The urgency 
of now

This report shows that world leaders can fulfil their promise to end AIDS as a public health threat by 2030, and in so doing prevent millions of AIDS-related deaths, prevent millions of new HIV infections, and ensure the almost 40 million people living with HIV have healthy, full lives. Through powerful case studies and new data, the report shows how some countries are already on the right path—and how all countries can get on it.

The report also shows that, right now, the world is not on track to succeed, and the inequalities that drive the HIV pandemic are not being addressed sufficiently. It shows that due to the lack of progress on prevention, global numbers of new HIV infections are not declining fast enough, and in three regions of the world numbers of HIV infections are rising. It shows that almost a quarter of people living with HIV are not receiving lifesaving treatment, and consequently a person dies from AIDS-related causes every minute.

We know what enables success. Progress against HIV has been strongest in the countries that have invested as required in their responses and reformed their policies to enable people to access the services they need. To accelerate the end of AIDS as a public health threat, and to ensure services and systems are in place to meet the needs of the millions of people living with HIV for decades to come, resourcing needs to be both sufficient and sustainable. Building a legal environment that facilitates access to effective, equitable and person-centred HIV services—including removing harmful criminalizing laws and tackling discrimination—is key to advancing and sustaining progress on prevention and treatment.

We know, too, what obstructs success. Progress is imperilled by the fraying of solidarity between and within countries. When political commitment to full financing and human rights is put at risk, progress in the HIV response is put at risk too.

A widening funding gap is holding back the HIV response in low- and middle-income countries, with fiscal space being tightened even further by the debt crisis. The recent surge in the promotion of anti-rights, anti-gender and anti-democracy policies is generating justified fear among people from marginalized communities who most need HIV prevention, testing, treatment and care services, and among the heroic frontline workers who provide them.

Advances in technology, in particular in the development of long-acting treatment and prevention options, can protect the health of everyone living with or at risk of HIV—but only if these technologies are shared with all low- and middle- income countries, and are produced by multiple manufacturers across the world at scale. Currently, patent-holders are not opening up access broadly enough to enable this breakthrough.

The HIV response is at a crossroads. Whether the world ends AIDS depends on the path that leaders take. The path that ends AIDS is not a mystery. It is a political and financial choice.

Some are reluctant to provide the scale of resourcing needed for ending AIDS. But, as the report demonstrates, the costs of not ending AIDS would be exponentially higher.

Some might like to walk away from the HIV response because the end is now in reach. But, as this report sets out, we cannot partly end a pandemic. Leaders can end AIDS as a public health threat only by overcoming it everywhere, for everyone.

Some imply that investments and reforms to end AIDS would detract from addressing other challenges. But, as the report illustrates, the actions needed to end AIDS will help advance the achievement of all the Sustainable Development Goals, ensure countries are prepared to overcome the pandemics of the future, and help secure a safer, fairer world for everyone.

I am sometimes asked whether I am an optimist about the HIV response, because the progress we have made shows the path that ends AIDS—or whether I am a pessimist, because restrictions on resourcing and rights are putting progress in danger. The answer is that I am neither an optimist nor a pessimist—I am an activist, because success depends on rising to the moment, on recognizing the urgency of now.

We can end AIDS, but only if leaders choose the right path now. We the people will ensure they do.