Fallout from COVID-19 Derailing Public Health Gains, Draining Coffers, Ministers Warn as High-Level Meeting Moves into Day Two
Countries must embrace hard lessons learned over four decades of the HIV epidemic — including the need for human rights-based action focused on populations most at risk — as they confront the “colliding pandemics” of COVID-19 and its fallout, which threaten to derail crucial public health gains, ministers stressed during the second day of the high-level General Assembly meeting on HIV/AIDS.
Health ministers, foreign affairs officials and other senior leaders representing Governments around the globe addressed the Assembly on the heels of its adoption of a sweeping Political Declaration aimed at helping countries end inequalities and “get on track” to halt AIDS by 2030. The high-level meeting, which runs through 10 June, is convened every five years to take stock of progress and challenges ahead.
Amid the COVID-19 pandemic and its devastating economic toll, which has drained national coffers and put up new barriers to health‑care access, many speakers sounded alarms over the erosion of hard-won victories over HIV. While some diverged on the definition of the “key populations” most at risk of infection, there was broad agreement on the need to reduce inequalities which are soaring amid COVID-19, and which have made access to HIV testing and treatment even more difficult for the most marginalized groups.
Sigrid Kaag, Minister for Foreign Trade and Development Cooperation of the Netherlands, said that, after 40 years of HIV response, “we know what works”. Underlining the need to “recognize reality” and respect human rights, she said adolescent girls and young women, men who have sex with men, sex workers, people who use drugs, transgender people and prisoners continue to pay the highest price for the collective failure to stop the spread of HIV. Spotlighting similar injustices facing marginalized groups, she noted that the COVID-19 crisis has made it even more difficult to get tested, let alone treated, for HIV. She called on the global community to rally behind the people and countries most affected.
Echoing those points, Dag-Inge Ulstein, Minister for International Development of Norway, declared: “HIV and AIDS remains a serious threat to public health, but its history also shows what can be achieved.” Indeed, he said, a virus that was once a death sentence can now be managed with medication, allowing people to live long and healthy lives. Noting that HIV regrettably continues to impact those in vulnerable situations the most, even in 2021, he joined calls to focus on those most at risk — including young people “in all their diversity”. Changing attitudes on gender and ensuring that all people are able to realize their sexual and reproductive health and rights will be crucial, he said, calling for human rights-based approaches that “work with people, not against them”.
Carla Vizzotti, Minister for Health of Argentina, was among today’s speakers who highlighted the lingering barriers to HIV testing and treatment, including gender discrimination and social stigma. Agreeing with others that special attention should be paid to racial monitories, Afro-decedents, indigenous people, migrants, refugees, sex workers, drug users and LGBTI individuals, she said that, in the context of both HIV/AIDS and COVID-19, “we need to place people and communities at the centre of our response”. The current moment also presents a unique opportunity to reform intellectual property laws and free up patents, allowing everyone in need to access essential HIV treatments, she said.
Isatou Touray, Vice‑President of the Gambia, recalled the “90-90-90” commitment made in 2016 — to ensure that 90 per cent of people living with HIV know their status, 90 per cent of those diagnosed with HIV receive antiretroviral therapy, and 90 per cent of those receiving such therapy are virally suppressed — by 2020. While the target undoubtedly helped countries reduce infection rates and scale up treatment, there is now ample evidence that COVID-19 is jeopardizing that progress. Governments should use this difficult moment as a springboard to reduce rising inequalities and root out the social determinants fuelling the HIV epidemic, she stressed.
Francisco Duque III, Secretary for Health of the Philippines, said his country has made significant progress towards the global goal of ending the HIV epidemic by 2030. Outlining national laws that ensure equitable access to HIV services and to broaden the scope of those services for vulnerable populations — such as migrants — living with the disease, he said the health system has managed to adapt to a “new normal” despite the many constraints imposed by COVID-19.
