By Ndivhuwo Mukwevho

In the fight against HIV, ignoring societal enablers could see new infections and deaths reach over 4 million by 2030. This is according to UNAIDS Deputy Executive Director, Eamonn Murphy.
“We need societal enablers to reach impact goals. Failure to make any progress would undermine efforts to reach the HIV service targets, resulting in an additional 1,7 million Aids-related deaths and 2,5 million additional new HIV infections between 2021 and 2030,” said Murphy.
He was speaking at the 24th International Aids conference in Montreal on Sunday, 31 July.

The role of societal enablers
According to Murphy, the globe would not reach epidemic transition without focusing on societal enablers and community engagement.
“We will not reach epidemic transition without focusing on societal enablers and community engagement 30-80-60.”
Murphy said it is concerning that the decline in the number of new HIV infections has stagnated.
“Last year, governments committed to 25 targets within the political declaration. Two of the targets were prevention and treatment. Gender equity, human rights, community leadership, integration and investments were also targeted.
“But the decline in new HIV infections has stagnated,” said Murphy.
“We are all familiar with the epidemic and the targets, the reduction of new infections and Aids-related deaths. But we are missing these targets. The challenge for us is how do we get back on track?
“This year’s report highlights the danger of the risk we are facing. We had success, but gaps in the response prevent us from reaching the levels we want to reach.”
Murphy said the disparity between the number of children under treatment compared to adults is worrying.
“We will miss the 2025 target, unless we accelerate the treatment coverage, re-invigorate effective prevention efforts and remove all barriers to inclusion.
“No region has achieved the 95-95-95 or the 90-90-90 targets. Children remain far behind adults. 52% of children are living with HIV on treatment, compared to 76% among adults,” he said.

SA’s huge brunt
Professor Refilwe Phaswana-Mafuya, of the faculty of health sciences at the University of Joburg, said South Africa continues to record the highest share of the HIV/Aids epidemic worldwide.
“Although HIV prevalence plateaued at 13%, during the last five years, South Africa still has the largest HIV epidemic in the world,” said Phaswana-Mafuya.
“Almost 20% of people living with HIV worldwide are in South Africa. And the South African epidemic is heterogeneous as it differs by socio-demographics such as race, gender, age and geographic location.”
Phaswana-Mafuya said the highest prevalence is among Black Africans (17%) and the least among whites and Asians (1%).
In terms of age, there is a higher prevalence in younger age groups (15-49%), with higher proportions among females (15-24 years). This is almost three times more than their male counterparts.
There is also a higher prevalence in key populations, for example, gay and other men who have sex with men (29,7%) and female sex workers (59,2%).

The gap between goals and achievements
Phaswana-Mafuya said South Africa has to jump several hurdles to end the epidemic by 2030.
“Clearly, South Africa has ambition and focus. To date, the gap between achievements and the goal to end HIV remain too wide.
“South Africa needs to use its accumulated implementation experience, political will, human rights advances and follow the science toward epidemic control by 2030,” she said.

Stigma and discrimination
According to Murphy, stigma and discrimination remain some of the hurdles in the fight against HIV.
“Stigma and discrimination still block the way forward. In nine of the 21 countries, more than half of the people living with HIV surveyed reported feeling ashamed. Although we see increased action on stigma and discrimination, more needs to be done,” Murphy explained.
“Countries must also take action to meet broader human rights obligations and reduce the underlying inequalities and intersecting forms of discrimination that hold back progress.
“They also need to support and effectively resource community-led responses. New policies and models are needed for the scale-up of integrated community-led responses.
“More consistent and easily accessible funding and capacity-building support should also be made available to enable women and young people in their diversity to assume leadership roles.”
– Health-e News