A new United Nations report released today shows that the HIV response in Eastern Europe and Central Asia is critically off track. Data in UNAIDS' global report The Urgency of Now: AIDS at a Crossroads reveals that in this region, new HIV infections have risen by 20% and AIDS-related deaths have risen by 34%, since 2010. Only half of the 2.1 million people living with HIV in the region are accessing treatment, and only 42% of all people living with HIV in the region have suppressed viral load, the lowest rate globally. The report shows that it is still possible to end AIDS as a public health threat by 2030, but only if governments reform laws to protect everyone's human rights and increase resources to ensure services are available for all.
"The promise to end AIDS is off track in Eastern Europe and Central Asia. But leaders can get on the path that ends AIDS. Programmes need to focus especially on people most affected by HIV, who are often the most marginalized and vulnerable. Community organizations need to be properly funded, supported and enabled to provide HIV services to people affected by HIV. The barriers of stigma and discrimination need to be broken down," said Winnie Byanyima, UNAIDS Executive Director.
The new data shows that in 2023, there were 140,000 new HIV infections across the region, with 93% occurring in Russia, Ukraine, Uzbekistan, and Kazakhstan. Eight out of 13 countries in the region reported increases in new infections.
Because stigma, discrimination and harmful punitive laws obstruct marginalised communities' access to vital services, 94% of new infections were among people from key populations - including men who have sex with men, people who inject drugs, and sex workers - and the sexual partners of people from key populations. Only 58% of sex workers, 43% of gay men, 52% of people who inject drugs, and 65% of transgender people receive HIV prevention services. Only 12% of resources are dedicated to prevention programmes for key populations.
The criminalization of small amounts of drug possession for personal use, of sex work, and of HIV transmission and exposure, are driving the people most in need underground and out of reach of HIV services. All 16 countries in the region criminalize sex work, 13 criminalize the non-disclosure, exposure, or transmission of HIV, and 7 criminalize small amount of drug possession for personal use. Studies show criminalization increases HIV prevalence among key populations. Unless countries can ensure fear-free access to HIV prevention services for everyone, new infections will continue to grow.
"Restrictive legal environments and stigma are obstructing progress in the region," said Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia and Asia Pacific. "Restrictive laws, along with aggressive policing and stigma, push people away from medical care. If people are pushed underground, the HIV response will not succeed."
Powerful prevention technologies like PrEP are also not widely accessible for the same reason. Criminalization fuels stigma, with many avoiding medical care due to discrimination. Nearly half of people surveyed who inject drugs in Kyrgyzstan and 32% of people living with HIV in Tajikistan reported avoiding medical care due to stigma and discrimination. UNAIDS data shows that people in key populations are experiencing high levels of violence.
"Supporting the leadership of communities is essential for reaching marginalised people providing vital outreach services. Without community leadership and the integration of community services into the health system, reaching these groups is too difficult," said Yelena Rastokina, lead of the 'Answer-Kazakhstan' Association.
Recent years have seen worrying restrictions of civic space and limits to communities' involvement in public health initiatives, including those related to harm reduction, access to public health services for LGBTQ+ people, sex workers and other marginalised people. Restrictive systems at local, national, and regional levels are holding back communities' contribution to public health.
Ganna Dovbach, Executive director of the Eurasian Harm Reduction Association, highlighted: "The shrinking of civic space and attacks on human rights threaten our response to HIV, which is based on community-led or civil society provided services. Addressing these interconnected issues is essential for a sustainable response to the AIDS epidemic in our region."
The region's HIV response has also been hurt by the war in Ukraine.
But despite the conflict, Ukraine remains committed to its HIV response. Through a strong coalition of the government, civil society, international organizations and donors, HIV services have been maintained, with 143,600 people receiving treatment in 2023. This collaboration has ensured vital supplies of antiretroviral and tuberculosis medicine, and opioid agonist therapy, contributing to uninterrupted HIV treatment and other services. As of January 2024, 7,900 Ukrainian refugees in other countries and 1,900 returnees were accessing antiretroviral therapy.
Many community organizations working on HIV in Ukraine refocused their efforts to addressing humanitarian issues and supporting community members while continuing national advocacy for access to HIV services and the protection of human rights.
With support from the UNAIDS and other donors ALLIANCE.GLOBAL oversees a network of five specialized shelters across the country, providing shelter, humanitarian aid, and access to specialised services, including HIV prevention and treatment, for key populations and LGBTQ+ people who are internally displaced.
Despite the war, ALLIANCE.GLOBAL together with other community-led organisations continue advocating for laws that better protect LGBTQ+ people from intolerance and from hate crimes, to enhance access to public health services, including HIV-related services.
UNAIDS new report calls on leaders to develop sustainable plans for the HIV response to2030 and beyond. These plans should include enabling legal environments, support for community-led response and a boost in domestic funding. Repealing laws and norms that prevent people from accessing services is crucial.
"Ensuring access to services and treatment for all is how we end AIDS," said Mr Murphy.
UNAIDS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations-UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank-and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org
