The fight against HIV is no longer a challenge of science, but of equity

Every step we take today in the fight against HIV is going to be laborious: we must push harder to advance. This virus professionals meet this week in Yaoundé (Cameroon) for AFRAVIH, the largest French-speaking international conference on HIV/AIDS. In the early years of fighting this virus, our advances were often rapid and immense because everywhere you looked, there were great needs. These were devastating times: the disease killed three million people in 2000, more than 2.4 million of them in Africa. In the southern tip of the continent, where I am from, the disease threatened to disintegrate the social fabric.

When the world came together to form partnerships like the Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR, it challenged the injustice of only the rich being able to receive HIV treatment. It was to stop the possibility of losing a generation of people in many low- and middle-income countries, as well as those who were stigmatized and discriminated against for being considered different.

We have come a long way: from less than 50,000 people on HIV treatment in Africa in 2000 to more than 20 million today

I am proud to say that we have come a long way since then. From fewer than 50,000 people on HIV treatment in Africa in 2000 to more than 20 million today, innovations in HIV prevention have proliferated, dramatically reducing HIV infections. However, more than 1.3 million people were infected by the virus in 2022 worldwide.

These infections now occur mainly among men who have sex with men, people who inject drugs, trans women and sex workers. Furthermore, their voices are increasingly silenced and they are under constant threat of violence and abuse, as discriminatory legislation targeting LGBTI people is emerging around the world. Among these groups, young people aged 15 to 24 years bear a disproportionate burden of HIV and are even more vulnerable, as they face greater barriers to accessing health services.

The fight against HIV is no longer a challenge of science, but of equity. For us to accelerate progress again, we must recover that strong spirit of equity that animated us two decades ago. That means focusing on the communities most affected by HIV. In Africa, focusing on adolescents of both sexes is an urgent imperative.

In Africa, focusing on adolescents of both sexes is an urgent imperative

Although the incidence of HIV among adolescent girls and young women has greatly decreased over the last decade, 4,000 girls and young women continue to become infected with HIV each week worldwide, mainly in sub-Saharan Africa. This is unacceptable. This group continues to suffer the most iniquitous conditions of all, with structural injustices that predispose them to disease.

If we want to prevent HIV infections among this population, we must bring together diverse partners to invest in long-term efforts to keep girls in schools. Education turns girls into women with the possibility of greater equality of opportunity, and protects them from diseases such as HIV. Educated girls have lower rates of teenage pregnancies, sexual violence, early marriages and, ultimately, fewer HIV infections. We must also accelerate investments in programs that support comprehensive sexual and reproductive health and rights, especially for adolescent girls and young women.

And we must ensure that young women and girls are at the center of projects that seek their participation. These are some of the goals that the Global Fund partnership seeks to achieve with projects such as Voix EssentiELLES and the HER Voice Fund, which strive to meaningfully engage young women and girls in key health programs and decision-making forums of their communities.

Educated girls have lower rates of teenage pregnancy, sexual violence, early marriage and, ultimately, fewer HIV infections.

To end HIV infections among young women and girls, we must also reduce infections among their sexual partners. This means investing in efforts to transform the cultural and social norms that predispose men and boys to HIV and that shape their relationships with girls and women in their communities. It also means that men at high risk of HIV infection are tested and supported to start and stay on treatment. Protecting heterosexual men and boys from HIV can also help protect women and girls.

It's about renewing our focus on promoting equity. We know how to do it. We did it at the turn of the millennium with our push for equity in HIV treatment. The 25th International AIDS Conference in Munich is three months away. Let us move forward now and end this unfinished fight by reducing HIV infections among the most affected groups. To achieve this, we can re-energize ourselves with the goals and unbreakable spirit of those golden years of progress in the fight against HIV.