The global response to COVID-19 has rewritten the rules regarding what can be done to fight a deadly communicable disease. The measures taken over the past year at individual and societal levels, and the resources mobilised and deployed are unprecedented in the purest sense of the word.

Two decades before COVID-19, HIV similarly broke the mould. In 2001, as AIDS-related deaths climbed past 1·5 million a year, the UN General Assembly held a landmark special session on HIV that galvanised global political commitment, established the Global Fund to Fight HIV, Tuberculosis and Malaria, and brought long-awaited treatment to people living with HIV in low-income and middle-income countries.

Great progress has been achieved: UNAIDS estimates that annual AIDS-related deaths have fallen by 60% since their peak in 2004, and annual HIV infections have declined by 40% since a 1998 peak.

However, as the General Assembly prepares to convene its 5th high-level meeting on HIV in June, 2021, the world must confront the reality that progress has dangerously slowed. Global targets for 2020 have been missed. Successes in some places have been tempered by minimal gains or growing epidemics in others. The COVID-19 pandemic has caused further setbacks. Across all regions, people experiencing the impact of gender inequality, social marginalisation, and criminalisation are most often left behind. A course correction is urgently needed if the world is to reach its goal of ending the HIV pandemic by 2030.

A new bearing has been set by the 2021–26 UNAIDS strategy,1UNAIDS
End inequalities. End AIDS. Global AIDS strategy 2021–2026. including bold targets for 2025. Epidemic modelling shows that urgent action to implement the strategy would cause HIV infections to fall from 1·7 million in 2019 to 370 000 by 2025, and the number of people dying from AIDS-related illnesses to decline from 690 000 in 2019 to 250 000 in 2025.1UNAIDS
End inequalities. End AIDS. Global AIDS strategy 2021–2026.Reality is much more complicated than epidemic modelling. Getting HIV services to 95% of the people who need them is not as straightforward as selling bottles of sugary soda. HIV-related stigma and discrimination, gender inequality and gender-based violence, and laws and policies that criminalise the populations at highest risk of HIV infection have stood in the way since the earliest days of the pandemic. Continued failure to address these barriers will slow HIV service expansion, leading to an additional 1·7 million AIDS-related deaths between 2020 and 2030, and an additional 2·5 million new HIV infections over the same period.2UN General Assembly
Addressing inequalities and getting back on track to end AIDS by 2030. Report of the Secretary-General.

The UNAIDS global strategy calls for legal, policy, and programmatic changes that would reduce to no more than 10% the number of people living with or affected by HIV who experience stigma and discrimination, the number of people who experience gender-based inequalities and gender-based violence, and the number of countries that have punitive laws and policies in place.

The UNAIDS strategy also recognises that the people in greatest need of HIV services also require health care, education, sustainable livelihoods, and social safety nets. The strategy calls for 90% of people living with HIV and people at risk to be linked to services they need for their overall health and wellbeing. However, public health systems, education systems, and social protection systems are often underfunded and overstretched. The response to the COVID-19 pandemic has emphasised the importance of communities in bridging these gaps. Communities living with and affected by HIV who have been the backbone of the HIV response since its earliest days must be further supported—in policies and in budgets—if gaps in HIV services are to be closed. The UNAIDS strategy includes clear targets for this.

A robust HIV response also requires sufficient investment. The bill for ending AIDS keeps climbing as funding and action continue to fall short, resulting in more people in need of services. If additional resources can mobilised, reaching US$29 billion (in constant 2019 dollars) in low-income and middle-income countries by 2025, and efficiently used in line with the UNAIDS strategy, the current year-on-year growth in resource needs can be halted by 2025.

Some might argue that the world cannot afford to end AIDS as it wrestles with the immense challenges of COVID-19 pandemic. Such short-sightedness is what left the world unacceptably vulnerable to COVID-19. Continued underinvestment in pandemic preparedness and responses is akin to playing with fire. The General Assembly's high-level meeting on HIV/AIDS on June 8–10, 2021, is a critical moment for countries to embrace the UNAIDS strategy and put the world back on track to ending AIDS by 2030.

I declare no competing interests.

References1.

End inequalities. End AIDS. Global AIDS strategy 2021–2026.

UNAIDS, Geneva2.

Addressing inequalities and getting back on track to end AIDS by 2030. Report of the Secretary-General.

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DOI: https://doi.org/10.1016/S2352-3018(21)00107-7

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