By Mr Henry Damisoni
The world has made enormous progress in reducing the impact of HIV over the last 15 years.
Globally, a total of 30.7 million people—77% of those living with HIV—were on treatment in 2023, up from just 7.7 million in 2010. This has resulted in a dramatic decline in AIDS-related deaths, down by 51% over the same period. In Zimbabwe, 95% of the 1.3 million people living with HIV were on treatment in 2023. Treatment coverage increased by 40% from 55% in 2010. The country surpassed the 2025 UNAIDS treatment targets of 95-95-95 at 95-99-96. New HIV infections declined by 80% between 2010 (79,000) and 2023 (15,000) and Mother to child HIV transmission rate has declined from 23.8% to 7.4% over the same period. AIDS deaths declined by 66% from 57,000 in 2010 to 19,000 in 2023. The response to HIV in the country has faced some challenges notable ones being programmes for Adolescent Girls and Young Women (AGYW) and Key and Vulnerable Populations not implemented at national scale thereby limiting reach and effectiveness, and the HIV response being predominantly funded from external sources (PEPFAR and Global Fund) thereby threatening sustainability.
But although a range of effective treatment and prevention tools have been developed, the world is still not on track to end AIDS as a global health threat by 2030. Global progress is too slow. Indeed, in at least 28 countries, new HIV infections are on the rise.
So how do we protect the gains already made against HIV and make further progress towards that vital 2030 goal?
A new UNAIDS report released ahead of World AIDS Day, called Take the Rights Path, shows that upholding rights is the pathway to an HIV response that is robust and sustainable.
The world can end AIDS as a public health threat, if the human rights of all people living with and at risk of HIV are protected.
Upholding the rights of women and girls is central to ending the AIDS pandemic.
Gender-based violence increases vulnerability to HIV.
Gender Inequality Index score of Zimbabwe was 0.527, ranked at 129 out of 162 countries in 2019. According to the multi-cluster indicator survey of 2019, 19% of women aged 15-49 had experienced intimate partner violence and close to 10% experienced sexual violence committed by their current or most recent husbands or partners. Furthermore, 7.1% of youth aged 15-24 were married before the age of 15. Most women who get married at a younger age are often in intergenerational marriages, thus increasing their vulnerability to poor health outcomes due to early childbearing and abuse owing to unequal power dynamics. Roughly 15% of women aged15-49 believe it is justifiable for a husband to beat her for refusing sexual intercourse according to the Zimbabwe Demographic and Health Survey of 2016. The denial of education and information puts people at risk. There is an urgent need to invest in girls’ education and to provide comprehensive sexuality education—a critical component of HIV prevention.
Barriers to health need to be dismantled. For example, more than half of countries have laws that prevent young people from being able to get tested to learn their HIV status unless they get parental permission, which scares young people away and leads many young people to remain unaware of whether they are living with HIV.
In Zimbabwe, there were around 65 new HIV infections in a week among young women and girls aged 15—24 in 2023. The age of consent law prevents young people below 18 years of age to access HIV testing services and sexual and reproductive health services without parental consent.
Although many countries have made great progress in reducing the impact of HIV among children, the commitment to protect all children living with and affected by HIV is not being met. One in three children do not receive HIV testing within the first two months of life, the provision of lifelong antiretroviral therapy to pregnant and breastfeeding women living with HIV has not increased over the last decade and HIV treatment coverage is markedly lower for children at 57% than it is for adults at 77%.
About 3,600 children acquired HIV in Zimbabwe in 2023. There are an estimated 69,700 children living with HIV and 44,141 (63%) were on treatment. Children are lagging on the UNAIDS 2025 treatment target of 95-95-95 at 63-100-88. Identification of children living with HIV to be initiated on treatment is one key challenge.
The criminalization and marginalization of groups of people, such as gay men, transgender people, sex workers and people who use drugs, is also undermining efforts to end AIDS. The enactment of even more severe legislation against these groups in many countries is increasing levels of stigma and discrimination and driving people away from HIV treatment and prevention services.
The anti-rights backlash which threatens to undo much of the progress made in the global AIDS response needs to be challenged head on. To protect everyone’s health we need to protect everyone’s rights.
There is hope.
Across the world, a number of divisive laws that impede the delivery of public health services to vulnerable groups of people have been removed. Two thirds of countries now do not criminalize LGBTQ people. There is a clear trend also towards the removal of the counterproductive laws criminalizing HIV exposure, non-disclosure or transmission.
In Zimbabwe, more needs to be done to reach key and vulnerable groups of people such as gay men and other men who have sex with men, sex workers and people who use drugs with HIV services. Laws that criminalize these population groups need to be repealed as they hinder access to HIV services.
UNAIDS new report provides a clear roadmap: To end AIDS, take the rights path.
