Ending the AIDS Pandemic: What Still Needs to be Done?

Available Downloads

Jeffrey Sturchio: Hello. I’m Jeff Sturchio, senior associate at the Global Health Policy Center here at CSIS, and I’d like to welcome you all to today’s discussion on “Ending the AIDS Pandemic: What Still Needs to be Done.”

Forty years into the HIV/AIDS pandemic, progress toward the goal of eliminating AIDS is mixed. On World AIDS Day on December 1st, UNAIDS reported that there were 37.7 million people living with HIV/AIDS of whom an estimated 27.5 million people were receiving antiretroviral treatment.

That was an impressive increase from the 7.8 million who were on treatment in 2010. New infections had declined by 31 percent between 2010 and 2020, and AIDS-related deaths declined by 47 percent during the same period.

But there are still over 1.5 million infections per year globally – that’s about 4,000 a day – and some 680,000 deaths. Prevention rates are not falling fast enough to stop the pandemic, and infections are actually rising in some countries and regions and among certain key populations.

UNAIDS also reports that six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among adolescent girls. Gay men and other men who have sex with men, sex workers, and people who use drugs face a 25 to 35 times greater risk of acquiring HIV worldwide.

In the United States, the U.S. government adopted an ambitious plan in 2019 to end the HIV epidemic with goals of reducing new HIV infections by 75 percent in 2025 and 90 percent in 2030. But new data from the CDC show, for example, that the rate of new infections among Black and Hispanic, Latino, gay, and bisexual men did not decline over the past decade.

The global targets adopted in 2016 were not reached by 2020 despite ambitious efforts to address the challenges of HIV/AIDS, nor were the U.S. goals for EHE – that is, ending the HIV epidemic – on track. Of course, the disruptions caused by COVID-19 over the past 20 months explain part of the shortfall in delivery of HIV prevention and treatment services. But what else explains why the HIV response seems to have been stalled?

As Winnie Byanyima, executive director of UNAIDS, has said, quote, “To beat a pandemic, you have to confront the inequalities that drive it, inequalities in wealth and power and status and in access to services, stigma and denial, structural racism, discrimination against adolescent girls and young women, as well as bias and barriers to access for other vulnerable and key populations, social determinants of health like poverty, housing, and education, these are all persistent sources of inequalities that have an impact on efforts to fight HIV/AIDS.”

The renewed U.S. HIV/AIDS strategy also notes that structural inequalities have resulted in racial and ethnic health disparities that are severe, far reaching, and unacceptable. The solutions to these problems will require renewed efforts beyond technical interventions, such as better prevention tools, diagnostics, and medicines. It will require efforts that place affected communities at the center of the public health response.

So in our panel discussion today we’ll explore these issues in more detail from both the U.S. and global perspectives. The discussion will focus on how inequalities are the drivers of HIV transmission and how they still affect vulnerable populations disproportionately in countries rich and poor alike.

It’s a pleasure to welcome my fellow panelists. Here on the stage with me at CSIS are Kate McManus, assistant professor of medicine, infectious diseases and international health at the University of Virginia, and Greg Millett, the vice president and director of public policy at amfAR. And joining us virtually is Wafaa El-Sadr, founder and director of ICAP at Columbia University’s Mailman School of Public Health, and she’s joining us from New York.

So welcome to all three of you and thanks for participating.

So let’s start with Greg. Greg, what’s the status of the HIV epidemic in the U.S. today? What’s driving it? What are the key sources of risk and vulnerability and, you know, and how do those make it challenging to achieve the EHE goals?