A new report released in July this year by the Joint United Nations Programme on HIV/AIDS (UNAIDS) highlighted significant progress in the global fight against HIV/AIDS. However, it also underscored the substantial work that still needs to be done in various regions and populations that are falling behind.

Among other key findings, the report revealed that fewer people acquired HIV in 2023 than at any point since the late 1980s. In addition, almost 31 million people were receiving lifesaving antiretroviral therapy in 2023, marking a public health milestone that has reduced AIDS-related deaths to their lowest level since the peak in 2004.

The New Times’ Hudson Kuteesa sat down for an exclusive interview with Hind Hassan Abdalgalil, UNAIDS Rwanda Country Director, to discuss the recent achievements and the future outlook regarding global targets.

Excerpts:

Let us start with some of the positives from the report. For example, fewer people acquired HIV in 2023 than at any point since the late 1980s. How has such progress been achieved and how significant is it in the fight against HIV?

There has definitely been considerable progress since 2010. Currently, there are more than 30 million people on HIV treatment globally. However, we are still 10 million short of the total number of people living with HIV. Several factors made this progress possible, mainly the political commitment, the right mix of strategies and programme interventions, and of course, the treatment that was made available and accessible since 2005.

With such achievements, can you say we are on track to meet UNAIDS’ 2030 targets?

Some countries have already achieved the 2025 targets, Rwanda being one of them, and are on track to achieve 2030 targets, while others are still lagging. This mixed progress is due to different reasons; the level of political commitment, stakeholders’ engagement especially communities; and enabling legal and policy environment. In some regions like Latin America, Eastern Europe and Central Asia, the Middle East, and North Africa, new infections are in fact still rising. In general, the world is not on track and that is why the AIDS epidemic is at a crossroads.

Let’s talk about Sub-Saharan Africa, zooming in on Eastern and Southern Africa. The AIDS response seems to be progressing well in the region, for instance, new infections are really decreasing. What is the reason behind this, and what areas need to be improved?

East and Southern Africa is home to more than 50 per cent of people living with HIV globally. Indeed, it is the region that is most affected but also the one that has made the most progress in reduction of new HIV infection and AIDS-related deaths, however not at the required pace. The countries that achieved the most progress are those that have addressed social and structural barriers like human rights violations, including decriminalising key populations, gender inequalities, stigma, and discrimination, all of which impede access to services.

Rwanda is one of few countries that have achieved UNAIDS’ 2025 targets of 95-95-95. Are there any lessons that the country gives to Africa and the world?

Rwanda is among the few countries that have achieved enormous progress and is on track to achieve the 2030 targets. It showcases that the path to end AIDS is clear, however it is a political choice to be made. The latest Global AIDS Update mentions Rwanda as one of only two African countries that are close to reaching the target of less than 10 per cent of people having discriminatory attitudes towards people living with HIV. This can mainly be attributed to the existing favourable legal and policy environment that puts people, including key and vulnerable populations, at the centre of the HIV response. There is an active and vibrant civil society in Rwanda that plays a central role in mobilising communities and addressing their needs. The Ministry of Health through the Rwanda Biomedical Centre is leading a coordinated effort among stakeholders to ensure the right strategies and programme interventions are in place to optimise resource allocation.

What are some of those programmatic shifts that Rwanda needs to implement ahead of 2030?

The main programmatic shift would be fully mainstreaming HIV in priority government sectors, having a multi-sectoral response, and moving beyond just health. We have more than 95 per cent of people living with HIV in Rwanda already on treatment, we now need to find ways to reach the last five per cent and help them access testing and treatment services. There is also a need to ensure the reduction of new infections. To do that, there is a need to engage the other sectors in more substantive ways. The good thing is that the NST2 integrates HIV as a cross-cutting issue, which means that different sectors will need to mainstream HIV in their programmes and strategic plans.

Africa is quite dependent on foreign support for its fight against HIV. Is this sustainable?

The short answer is no. The sustainability of the HIV programme is crucial. As the support from donor countries is decreasing, African countries, including Rwanda, need to start thinking about how to ensure that the required resources are in place to sustain their HIV programmes. Additionally, the debt situation in most countries is choking health budgets. Mobilising local resources from the private sector and other innovative means and ensuring programme efficiencies is critical. So is having a multisectoral response to HIV and integration where possible.

In the past, countries were receiving more funding compared to now, therefore, we are finding ourselves required to do more but with less money. This is where programme efficiency comes in. We must critically look at the programmes that governments are working on and ask ourselves whether these are the most effective, and if they will yield the required results.

The report emphasised the urgency to accelerate prevention and break down the barriers that keep people from both HIV prevention and treatment services. What is your message regarding this?

What we do today to make sure that resilient health systems are in place and that countries are able to bring down new HIV infections among young people, key and vulnerable populations as well as provide sustainable treatment and care services to people living with HIV will have a direct impact on what the AIDS pandemic will look like in future.

We should focus on where new infections are happening and this is where all our efforts should be. In East and Southern Africa, there are 2,372 new infections among Adolescent Girls and Young Women (AGYW) every week and girls are three times more affected than boys. The same applies to key populations where we find that HIV prevalence among them is much higher than the national average. Similarly, there may be different epidemics within one country where some locations carry more burden of HIV than others. So, the key message is to look at the granular data and design plans accordingly.

What is the role of the UN in supporting Rwanda to achieve the 2030 targets?

The UN in Rwanda is a technical partner. We provide coordinated technical support to the government, stakeholders, and community-led organisations in different aspects of the HIV programmes. UNAIDS coordinates the work of eleven other UN Agencies in the response to HIV based on their respective mandates on HIV and comparative advantages. This includes policy and strategic guidance for the availability and accessibility of HIV services for all i.e. sexual and reproductive health, as well as adolescent health in general, linking HIV, teenage pregnancy, and sexual and gender-based violence.

One of the areas of work that Rwanda needs to focus on a little bit more is children and HIV. The UN in Rwanda also provides support within refugee settings in terms of prevention and treatment as well as social protection for the refugees living with HIV. So, different UN agencies offer specific technical support to the government and partners in Rwanda. As UNAIDS, our role is to bring those efforts together and ensure that the UN's work is supported, coordinated, harmonised, and aligned with the national strategy for transformation and the overall Political Declaration on HIV endorsed by member states including Rwanda and the Global AIDS Strategy.

Let’s talk about some of the potential solutions that are promising to come soon. Recently, news spread about a new HIV pre-exposure prophylaxis drug, which can be taken twice a year and gives 100 per cent protection. What do you think about such innovations ahead of 2030?

The pre-exposure prophylaxis, which is groundbreaking, is a big milestone to help reduce new HIV infections. It will absolutely be a game changer because it is easier to take one pill every few months than to take a pill daily, which would help ensure adherence to the treatment. The need now is to ease access to this new technology, to make it available, accessible, and affordable in Africa. This innovation can change the whole dynamic of HIV prevention and care if it is made available, hopefully, sooner rather than later.