Also speaking today were ministers and other senior officials from Côte d’Ivoire, Paraguay, Equatorial Guinea, Liechtenstein, Guatemala, Kazakhstan, Armenia, Australia, Cambodia, Ghana, United Kingdom, Russian Federation, Cuba, Morocco, Brazil and Nicaragua.
The Assembly will reconvene in plenary at 3 p.m. on Thursday, 10 June, to conclude the general debate and close its high-level meeting.
ISATOU TOURAY, Vice-President of the Gambia, recalled that the commitments made by States in 2016 included ending the AIDS epidemic as a public health threat by 2030, in line with specific 90-90-90 targets — for 90 per cent of people living with HIV to know their HIV status; 90 per cent of people with diagnosed HIV infection to receive antiretroviral therapy; and 90 per cent of all those receiving such therapy to have viral suppression. “Without doubt, the gains made towards meeting these targets continue to contribute to the overall progress towards the 2030 Agenda for Sustainable Development and the global health goal,” he said. He cited ample evidence that COVID-19 is jeopardizing access to HIV prevention, testing, treatment and care, and urged that appropriate strategies be adopted to mitigate those threats. Advocating for using the current meeting as a springboard for a decade of action to reduce inequalities and root out the social determinants that fuel the HIV epidemic, he expressed the Gambia’s strong commitment to the international push to end HIV/AIDS. It will continue to scale up community-led HIV prevention, testing and treatment by addressing social enablers, youth empowerment, gender inequality and ending gender-based violence, as well as stigma and discrimination, with key populations, adolescents, girls and young women prioritized in the national response.
PIERRE DIMBA, Minister for Health, Public Hygiene and Universal Health Coverage of Côte d'Ivoire, said today’s meeting comes against the backdrop of yet another pandemic, whose impact on the continuity of HIV/AIDS care and services has been considerable around the globe. Outlining progress made by his country in combating HIV/AIDS in recent decades, he said the prevalence of the virus among the population dropped from 4.7 per cent in 2005 to 2.1 per cent in 2020. While those results are encouraging, Côte d'Ivoire’s efforts to achieve the “90-90-90” targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) regrettably fell short. In response, the Government is poised to leverage innovative new strategies to screen for HIV, focusing its efforts on women, young people and key populations, he said.
CARLA VIZZOTTI, Minister for Health of Argentina, said national health policies should focus on accelerating collective action to end HIV/AIDS by 2030, in line with the Sustainable Development Goals. The right to health is an absolutely crucial precondition for such work, she said, while spotlighting such barriers as gender inequality and social stigma. In that context, she called for special attention to be paid to sex workers, drug users, LGBTI individuals, people in prisons, transgender women, racial monitories, Afro-decedents, indigenous people, migrants, refugees and displaced persons. “We need to place people and communities at the centre of our response,” she stressed, also underlining the need to ensure sexual and reproductive rights are upheld and that everyone has control over their own bodies. The current moment also presents a unique opportunity to reform intellectual property laws and free up patents, allowing everyone in need to access essential medications to treat HIV.
JULIO BORBA, Minister for Health and Social Welfare of Paraguay, detailed the Government’s national response plan for HIV/AIDS in his country, which includes measures aimed at treatment, prevention and the reduction of stigma and inequality. He stressed that improvements to public health through education are vital to securing the human rights of every individual. Expressing concern over the impact that COVID-19 has had on the global AIDS response — which has slowed progress towards ending the HIV/AIDS epidemic, particularly among vulnerable populations — he said that global solidarity and shared responsibility will drive action to significantly reduce new infections and deaths related to HIV. He called on Member States, the United Nations, regional organizations, private sector, civil society and academia to collectively strengthen the multisector response to HIV/AIDS.
TEODORO OBIANG NGUEMA MBASOGO, President of Equatorial Guinea said that the fight against HIV/AIDS is a national policy priority for his country; to this end, the Government guarantees its citizens access to HIV/AIDS diagnosis and treatment by providing these services free of charge. The goal of these measures is to decentralize the health system and prioritize local treatment at general hospitals and national health centres. However, work remains to eradicate HIV/AIDS; it is important that competent authorities continue to raise awareness about the virus, particularly among young people. He added that the COVID-19 crisis should not distract from the fight against HIV/AIDS, which remains lethal in the absence of a vaccine.
