World AIDS Day 2021 Opinion Piece by Prof. Adeeba Kamarulzaman

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Dr Kamarulzaman is the current IAS president, and APCOM Ambassador for Research.

A graduate of Monash University and trained in Internal Medicine and Infectious Diseases in Melbourne Australia, Dr Adeeba Kamarulzaman established the Infectious Diseases Unit at the University of Malaya Medical Centre.

In 2008, she established the Centre of Excellence for Research in AIDS (CERiA) at the University of Malaya. Research activities undertaken at CERiA include clinical and basic science studies, epidemiological as well as socio-behavioural research focusing on the marginalised communities in Malaysia, particularly people who use drugs, prisoners, and men who have sex with men.

“This year’s World AIDS Day theme End inequalities. End AIDS reminds us that division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis.”

As we commemorate this year’s World AIDS Day, let’s take a moment to reflect on the milestones we have achieved and also remind ourselves of the work that still needs to be done collectively. In the year 2021, COVID-19 continues to hit hard on people living with HIV and key populations: delay and disruption of key HIV prevention and treatment services, and increased vulnerabilities among at-risk populations. At the same time, we witnessed the resilience and creativity of civil society to address these challenges, in collaboration with Ministries of Health, partners and donors. We see rapid expansion of the WHO-recommended differentiated models for HIV such as multi-month dispensing of medicines, roll out of self-testing and other key population led health services such as PrEP.

This year’s World AIDS Day theme “End inequalities. End AIDS” reminds us that division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis. COVID-19 exacerbates these inequities and disruptions to services. Research plays an important role in addressing these inequalities. Research priorities should focus on advancing cross-cutting areas in basic science, behavioral and social science, epidemiology, implementation science, information dissemination and research training. These priorities should include but not limited to:

• Implementation strategies to improve systematic uptake of evidence-based prevention, care, and treatment interventions in diverse settings and populations;
• Individual, interpersonal, community, and social-structural factors influencing inequalities in HIV testing; engagement and persistence with prevention and care services, and health outcomes in different settings
• New methods and delivery of pre-exposure and post-exposure prophylaxis, multi-purpose prevention technologies, and community-level behavioral and social-structural interventions
• Strategies for mitigating HIV-associated stigma and discrimination

The United Nations General Assembly’s 2021 Political Declaration on HIV and AIDS emphasizes the commitment to increase investments in research, development, science and innovations to build a healthier world for all; and leverage the decade of action and delivery for sustainable development and ensure that no one is left behind, with an effort to reach the furthest behind first.  It also reiterates the commitment to build back better in a more equitable and inclusive manner from the Covid-19 pandemic and its impact on the global AIDS epidemic. The Political Declaration commits to build resilience against future pandemics and other global health and development challenges, and continue to leverage the investments and experience of the HIV response to further enhance public health and strengthen health systems.

The Global AIDS Strategy (2021-2026) and the development of the Global Fund 2023-2028 Strategy Framework similarly focus on reducing inequalities. The Global Fund AIDS Strategy highlights the importance of data, science, research, and innovation to inform, guide, reduce HIV related inequalities and accelerate the development and use of HIV services and programmes. The Global Fund stresses the importance of deploying quantitative and qualitative data to identify drivers of HIV inequity and inform targeted responses, including by gender, age, geography, and income for key vulnerable populations.

I urge that we renew our efforts and commitment to end HIV as a public health threat by 2030 to combat the ongoing and persistent inequalities and challenges posed by the Covid-19 pandemic. To reach the new proposed global 95–95–95 targets set by UNAIDS, we will need to redouble our efforts to avoid the worst-case scenario of a half million excess HIV-related deaths in sub-Saharan Africa, increasing HIV infections due to HIV service disruptions during COVID-19, and the slowing public health response to HIV.

We must ensure that everyone, everywhere has equal access to HIV prevention, testing, treatment and care, including COVID-19 vaccinations and services. We must prioritise our efforts to reach diverse groups of people marginalized in each country, including key populations and people who are at high risk.

Equality starts from our compassion, determination, innovation, and collaboration with others. Let us all commit to end inequality and end AIDS.

Adeeba Kamarulzaman

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