, and former Health Secretary, Government of India. Views are personal

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