DAG-INGE ULSTEIN, Minister for International Development of Norway, said “HIV and AIDS remains a serious threat to public health, but its history also shows what can be achieved,” stressing that a disease that was once a death sentence can now be managed with medication, allowing people to live long and healthy lives. Noting that HIV regrettably continues to impact those in vulnerable situations the most, even in 2021, he emphasized that prevention is critical. “We must focus on young people in all their diversity,” he said, adding that changing attitudes on gender and ensuring that all people are able to realize their sexual and reproductive health and rights will be crucial. Noting that civil society initiatives are vital to help countries provide a range of services on the ground, he expressed concern that paediatric testing and diagnoses are lagging other efforts, stressing that HIV services must be better integrated into childhood health care. It is now evident from the “colliding pandemics” of HIV/AIDS and COVID-19 that human rights approaches must prevail, he stressed, adding: “We must work with people, not against them.”
DOMINIQUE HASLER, Minister for Foreign Affairs, Education and Sport of Liechtenstein, said that inequalities are obstructing progress in combating HIV/AIDS. “We must do more to address them if we want to win this fight.” Implementation of the 2030 Agenda must be accelerated, she said, adding that Goal 16 — which calls for effective, accountable and transparent institutions — is key not only for effectively responding to pandemics, but also for preventing them in the first place. The rule of law is critical, as well. The fight against HIV/AIDS is not only about our health and well-being, but also about respecting human rights and fundamental freedoms, and setting the stage for more peaceful, just, inclusive and prosperous societies, she emphasized.
MARIA AMELIA FLORES GONZALEZ, Minister for Health and Social Assistance of Guatemala, welcomed the Political Declaration adopted by the Assembly on 8 June. Her ministry is working to implement Guatemala’s national law on HIV/AIDS, which provides for testing, treatment, research and development, as well as the promotion and protection of the rights of persons living with HIV. Outlining its various efforts, she said they are all driven by the goals of inclusion and leaving no on behind. Civil society members, indigenous peoples, vulnerable populations and those most at risk of HIV infection are important stakeholders in Guatemala’s national response. “It is our commitment to provide comprehensive care to our population,” she said, underlining the importance of ensuring spaces that are free of stigma and discrimination.
ALEXEY TSOY, Minister for Health of Kazakhstan, said his country established universal access to HIV testing and treatment, resulting in 83 per cent of HIV patients today being aware of their status. Noting that it is also the only country in Central Asia where the cost of HIV treatment is covered entirely by the Government, he said remarkable progress has been achieved in ending mother‑to‑child transmission. All those strides were made as Kazakhstan made the gradual transition from donor funding to funding by the Government, which now takes full fiscal responsibility for its own HIV prevention programmes. Spotlighting Kazakhstan’s low infection prevalence — which stands at 0.2 per cent of the population — he welcomed the Political Declaration not only as a document that addresses current gaps and shortcomings, but also as a tool for creating new opportunities to address the HIV/AIDS epidemic at the national and international levels.
ANAHIT AVANESYAN, Acting Minister for Health of Armenia, pointed to the difficulties in meeting United Nations goals on fighting HIV/AIDS and achieving the 2030 Agenda all over the world. Armenia was not an exception. The Political Declaration highlights the key approaches and steps needed to prevent AIDS as a public health threat and to accelerate achievement of the Sustainable Development Goals. Few countries were able to even partially meet the targets defined in the previous Declaration. The new Declaration should consider the priorities and strategic goals of Member States, he said, underscoring the importance of prioritizing HIV/AIDS high on the international agenda and ensuring that sustainable funding is available despite the heavy financial costs caused by COVID-19.
