An evolving challenge
HIV first shocked the world when it emerged in developed countries in the 1980s, largely among men who have sex with men. It soon exploded in poor countries, killing tens of millions of people. Sub-Saharan Africa was hit hardest; it still accounts for over 70 per cent of new infections. Over the last decade and a half, an unprecedented global response has made HIV prevention and treatment services available in almost every country in the world. Indeed, the goal of ending the epidemic may be possible within a generation.
AIDS-related deaths in adults and children, global. Source:UNAIDS
Inequalities at the heart of the epidemic
Although new HIV infections are declining, the disease remains one of the foremost health and development challenges of our time. Some 2.1 million people acquired the virus in 2013, and within this number are startling inequalities.
Key populations – a term that principally refers to sex workers, men who have sex with men, people who use drugs and transgender people – are disproportionately affected by the epidemic. Their vulnerability is aggravated by punitive laws, stigma, human rights violations, social exclusion, and HIV responses that inadequately address their needs.
For example, HIV prevalence among female sex workers is 14 times higher than HIV prevalence among all other women aged 15-49. An estimated 37 per cent of female sex workers in sub-Saharan Africa are living with HIV.
Globally, men and women make up an equal share of the people living with HIV. However, in sub-Saharan Africa, women account for 58 per cent of people living with the virus. For social and physiological reasons, adolescent girls and young women are particularly vulnerable, with HIV infection rates more than double those of males of the same age group. HIV is the leading cause of death among women of reproductive age, and it contributes significantly to maternal mortality due both to progression of the disease itself and through higher rates of sepsis, anaemia and other pregnancy-related conditions. Women’s and girls’ vulnerability to HIV is driven also by gender inequality, including gender-based violence which limits their ability to make safe choices about their sexual and reproductive health.
Adults and children newly infected with HIV, global. Source:UNAIDS
And young people are disproportionately affected HIV. Although the overall number of HIV-related deaths is down 30 per cent since the peak eight years ago, estimates suggest that HIV deaths among adolescents are actually rising. Young people’s vulnerability to HIV is exacerbated by a lack of access to comprehensive sexual and reproductive health information and services and by exclusion from decision-making processes.
For all these groups, a dangerous mix of stigma and discrimination, restrictive and punitive laws, and inadequate medical and social services increases the risk of HIV infection and HIV-related illness and death.
Addressing HIV is integral to UNFPA’s mission of achieving universal access to sexual and reproductive health and realizing human rights and gender equality. UNFPA works with partners to increase access to HIV-related services and sexual and reproductive health services for young people, key populations, and women and girls, including those living with HIV. We also support the empowerment of these populations to claim their human rights, access the services they need and lead healthy, fulfilling lives.
In the absence of a functional cure, prevention is crucial to ending AIDS. This requires intensifying the scale and scope of HIV-prevention measures that have been shown to work. UNFPA focuses on reducing HIV transmission and on comprehensively addressing the sexual and reproductive health and rights of key populations, women and girls and young people. As a UNAIDS Cosponsor, UNFPA is committed to the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
In 2013, UNFPA was the top supplier of male and female condoms to low- and middle-income countries.
Because the majority of HIV infections are sexually transmitted, reducing this mode of transmission is crucial. Working with partners, UNFPA is scaling up age-appropriate and culturally sensitive comprehensive sexuality education, increasing access to and use of male and female condoms, and promoting human rights and gender equality. UNFPA and partners are also strengthening access to quality, integrated HIV and sexual and reproductive health services, including services that eliminate mother-to-child transmission of HIV.
At the heart of any effective HIV response is the empowerment of those who are most at risk.
UNFPA supports the empowerment of men who have sex with men, sex workers and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy. UNFPA is also strengthening the capacity of community-led organizations, networks of key populations and people living with HIV, to enable them to meaningfully participate in all aspects of HIV- and sexual and reproductive health policy, programme development and implementation. UNFPA also supports municipalities in addressing micro-epidemics among key populations.
UNFPA also supports the empowerment of women and girls by helping prevent HIV infections among women and by ensuring that women living with HIV have access to rights-based sexual and reproductive health services. And by fighting to eliminate gender-based violence, child marriage and discrimination, UNFPA helps to reduce the vulnerability of women and girls to HIV. The specific needs of women and girls are also factored into UNFPA's humanitarian assistance.
UNFPA also supports the empowerment of young people to protect themselves from HIV, in particular by addressing their sexual and reproductive health needs. And UNFPA strengthens the availability and use of strategic data on young people and HIV, and works closely with youth organizations and networks.