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By Robin Montgomery, Executive Director, ICAD

Today is December 1 – a day when communities around the world commemorate World AIDS Day with efforts that celebrate our successes and pause to remember the millions who we have lost the fight against HIV. World AIDS Day also offers us opportunity to reflect, to re-calibrate, and to mobilize with increased force towards our collective Global Goal to end HIV as a public health threat by 2030.

…sirens are blaring with warning that the world is off-track… like, way off track.

This year’s World AIDS Day is unlike those that have come before. Today recognizes the 30th anniversary of World AIDS Day. Yes, you heard me. The big 3-0. This annual day of global recognition is quickly moving from youth and closer to middle age. While it’s true that there has been inspiring progress achieved globally, we have far distances to travel before truly being able to make HIV and AIDS history. In fact, sirens are blaring with warning that the world is off-track… like, way off track.

For one thing, HIV is preventable. Yet, we continue to struggle in bringing down rates of new infection.

According a UNAIDS report on HIV Prevention that is up for discussion at the December meeting of its global governance body, UNAIDS confirms that new HIV infections are declining – but not fast enough to achieve the 2020 milestone of fewer than 500,000 new HIV infections annually! Nor is the decline consistent across regions of the world. For instance, the annual number of new HIV infections has approximately doubled since 2000 in Eastern Europe and Central Asia. Looking closer to home, our 2016 Canadian federal estimates also indicate a 5% increase in new infections since 2014.

HIV does not discriminate but it is largely both a cause, and a consequence of poverty. Isolation, marginalization, criminalization, vulnerability, stigma and discrimination are its closest friends. Harmful gender norms, punitive legal frameworks, discrimination, violence, limited access to education, and a lack of tailored services are the fuel that drive new infections.

Isolation, marginalization, criminalization, vulnerability, stigma and discrimination are its closest friends.

In countries with the heaviest burden of HIV, adolescent girls and young women (ages 15-24) make up over 80 percent of all new infections among adolescents and are up to 8 times more likely to be living with HIV that their male peers. In sub-Saharan Africa, the number of 15-24 year-olds is anticipated to more than double over the next 10 years. Racheting up HIV prevention efforts for adolescent girls and young women is critical to stemming a looming catastrophe that promises to affect societies from the national level down to the household.

In middle and upper income countries, like Canada, HIV is often nestled within society’s most vulnerable populations attributed as “key populations” because of biological risk factors and social determinants of health. In Canada, communities shouldering the heaviest burden include gay men and men who have sex with men (51.9%), young people, including young people of key populations (27%), women (23%), people who use drugs (17.4%), and Indigenous Peoples (9.6%). When we look a little deeper, we see that Indigenous people experience a disproportionate burden of HIV. While Indigenous Peoples represent approximately 4.9% of the general Canadian population, they are over 11% of all people living with HIV in Canada. Similarly, people born in countries where HIV is endemic represent 2.5% of the Canadian population and an astounding 14% of people living with HIV.

So what can be done to fill this gap in our HIV response at home and abroad? Well, there are many priorities – but here are my top two:

  1. Accelerate efforts to ensure enabling environments flourish which enable personal and individual identities, eliminate stigma and discrimination, uphold and advance human rights, remove pressures in the social determinants of health (such as, criminalization and punitive legal frameworks, gender and racial discrimination, affordable housing and homelessness, unemployment, barriers to education, etc.), and facilitate access to timely, quality and culturally appropriate prevention, testing, treatment, care and support services;
  2. Robust financial investment in and meaningful engagement of key population communities and their civil society partners in Canada and globally. The emergence of HIV redefined community responses beyond the traditional understanding of community health workers. It highlighted the role of communities affected by HIV as critical agents of change driving impact with innovations in service delivery; as advocates for the rights of those affected; and, as defenders for better access to treatment and other services. Community-driven HIV responses have been a source of key learning that have inspired other health domains (e.g., responses to Tuberculosis and Ebola). Communities and civil society remain at the forefront of the HIV response as service providers reaching those who are the hardest to reach, and linking community with formal health care. As a friend said, ‘without robust investment in communities and civil society, we put the entire HIV response at risk of failure’.

There are opportunities for systematic reporting of funding for civil society and community-led responses and other commitments under the 2016 United Nations Political Declaration on HIV, however reports from multilateral, philanthropic, and civil society organizations recognize steady funding declines from 2014 onwards. While domestic resources must serve as the backbone of national HIV responses, multilateral organizations like the Global Fund to Fight AIDS, TB and Malaria and the Robert Carr Fund have enabled huge progress to be made in areas of human rights, gender equality, empowering communities affected by HIV, building resilient and sustainable health systems, and have saved millions and millions of lives.

According to UNAIDS, 1.8 million people were newly infected with HIV in 2017 – that’s roughly 5,000 people daily. In terms of population, that’s akin to the size of Canadian towns like Perth, Gananoque, Antigonish, Deer Lake, or Nipawin. Is this acceptable? I think not. This is a call to action – not only to our political leaders but to each and every one of us. What are we going to do? That is, what are you going to do to ensure that when we celebrate the 40th anniversary of World AIDS Day, we are celebrating a very different moment in time – a time when HIV is history.

Robin Montgomery is the Executive Director of the Interagency Coalition on AIDS and Development (ICAD), a coalition of over 100 AIDS Service organizations (ASOs), international development non-governmental organizations (INGOS), faith-based organizations, educational institutions, labour unions and individuals committed to improving the response to HIV and related co-infections in Canada and in countries globally. Robin is also the Alternate Board Member to the Global Fund to Fight AIDS, TB and Malaria.

This blog is part of the blog series: Closing the Gap by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (1 December). The series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on what they think needs to be done to strengthen our HIV prevention efforts at home and abroad in order for the world to meet the ambitious target of ending AIDS as an epidemic by 2030.