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World AIDS Day calls for an end to inequality

World AIDS Day is held on the 1st of December and for 2021 the key theme is to try and end both inequality and the virus itself

A key theme for World AIDS Day in 2021 is a call to end the inequality associated with AIDS and which has been driven by division, disparity and disregard for human rights. AIDS was first recognised as a new disease 40 years ago in1981 in a number of homosexual men who were found to have succumbed to unusual opportunistic infections and rare malignancies. It was identified that these individuals were infected with the human immunodeficiency virus type 1 (HIV-1) and which was spread via sexual transmission through the lower genital and rectal mucosa. In fact, even today, it is these routes of infection that account for the vast majority of current and new infections. HIV targets the immune system and weakens an individual’s defence against many infections and by impairing the functionality of immune cells, those infected with the virus gradually become immunodeficient.

Although antiretroviral therapy (ART) has been available for many years but while not curative, treatment has enabled infected patients to live longer lives, as well as reducing HIV transmission. However, to date, there is still no effective vaccine but this could soon change as a trial is about to begin at Oxford university.

Even with ART, the HIV virus continues to represent a global major health challenge. According to the World Health Organization (WHO), the virus has already claimed 36.3 million [27.2–47.8 million] lives and WHO estimates that in 2020, there were 37.7 million [30.2–45.1 million] people living with HIV, of whom over two thirds (25.4 million) reside in the African Region.

In order for those infected with the virus to access ART and associated counselling services, it is imperative to have equality of access to HIV testing, especially in areas of African, where the virus affects a huge number of people. Sadly however, a 2020 analysis from 16 countries in sub-Saharan Africa, revealed that while relative socioeconomic inequalities in uptake of HIV testing in the region have decreased to some extent, absolute inequalities have persisted or increased. 

Other data from the Start Free, Stay Free, AIDS Free initiative which began in 2015, also highlights the continued existence of inequality. The initiative has a five-year framework which called for a super Fast-Track approach to ensure that every child has an HIV-free beginning, that they stay HIV-free through adolescence and that every child and adolescent living with HIV has access to antiretroviral therapy. The approach focused on 23 countries, 21 of which were in Africa, that accounted for 83% of the global number of pregnant women living with HIV, 80% of children living with HIV and 78% of young women aged 15–24 years newly infected with HIV. The group’s most recent report from 2020 provides additional evidence of the current inequalities of access among those with HIV, revealing how nearly half (46%) of the world’s 1.7 million children living with HIV were not on treatment in 2020 and 150,000 children were newly infected with HIV, which is four times more than the 2020 target of 40,000.

Despite having being discovered over 30 years ago and with treatments which enable infected individuals to live a virtually normal life, HIV is still very much a global health concern. Given the current enormous and global effort directed towards fighting COVID-19, it is hoped that the 2021 World AIDS day call can gather an equal amount of energy in both reducing the inequality of access to testing and treatment as well as ending HIV.

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