/ 8 September 2023

World leaders can choose the path that ends Aids

Demonstrating against denial: While the government’s Aids policies sparked protests like the one pictured in 2001 in Cape Town, the author believes that ending the disease is a political and financial choice. (Per-Anders Pettersson / Getty Images)

The Aids pandemic has been devastating. It continues to take a life every minute. But as world leaders prepare to meet at the United Nations General Assembly, at a moment of polycrisis when hope can seem in short supply, the HIV response offers world leaders the opportunity for an extraordinary global breakthrough. There is a path that ends Aids as a public health threat by 2030. Leaders’ decisions this year can put the world on that path. 

We know the path well, because some countries are already on it — and succeeding. Botswana, eSwatini, Rwanda, Tanzania and Zimbabwe have achieved the “95-95-95” targets. That means that in those countries 95% of the people who are living with HIV know their HIV status, 95% of the people who know that they are living with HIV are on life-saving antiretroviral treatment, and 95% of people who are on treatment are virally suppressed. A further 16 other countries are close to meeting these targets.  When a person’s viral load is suppressed, HIV cannot be transmitted, taking us a step closer to ending Aids .

Worldwide, our data show that 29.8 million of the 39 million people living with HIV are receiving life-saving treatment, something that was only a dream two decades ago.  Behind every statistic are the lives of people freed to live fully and without fear. Like 50-year-old Hanni Dlamini, who was diagnosed with HIV at the age of 20, in eSwatini, who would not have lived beyond his 30th birthday if he was not on life-saving antiretroviral treatment. Like the mothers I met recently in Tanzania, living with HIV, who introduced me to their babies born free of HIV. This is the promise and progress of the HIV response.

But despite this progress, our work is not yet finished, because millions of people are still not receiving HIV treatment, including 43% of children living with HIV, and because hundreds of thousands of people contract HIV each year even though it is preventable. In a pandemic, facing a deadly virus, there is no room for “almost” succeeding or succeeding only for some. The iron law of inequality and pandemics says that allowing inequality to fester undermines the response for everyone. That is why people globally  are calling on the world leaders meeting at the upcoming 78th United Nations General Assembly in September to take the steps needed to get the world on the path to end Aids .

Taking this path will not only enable leaders to end Aids. What we need to end the Aids pandemic will also help us keep tomorrow’s outbreaks from becoming pandemics. The success of the global response to Aids is bolstering the achievement of sustainable development goals for health (SDG 3) while contributing to progress in other goals such as those focused on quality education (SDG 4), gender equality (SDG 5) and reduced inequalities (SDG 10). 

Investments in community health workers and support for policy reforms that protect human rights and reduce inequalities are helping to advance the health, well-being and security of everyone. Pioneering multisectoral approaches developed and deployed in the Aids response, that let communities lead, and leverage the whole of government, are further strengthening programmes and policies across health and development. The Aids movement is one of the greatest assets for global progress. Ensuring the end of Aids is not an alternative to investing in other problems, it is how those other challenges can be overcome.

It is clear what leaders need to do to get the world on the path to end Aids and sustain its gains into the future. Efforts to end Aids succeed when, anchored in strong political leadership, they follow the evidence; tackle inequalities holding back progress; enable communities and civil society organisations in their vital roles in the response; and are supported by sufficient and sustainable funding. The path that ends Aids requires collaboration — south and north, governments and communities, the UN system and member states together. 

The crises of recent years, from the Covid-19 pandemic to wars and more, have brought shocks that have made achieving the end of Aids and achieving the sustainable development goals more difficult, but they have not made it impossible. Success is within our grasp. 

Ending Aids is a uniquely powerful legacy for today’s leaders. They can save millions of lives while protecting the health of us all. They can be remembered by future generations as those who ensured the policies, programmes and investments that put a stop to the world’s deadliest pandemic helped ready the world for future pandemics and enabled the achievement of the sustainable development goals. They can show what leadership can do. 

The path that ends Aids is not a mystery. It is a political and financial choice. Let’s take that path together.

Winnie Byanyima is the executive director of UNAIDS and under-secretary general of the United Nations.