It will depend on the responsibility and decision-making of heads of state and government worldwide whether the United Nations' goal that AIDS would no longer pose a threat to public health by 2030 is achievable. The report ‘The Urgency of Now: AIDS at a Crossroads’ presented by UNAIDS on 22 July 2024 in the run-up to the International AIDS Conference in Munich (which contained current data up to 2023), shows that the goal of ending AIDS in this decade is ‘within reach’. However, the world is not on course to achieve it. A quarter of the 39.9 million people living with HIV worldwide are not receiving treatment. The commitment made by heads of state and government to reduce the number of new infections to below 370,000 per year by 2025 will also be missed by a wide margin: in 2023, the figure was more than three times as high at 1.3 million.
The enormous progress made in the prevention and treatment of HIV and AIDS over the past 40 years has made it possible to suppress the virus to such an extent that infected people no longer pose a risk of infection. Recently, there have been isolated reports of successful cures. The world has made progress in implementing the AIDS 95-95-95 strategy by 2023:
Although the number of people living with HIV is still rising at the moment (2023: 39.9 million), the increase is levelling off. This is because the number of new infections is falling: from 2.1 million in 2010 to 1.3 million in 2023. The number of AIDS-related deaths has more than halved since 2010 to 630,000. The number of people with access to retroviral therapy has risen from 7.7 to 30.7 million.
‘The path to ending AIDS is not a mystery,’ said UNAIDS Secretary-General Winnie Byanyima. ‘It is a political and financial decision’. She sees a clear and urgent current responsibility of the heads of state and government.
The declining budget (due to inflation and economic crises) has become a growing risk towards missing the target. Budgets for the particularly hard-hit low- and middle-income countries have fallen steadily since 2020 from 21.5 to 19.8 billion dollars. What is needed is 29.3 billion dollars, meaning that the annual financial gap to be closed is 9.5 billion dollars and could continue to rise.
The extent of criminalisation, discrimination and stigmatisation of homosexuals, bisexuals, trans* people, sex workers, and drug addicts is also largely in the hands of political decision-makers. These groups are infected with HIV at an above-average rate: While the global prevalence in the population between the ages of 15 and 49 is 0.8 per cent, it is 7.7 per cent among homosexual men and MSM, 3 per cent among sex workers, 9.2 per cent among trans* people and 5 per cent among drug addicts. While women account for 44 per cent of all new infections worldwide, the figure in sub-Saharan Africa is 52 per cent. The cause of the inverse ratio is said to be pronounced sexual violence.
The possible influence of radical Islamic manifestations and ultra-reactionary Russian orthodoxy on society and politics with regard to the stigmatisation and criminalisation of homosexuals and trans* people as well as discrimination against women is shown by the data for the region of Central Asia and Eastern Europe - with Russia as the most populous country, and the Central Asian states between Russia and China, all of which are under authoritarian rule.
While the number of AIDS-related deaths fell by 51 per cent in all regions of the world between 2010 and 2013, it rose by 34 per cent in Central Asia and Eastern Europe. In this region of the world, only 50 per cent of people with HIV receive antiretroviral therapy, compared to 77 per cent globally. In the Middle East and North Africa, too, only 49 per cent of people infected with HIV receive antiretroviral therapy. Both regions have the world's largest financial gap in the medical fight against HIV.
It is therefore essentially political, social and economic decisions that determine whether HIV and AIDS can be eradicated in the long term. The impact of fully funding the necessary prevention and treatment programmes alone is considerable: starting from 39.3 million infected people worldwide, the number of infected people would reach 45.3 million in 2040 and then 46.4 million in 2050 if the financial gap persists, but with sufficient budgets the number could fall to 33.8 million in 2040 and to 28.8 million in 2050. UNAIDS argues that the welfare gains from long-term treatment savings and, above all, from the increased labour productivity of younger people would be considerable and represent a substantial return on investment.