Reaching 2030 and Beyond: Four Actions to Sustain the HIV Response for Future Generations
By Henry Nagai, Olawale Durosinmi-Etti, and Pamela Donggo
While the UN goal is to end AIDS as a public health threat by 2030, depending on what we do in the next five years, 20–40 million people are still projected to be living with HIV by that time. To create a sustainable HIV response, we must consider how our actions now will lay the groundwork for a long-term future in which AIDS is no longer a global health and economic threat.
UNAIDS is charting the global roadmap to sustainability, and while each national response will require contextually appropriate solutions, they will have some common elements. Across geographies, here are four actions the global HIV community can take today to ensure that people living with and at risk for HIV can thrive into the future:
Accelerate Prevention
There will still be millions of people living with HIV in and after 2030. We don’t yet have a viable and effective cure or vaccine, and when we do, it will take considerable time and resources to test, approve, and make it accessible to all who need it. Until that time, we need to sustain lifelong treatment and long-term prevention.
However, there is an intermediate goal that we can aim for now: Keep the HIV epidemic as small as possible. That means expanding prevention access and choice to all who need it, especially those most at risk of acquiring HIV. It also means keeping people on treatment so they are healthy and un-transmissable. Our efforts today will determine the size of the epidemic tomorrow.
Build Sustainable, Integrated Health Systems
HIV treatment and prevention rely on health systems that are strong, accessible, adaptable, and capable of sustaining lifelong care. This is no easy charge, as health systems face increasingly challenging political and funding environments alongside pandemics and disasters that threaten peoples’ well being and health service continuity.
While many see these exacerbating threats as competing with HIV, we see them as converging. Yes, if we redirect resources from HIV to focus on these other threats, we risk losing the hard-won progress in HIV. However, if we neglect them, overall health care will suffer. Facilities may have enough ARVs, but people living with HIV may still die of non-communicable diseases, other infectious diseases, or socioeconomic and humanitarian conditions. To stay healthy, people living with HIV need more than just ARVs — they also need high-quality primary health care and wrap-around social services.
If we integrate HIV prevention, care, and treatment into broader health systems, then investments in the HIV response benefit the whole health system, and investments in public health will, in turn, advance the HIV response. JSI supports countries, organizations, and partners to manage and deliver health services together and equips and leverages the health system to enable intersectional service provision. This includes more interoperable and shared data and information systems, integrated health logistics mechanisms, shared management structures, strengthened human resources for health, and updated governance and policies to support these changes. With these strategic and shared investments, we can improve health care quality and accessibility for all people — no matter their location, socioeconomic status, or health condition.
Prioritize Innovations for Person-Centered Prevention and Treatment Options
Medical advances have made it possible to imagine a future in which preventing and treating HIV involves fewer side effects, health facility visits, and daily effort. We’ve seen enthusiasm for long-acting cabotegravir (CAB-LA) when JSI supported its introduction and integration into HIV prevention services in primary health care settings, and promising early results from the twice-yearly injectable lenacapavir for HIV prevention. Now we must secure continued access to these life-saving medicines and expand them to more communities.
Innovation must be inclusive. When we have new products that can save lives, we must make them available and accessible to everyone, regardless of geographic or economic barriers. Long-acting injectable lenacapavir has been approved in the United States for treatment in adults with first- and second-line resistance since 2022, yet is only available in a handful of countries. In addition to prevention, it is time to expand access to long-acting treatment options to help people living with HIV become undetectable and untransmittable.
In addition to products, innovation in service delivery and system operations will improve person-centered care. With advancements like digitization and artificial intelligence, opportunities for improving diagnosis, treatment selection, and laboratory services arise. Resourceful provider teams and clients are working to expand service delivery to more remote settings and communities in which stigma and discrimination are high.
Reduce Health Inequities by Working on HIV’s Root Social Determinants
We know that when people are safe, well-nourished, educated, and supported, they are more likely to stay HIV-free or achieve and maintain viral suppression. We also know that marginalized members of society are less likely to have access to nutritious food and clean water; adequate education; physical and emotional safety and security; and livelihood opportunities that sustain them and their families.
We cannot accept that stigma related to HIV status or identity will prohibit access to high-quality health care, housing, or employment. We cannot accept acts of marginalization such as gender-based violence. Current inequalities perpetuate the HIV epidemic, and closing the gaps will require cross-sector collaboration to mitigate these root contributors to poverty, illness, and violence.
Reaching 2030 and Beyond
We know that a better reality for people living with or affected by HIV is possible. If we center our efforts on these four actions and work closely with partners to contextualize solutions, we can end AIDS as a public health threat. This World AIDS Day, we recommit to these actions and to working toward this future.
