Pandemics are not fate: Concrete actions to tackle inequalities can overcome AIDS, Monkeypox and COVID-19

By United Nations Programme on HIV/AIDS

Pandemics are not fate: Concrete actions to tackle inequalities can overcome AIDS, Monkeypox and COVID-19

The world does not need to accept pandemics as fate, experts gathered at the International AIDS Conference concurred. By taking specific, well-evidenced, concrete actions to tackle the inequalities driving them, the health threats can all be overcome.

As the latest data reveals that progress in the HIV response is stalling, putting millions of lives in danger, as the COVID-19 crisis drags on, and as Monkeypox presents new risks, all are being held back by inequalities, and all three viruses are in turn further exacerbating those inequalities. However, a focus on tackling underlying drivers of pandemic risk can enable a successful response, scientists, economists, and heads of AIDS programs concurred.

“There are Monkeypox vaccine doses in Europe but none in Africa. Most people at risk of dying from COVID-19 in lower-income countries have still not received a COVID-19 vaccine. New game-changing prevention medicines for HIV will not be widely available in lower income counties for years unless there is a dramatic course correction,” said Winnie Byanyima, Executive Director, UNAIDS, and Under-Secretary-General of the United Nations. “An effective response to disease outbreaks and pandemics means tackling inequalities. That means empowering women and girls to shift power relations between men and women. It means tackling inequalities in access to health services between rich and poor. And it means removing punitive laws that push away from life-saving services LGBTQI+ people, people who use drugs, and sex workers.”

The application of scientific advancements is currently being undermined by inequalities, delegates at the International AIDS Conference noted. They recalled how, at the turn of the millennium, civil society and generic manufacturers teamed up to demand access to antiretrovirals for people living with HIV and their victory against the odds helped save millions of lives. But whilst that battle was won, delegates highlighted that the overall process of research and development, innovation, and how that translates into manufacturing, pricing and distribution has remained untransparent and heavily skewed to the interests of rich countries. This played out during the COVID-19 pandemic as tests, vaccines and now antivirals are widely available in rich countries while still scarce in lower-income countries. And now this is repeating again with Monkeypox.

Inequality is not only about differential risks but is about cycles of power, the imbalance in how laws and policies are implemented, who is empowered by these policies, and who is disempowered.

“The AIDS movement is one of the best examples of how groups of people experiencing intersecting inequalities can unite to overcome them, leading to millions of lives being saved,” said Professor Joseph Stiglitz, Nobel laureate in economics. “But those gains were not permanent. Now a heating world combined with systemic inequalities means that new disease outbreaks are becoming more frequent and while technological advancement is important if there’s not a serious move to tackle inequality, the pattern of prolonged pandemics will only continue.” Professor Stiglitz was speaking at the AIDS Conference’s flagship session entitled “How Inequalities Perpetuate Pandemics: Why We Need a New Approach to End AIDS.”

New HIV infections occurred disproportionately among young women and adolescent girls, with a new infection every two minutes in this population in 2021. The gendered HIV impact, particularly for young African women and girls, occurred amidst disruption of key HIV treatment and prevention services, millions of girls out of school due to pandemics, and spikes in teenage pregnancies and gender-based violence. In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men.

Worldwide, only half (52%) of children living with HIV have access to life-saving medicine, and the inequality in HIV treatment coverage between children and adults is increasing rather than narrowing.​

Racial inequalities drive HIV too. In the United Kingdom and the United States, declines in new HIV diagnoses have been smaller among Black populations than among White. In Australia, Canada, and the United States, HIV acquisition rates are higher in Indigenous communities than in non-Indigenous communities.

Sbongile Nkosi, Co-Executive Director of the Global Network of PLHIV stated “Our experiences to date remind us that responding to pandemics such as HIV and COVID-19 is not just about dealing with a medical condition, it’s also about the environment in which we live and how my social status will determine the care I receive. It means centering interventions around the needs of people and listening to people. When we talk about key populations, we tend to group people. But then we misunderstand inequalities. People live intersecting lives and inequalities affect them differently.”

During the disruptions of the last few years, key populations have been particularly affected in many communities – with rising prevalence in many locations. UNAIDS data have shown the increased risk of new infections faced by gay men and other men who have sex with men (MSM) globally. As of 2021, UNAIDS key populations data show MSM have 28 times the risk of acquiring HIV compared to people of the same age and gender identity while people who inject drugs have 35 times the risk, sex workers 30 times the risk, and transgender women 14 times the risk.

Just as tackling inequalities has been key to progress in tackling HIV, so it is in tackling COVID-19. But too many COVID-19 responses have ignored this.

“We have failed to learn a lot of the lessons from HIV/AIDS in the way we responded to COVID-19. And we need to be honest about that and reflect on where we go from here,” noted Executive Director of the Global Fund, Peter Sands.

“It’s time not only to know your gaps but to close those gaps,” said Ambassador John Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy.

The inequalities are bleak. But the most important message is a hopeful one. UNAIDS knows how to end AIDS by 2030 and also how to overcome Monkeypox, COVID-19, and other current and future health threats: when the world tackles the inequalities which drive health risks, then can keep everyone safe.