Dangerous Inequalities

In 2021, 650,000 people died of AIDS-related causes and 1.5 million people newly acquired HIV. Worldwide, 38.4 million people are living with HIV/AIDS.

Dangerous Inequalities, a new World AIDS Day report by UNAIDS, identifies three key drivers of the global HIV epidemic: gender inequalities, discrimination against key populations, and failure to adequately respond to children impacted by the virus.

Gender

• In 2021, women and girls made up 49% of new HIV infections worldwide.
• Every two minutes, an adolescent girl or young woman (15–24) acquired HIV, totaling an estimated 250,000, with 82% living in sub-Saharan Africa.
• Among women in Africa, AIDS-related illnesses are the leading cause of death; for all women aged 15–49, they are the third leading cause of death.

Solutions include reforming policies and laws that prohibit young women from accessing HIV prevention services and other sexual and reproductive healthcare without parental or guardian consent, and deeper investments in HIV-related programs for adolescent girls and young women.

Broader structural reforms will also lessen women’s risk for HIV: strengthening or enacting laws against gender discrimination and intimate partner violence and removing barriers to education and economic protections. Also needed: initiatives that seek to change harmful gender and masculinity norms to reduce gender-based violence and HIV risk for women, as well as tailored programs to engage a diverse spectrum of men and boys in prevention, care, and treatment.

Key Populations

• New infections among key populations—gay men and other men who have sex with men (MSM), sex workers, transgender people, people who inject drugs, and prisoners and other incarcerated people—are not declining, even as other populations are showing progress.
• Key populations are most at risk of acquiring HIV, yet least likely to be a priority in many national HIV/AIDS strategies and policies.

Solutions need to be population- and context-dependent, but, overall, dismantling barriers to healthcare services, including those beyond HIV, is essential. Yet, the report reminds, expanding access to vital services means little without also shutting down engines of violence, stigma, and discrimination, such as laws that criminalize sex, affection, positive serostatus, and identity expression.

Children

• In 2021, children made up 4% of all people living with HIV but 15% of all AIDS-related deaths.
• Children living with HIV are less likely than adults to be diagnosed, treated, or achieve viral suppression.
• The treatment coverage gap is perhaps the most striking—while 76% of adults (15 and older) receive antiretroviral therapy (ART), only 52% of children are on ART (in numbers: 800,000). And the gap has only grown since 2010, partly because mother-to-child transmission has not been eradicated.

Solutions include early diagnosis of children born to mothers living with HIV and increased healthcare access (both HIV-related and reproductive care) for adolescent girls and young women. Treatment options for children have expanded considerably, but these need to be made accessible everywhere.

The theme of this year’s World AIDS Day—“Equalize”—invites the global community to get back on track to end AIDS by 2030.

 “What world leaders need to do is crystal clear,” said Winnie Byanyima, UNAIDS executive director, about the report’s findings. “In one word: Equalize. Equalize access to rights, equalize access to services, equalize access to the best science and medicine. Equalizing will not only help the marginalized. It will help everyone.”

Read the report online here.

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