FRANCISCO DUQUE III, Secretary for Health of the Philippines, said that his country has made significant progress towards ending the HIV epidemic by 2030, detailing domestic legislation that defines the Government’s HIV response. These laws ensure equitable access to HIV services and broaden the scope of those services for vulnerable populations — such as migrants — living with the disease. Despite the constraints imposed by the COVID-19 pandemic, the national health system “has adapted to the new normal” and continues to provide testing, treatment and care services for HIV. The Government will continue to work with regional partners and renews its commitment to the global HIV response, he added.
MARISE PAYNE, Minister for Foreign Affairs and for Women of Australia, said her country is proud of its long history of supporting efforts to address the HIV epidemic, both nationally and across the Indo-Pacific region. “We know that community-led testing, treatment and prevention are the pillars of an effective HIV response,” she said, noting that Australia is partnering with UNAIDS to implement a new regional programme in seeking to increase the availability and uptake of HIV testing and prevention services among key populations. That support complements Australia’s substantial investments in the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS and bilateral and research programmes. Sexual and reproductive health and rights are also critical to the HIV response, including access to quality, age-appropriate, comprehensive sexuality education for all young people. Noting that COVID-19 has seriously disrupted access to those vital, life-saving services, particularly impacting women and girls, she announced a major new investment of A$44 million through key partners to address the urgent unmet need for sexual and reproductive health and rights services and information in targeted communities in the Indo-Pacific region. She also outlined a range of efforts to keep HIV infection levels low and support fundamental rights and freedoms at the national level.
MOULY IENG, Senior Minister, Chairman of the National AIDS Authority of Cambodia, said his country is one of seven to have achieved the 90-90-90 targets in 2017, driven by partnerships between national and subnational institutions, development partners, civil society and vulnerable populations. Yet, the country is not on track to reduce new infections up to the 2025 targets, due in part to insufficient funding for HIV prevention and the knock-on impacts of COVID-19, which have led to underinvestment in public health. Expressing Cambodia’s commitment to a people-centred and integrated approach applied through reforms and policies for universal health coverage and social protections, he said that, over the next five years, the country will carry out a coordinated national HIV response, based on a shared responsibility to fully implement the Political Declaration.
KWAKU AGYEMAN MANU, Minister for Health of Ghana, detailed national efforts to control the HIV/AIDS epidemic, including domestic law that protects the human rights of those living with the disease. While the Global Fund to Fight AIDS, Tuberculosis and Malaria has provided funding to Ghana over the years, gaps persist, and to address them, the Government is making use of domestic funding methods to implement its national HIV/AIDS strategy. He called on international partners to provide technical and capacity‑building assistance and to grant debt relief to free funds towards this end, adding that the Government will continue investing in the local manufacturing of antiretroviral medicine.
SIGRID KAAG, Minister for Foreign Trade and Development Cooperation of the Netherlands, said COVID-19 has made it even harder to get tested for HIV, let alone treated, which only deepens existing inequalities, and hampers access to health care. But, this can be overcome. After 40 years of HIV response, “we know what works”, she said. “What works is recognizing reality and respecting human rights.” Adolescent girls and young women, men who have sex with men, sex workers, people who use drugs, transgender people and prisoners are key populations who pay the highest price for the collective failure to stop the spread of HIV. Sex is part of this, and should be safe and enjoyable for everyone, she said, noting that the Netherlands provides free access to sexual health care for high-risk groups. This approach is effective because it recognizes the realities of life. The Netherlands takes the same approach in international efforts to advance sexual and reproductive health and rights, supporting UNAIDS. Welcoming the new global strategy, she said past progress must not be lost. Countries in Eastern and Southern Africa are showing the way through constructive political leadership, active civil society and community responses which have delivered a 38 per cent decline in new HIV infections. The world should rally behind the people and countries that are most affected. “They are counting on us,” she said. “Let’s not fail them.”
