Sustainability Roadmap For HIV Response

Globally, HIV is a pressing concern. In particular, low- and middle-income countries still face challenges of ensuring universal access to prevention, testing, treatment, care and support services at all levels. Political instability, economic downturn, natural disasters, poor health systems, pandemics such as COVID-19 have differential effects on HIV response.  

According to UNAIDS, globally, about 39 per cent fewer people acquired HIV in 2023 compared with 2010, with sub-Saharan Africa achieving the steepest reduction. Nonetheless, an estimated 1.3 million people acquired HIV in 2023 — over three times more than the target of 370 000 or fewer new infections in 2025. Three regions are experiencing rising numbers of new HIV infections: Eastern Europe and central Asia, Latin America, and the Middle East and North Africa.

The world has made a promise to end AIDS as a public threat by 2030. The commitment is enshrined in Sustainable Development Goals (SDGs). Unfortunately, there is an uneven progress within and across countries. Evidences suggest the intersecting inequalities that drive HIV epidemic are not being sufficiently and efficiently addressed yet to sustain the progress on prevention and treatment.  

Worrying scenario

Undoubtedly, HIV repose is at a crossroads. The worrying scenario is looming large as achieving 2025 and 2030 goals for HIV response is still elusive in many low-and middle- income countries. To accelerate the progress, political commitment and meaningful engagement of people living with HIV, key and vulnerable populations are necessary conditions for sustainability of the response. 

Considering larger socio-political, economic, and cultural contexts, there is urgent need to consider flexibility and resilience to transform policies, strategies, and systems. The 2025 prevention target simply implies that 95 per cent of people at a risk of HIV infection have access to and use effective combination prevention options. However, key populations such as migrants, sex workers, people who use drugs, sexual and gender minorities are not within reach in some countries for several reasons. Limited resources, lack of political commitment, natural disasters and pandemics such as COVID-19 are hindering the HIV response to sustain gains. 

While Nepal is facing concentrated HIV epidemic, it is estimated that around 30,000 individuals were living with HIV as of 2023. Interestingly, the total estimated number of People Living with HIV (PLHIV) has remained relatively stable, with a prevalence rate of 0.11. Although Nepal has made notable progress in prevention, testing, treatment and care with the support from the technical partners including civil society, heavy reliance is still on external funding. In order to sustain the significant gains made over time, it is high time for Nepal to consider sustainability of HIV response. 

Again, in order to ensure resilient and sustainable HIV response, narrowing the funding gap is critical. Understandably, both international and domestic funding for HIV are under stress. At the same time, it is also crucial to enhance the ability of governments to sustainably finance the HIV response with domestic resources. 

With the support from Global Fund and other key partners such as WHO, UNAIDS, EpiC/FHI 360, Save the Children, it is encouraging to note that health and community systems have been strengthened in providing prevention, testing, treatment, care and support services at local level. Over the years, access to treatment has significantly expanded. Consequently, supporting people living with HIV to start and stay on antiretroviral therapy has enormous personal and public health benefits.

On the other side, HIV-related stigma and social discrimination have declined in many countries. But it is still ingrained in many cultures due to intersecting socio-political inequalities, gender-based violence, lack of inclusive health systems and supportive policy environments. Notably, civil society networks working in the area of HIV response have made significant contributions in reaching out to the key populations for prevention, testing, treatment, care and support services in the families and communities. 

In Nepal, there is increasing priority for integration of HIV response with other services to improve health outcomes. In the context of achieving universal health coverage, integration across relevant sectors such as sexual and reproductive health, nutrition, gender equality and women empowerment, workplace interventions, humanitarian emergencies, and social protection services are closely linked to HIV response. Such integration also enhances opportunities for strengthening resilient health systems in HIV response. 

In this context, Ministry of Health and Population (MoHP) and National Centre for AIDS and STD Control (NCASC) have given high priority to develop sustainability roadmap for HIV response in an inclusive approach. Engaging a range of relevant stakeholders from governments, civil society, development partners, private sectors, academia and networks of key populations, the roadmap specifically aims to enhance allocative efficiency in the broader context of federal health systems, and ensure ongoing and future investments are strategically aligned with national health policies, HIV strategic plan and implementation priorities. 

Roadmap

As per UNAIDS guidance note, the roadmap is expected to identify high level outcomes across key domains of sustainability framework including political leadership, access to effective, equitable and quality services, capacity of health and community systems, and domestic and external financing. By taking stock of progress, the roadmap will articulate sustainability vision by facilitating an inclusive dialogue and engagement with key stakeholders.   

The sustainability journey will definitely address the diverse yet important issues of intersecting inequities in health care, socio-political and cultural contexts to ensure that no one is left behind. The approach accelerates concerted efforts that drive sustainable people-centred HIV response transformations beyond 2030 by ensuring growing equity, universal health coverage, and upholding the right to health for all. 

(Bhandari is a health policy analyst.)