Hopolang Phororo

Here is my reflection on the new UNAIDS Global AIDS Update launched by Winnie Byanyima, United Nations Under- Secretary General and UNAIDS executive director, on 14 July 2023 on Namibia’s AIDS health and development response. 

The new UNAIDS Global AIDS Update Report shows that there is a path that ends AIDS, which will help ensure preparedness to address future challenges, including pandemics and disasters, and advance progress across the Sustainable Development Goals.

The data in this report make it very clear what that path is. It is not a mystery. It is a political and financial choice that addresses inequalities and protects everyone, including diverse actors such as women and girls, and people living with HIV.  

HIV responses succeed when they are anchored in strong political leadership to follow the evidence; tackle the inequalities holding back progress; enable communities and civil society organisations in their vital role in the response; and ensure sufficient and sustainable funding.

Several countries are already on track. Botswana, Eswatini, Rwanda, the United Republic of Tanzania and Zimbabwe have already achieved the 95–95–95 targets, and at least 16 others, including Namibia, are close to doing so. In Namibia, 95% of all adults 15 to 49 years old are aware of their HIV status, of whom 97% were accessing HIV treatment, and 94% of these suppressed their viral loads. 

Significant progress has been in the countries and regions which have the most financial investments, such as in eastern and southern Africa. In Namibia, more than 71% of HIV care and support services, including procuring anti-retroviral drugs, is covered from domestic resources. I am confident that the government will make further investments in prevention. 

Legal and policy frameworks have been further strengthened to ensure that they do not undermine human rights, but rather enable and protect them, for example in Ghana, India, Spain, Kuwait, Kazakhstan and the Central African Republic. Several countries have removed harmful laws in 2022 and 2023. Such measures allow the opportunity for success in ensuring access to services. 

These examples of putting people and communities first demonstrate how together we can end AIDS as a public health threat by 2030 in Namibia. As the report highlights, none of this will come automatically. Whilst access to HIV treatment has helped save 20.8 million lives, these life-saving advances are still being denied to millions of people, who urgently need them. AIDS claimed a life every minute in 2022. There were 1.3 million new HIV infections, and 9.2 million people are still missing out on treatment, including 43% of children living with HIV.   

Ongoing social and economic inequalities within countries and between them are exacerbating and prolonging pandemics, and amplifying their impact amongst the poorest and the most vulnerable.        

Globally, 4000 adolescent girls and young women aged 15-24 years old are newly- infected with HIV every week. Deeply entrenched gender inequalities and discrimination, often combined with significant levels of poverty, increase their risk of HIV infection, particularly in sub-Saharan Africa, where HIV incidence among adolescent girls and young women is more than three times higher than among their male counterparts. It is vital to advance safe societies so that young women can protect their health and wellbeing. 

In Namibia, HIV prevalence is twice higher among adolescent girls and young women (5.7%) than among male peers (2.5%). Women 15 years+ and older accounted for 67% of the total HIV infections (5200) and 57% of total AIDS-related deaths (2800) in 2022. We must expand the choices of prevention tools available to women and girls, including approving and purchasing long-acting injectables for HIV prevention and treatment.  

The pandemic’s ongoing cost to children is among the most painful reminders that AIDS is not over. Even though AIDS-related deaths among children (0-14 years) were reduced by 64% between 2010-2022, the epidemic still claimed the lives of an estimated 84 000 children in 2022. It is vital to ensure that children are diagnosed and reached with life-saving treatment for some 660 000 children. In Namibia, only 76.0% of children know their HIV-positive status, the majority of whom are on HIV treatment. However, only 68.0 % of children living with HIV have suppressed viral loads. We must draw on diverse government and community systems to find HIV-positive children, and link them to care.

Punitive laws and policies, human rights violations and discrimination continue to greatly increase the risk of HIV transmission, and sabotage efforts to control the epidemic among key populations. Research has shown that repressive policing of sex workers almost doubled their risk of HIV or sexually transmitted infection, and there is compelling evidence linking policing practices with increased risk of acquiring HIV. 

The path that ends AIDS requires strong partnerships – South and North, government and communities, UN, people living with, at risk of and affected by HIV. And it requires bold and brave leadership. With these key factors, including political commitment and effective coordination, which I have witnessed, I am convinced that Namibia, the Land of the Brave, can be among the first countries to end inequalities to end AIDS in our lifetime. 

* Hopolang Phororo is the UN Resident Coordinator in Namibia.