WENDY MORTON, Minister for European Neighbourhood and the Americas at the Foreign, Commonwealth and Development Office of the United Kingdom, welcomed that over 25 million people now receive treatment that not only prevents death, but allows them to thrive. Expressing support for the new Global AIDS Strategy, she declared: “It rests on all of us to deliver it, and end the AIDS epidemic by 2030.” The need to drive down HIV infections among key populations, as well as women of reproductive age, is clear. The United Kingdom has invested substantially in WHO and the Global Fund, which work alongside Governments to address their HIV epidemics. Against that backdrop, she announced that the United Kingdom will contribute an additional £7 million over the next three years to the Robert Carr Fund, in order to support civil society networks in providing vital health services and advocate for the rights of inadequately served populations. “Tragically, one of the biggest barriers to ending AIDS is a lack of political will that flows from a lack of respect for the rights of women, adolescents, LGBTQ people and minorities,” she said, adding that, as is the case with COVID-19, “we cannot put it behind us until every country is able to do so”. For that reason, marginalized parts of society must be protected and empowered, and the sexual and reproductive health and rights of all people defended.
MIKHAIL MURASHKO, Minister for Health of the Russian Federation, said the redistribution of finances resulting from the COVID-19 pandemic must not be allowed to impact countries’ efforts to combat HIV/AIDS. The Russian Federation’s new national HIV strategy includes targeted programmes, as well as improved testing and prevention. The country continues to provide antiretroviral treatment and social support to people living with HIV, and it works with non-governmental organizations to provide care. Noting that it has reduced the number of new cases by 26,000 in recent years, he said vertical transmission has been virtually eliminated. He also underlined a range of innovative scientific initiatives, adding that international cooperation is crucial. In that vein, since 2013, the Russian Federation has funded the HIV Technical Assistance Programme for Central Asia and Eastern Europe, he said.
JOSE PORTAL MIRANDA, Minister for Public Health of Cuba, said wide inequalities in access to health care have only been compounded by the COVID-19 pandemic, which is also eroding gains made towards achieving sustainable development targets. Cuba’s HIV response is driven by its people-centred primary health care system and involves key populations, ensuring that the needs of each specific group are met. Noting that infection rates in Cuba are stabilizing, he recalled that, in 2015, Cuba was the first country in the world certified by WHO as having ended mother-to-child transmission. Spotlighting the importance of prevention, diagnosis and antiretroviral therapy, he said 2 million serological tests are performed in Cuba annually, and steady progress is being made in raising social awareness of the need to end gender stereotypes and discrimination against women. All those strides are taking place against the backdrop of a suffocating economic war and decades-long embargo that makes access to medication and medical equipment more difficult, he added.
KHALID AIT TALEB, Minister for Health of Morocco, noting that the international community has been mobilized for decades in the fight against HIV/AIDS, said that this high-level meeting will allow Member States to assess progress made and identify remaining gaps to ensure that those living with the disease have full access to quality health services. For its part, the Government fosters a strong partnership with civil society, supported by national initiatives aimed at ending social exclusion and insecurity and extending social protection. Further, the Government has expended significant effort towards mitigating COVID‑19’s impact on national health programmes, and new HIV infections and deaths in Morocco have decreased by 50 per cent since 2010.
MARCELO QUEIROGA, Minister for Health of Brazil, said that, while the international community has achieved significant results in reducing HIV/AIDS cases and mortality, the number of new HIV infections far exceeds the global target for 2020. He detailed national measures to combat the disease, such as the provision of free, universal health care for HIV since 1996 and national COVID-19 vaccination programmes that prioritize those living with HIV/AIDS. He also highlighted the need to expand access to prevention tools — especially among vulnerable groups — and to act so that the stigma and discrimination still keenly felt by these groups does not keep them away from care.
MARTHA VERONICA REYES ALVAREZ, Minister for Health of Nicaragua, said her country has enacted a range of laws to protect and restore the rights of persons living with HIV, and to accelerate prevention and testing. Describing that approach as a comprehensive one that focuses on the dignity and needs of key populations, she said Nicaragua has in place an epidemiological tracing system and an ombudsperson to protect the rights of persons living with HIV. Mother-to-child transmission has been eliminated. An emergency response plan is also in place to combat COVID-19, she said.