Today in Eastern and Southern Africa, there are 20.8 million people living with HIV. While our region is the most heavily impacted in the world, it is also the region that has made the most significant progress in the HIV response.
It is inspiring to note that Botswana, Eswatini, Rwanda, Tanzania and Zimbabwe are on track to ending Aids by 2030. They have already achieved a significant target – 95 percent of their population living with HIV know their HIV status; 95 percent of their population living with HIV who know their HIV status are on life-saving treatment; and 95 percent of their population living with HIV who are on treatment are virally suppressed. When a person’s viral load is suppressed, HIV cannot be transmitted, taking us a step closer to ending Aids.
We know that there is a clear and proven path to end Aids as a public health threat. It is not a mystery. It can be achieved if we let communities –- people living with or at risk of HIV -– lead the way. We have seen that communities are the drivers of progress in the Aids response since the discovery of HIV 40 years ago.
Earlier this year, when I was in Rwanda, I visited the Mayanga Health facility in Bugesera District, where I met with a young mother who was HIV positive. Covid-19 brought some challenges to her life. She was unable to take her antiretroviral treatment because she did not have access to food (some medications for HIV need to be taken with food). Recognizing the seriousness of her predicament, a volunteer community health worker in her sub-district and linked to the Mayanga Health facility, organized a regular food supply for her and she was able to resume her anti-retroviral treatment.
The contribution of the communities and community-led organizations in the Aids response has helped tackle other pandemics and health crises too, including Covid-19, monkeypox and Ebola. During the Covid-19 pandemic, communities pivoted services from in-person to virtual, becoming some of the primary distributors of HIV medicines and emergency tools for HIV and Covid-19 prevention.
In Iringa, Tanzania, the incidence of HIV among sex workers who were reached with peer-based interventions was half the incidence among people who did not participate in the peer-based programme. You see communities connect people to public health services; they build trust, innovate, monitor the implementation of policies and services and hold service providers accountable.
It has been a long-standing principle of the Aids response to bring people living with and affected by HIV to the decision-making table. Nothing about us without us! We cannot forget the iconic struggles around the world in the earlier days of the HIV epidemic, when grassroots movements challenged monopolies on antiretroviral medicines. Their advocacy brought the cost of these lifesaving medicines down from $25,000 per person a year in 1995 to as low as $70 per person per year today. Supporting communities in their leadership is not only the right thing to do, but also essential for advancing public health.
It is because of examples like these and countless other examples of community leadership and innovation, that communities are at the centre of World Aids Day commemoration this year, including in a major new UNAids report, Let Communities Lead.
But right now, community leadership is being held back. Community-led responses to HIV are under-recognised, under-resourced and, in some places, even under attack. Globally, funding for communities has fallen by 11 percent in the last 10 years, from 31percnt in 2012 to 20 percent in 2021. These barriers in the way of community leadership are obstructing the progress of HIV prevention, treatment and care services.
It is in everyone’s interests to fully fund community-led organisations and remove the many obstacles they face. This World Aids Day, we are using the occasion as a call to action to fully support communities’ life-saving work, pull down the barriers that stand in their way and unleash their full potential.
I must remind you that Aids is far from over. Last year alone, in Eastern and Southern Africa, 500,000 people were newly infected with HIV and 260,000 died of Aids-related illnesses.
We have the tools to prevent new HIV infections and ensure that all people living with HIV access treatment. The end of Aids is within reach. We even know how to get there: Let communities lead.
Anne Githuku-Shongwe is UNAids Regional Director, Eastern and Southern Africa