On Tuesday, I visited the Mayange Health Facility in the Bugesera District and learned that they have not experienced a single case of mother-to-child HIV transmission in the past few years. This is proof positive that Rwanda is closing critical gaps in HIV care and, by doing so, advancing progress against the United Nations’ target of ending AIDS as a public health threat by 2030. At the facility, I met a 21-year-old woman born with HIV. COVID-19 introduced new challenges to her life but thanks to this health facility and its community health workers, she was able to continue her antiretroviral treatment even during COVID. When she became pregnant, the Mayanga Health Facility supported her again and her child was born HIV-free. This is a powerful example of how improvements in caring for people living with, and at risk for, HIV – especially amidst concurrent challenges – help us end AIDS. The Joint United Nations Programme on HIV/AIDS (UNAIDS) just released its latest annual Global AIDS Update. It shows there is a path to ending AIDS—and that some countries, like Rwanda, are on it. Rwanda has achieved the “95-95-95 targets, which call for 95 percent of all people living with HIV knowing their HIV status; 95 percent of all people who are aware of their HIV status accessing antiretroviral treatment and 95 percent of all people on antiretroviral treatment achieving an undetectable viral load. The report shows declining rates of new HIV infections globally and in regions with the highest burden of HIV. Rwanda reduced its rate of new HIV infections by 73% in the last 12 years. In addition to Rwanda, Botswana, Eswatini, the United Republic of Tanzania and Zimbabwe have also achieved the 95-95-95 targets. At least 16 other nations are close to doing so. Not surprisingly, progress has been strongest in countries and regions that have made the greatest financial investments and where political leadership supports the goal of ending AIDS. Data in UNAIDS’ new report and real-world examples of progress, like the one I witnessed at the Mayanga Health Facility, demonstrate that the path to end AIDS is not a mystery. In fact, it’s crystal clear. Nearly 40 years into the response to AIDS, we know what works, where we need to work and who we still must reach with HIV testing, prevention and treatment. We know our response to HIV succeeds when empirical evidence is followed, when the inequalities that drive and perpetuate AIDS are overcome, when communities and civil society organizations are allowed to play their vital roles, when political leaders act boldly and when sufficient, and sustainable funding, is allocated. Investing in the end of AIDS also delivers broader benefits. The expansion of the global health architecture and health work forces, including those led by communities, allows the world to better prevent, prepare for and respond to future pandemics and advances progress against other UN Sustainable Development Goals – such as those focused on inequality and gender. I came to Kigali for the Women Deliver Conference where conversations centered on advancing gender equality. I carried the message that deeply entrenched gender inequalities and discrimination based on gender increase the risk of HIV infection among women and girls. In sub-Saharan Africa, AIDS remains the second biggest killer of women and girls of child-bearing age (the first is maternal mortality). While we have made considerable progress against AIDS overall, we must finish the job and reach all who remain at risk, including those who face heightened risk, such as adolescent girls and young women here in Africa. In 2022, there were 230 000 people living with HIV in Rwanda, 61 percent were women ages 15 and over. It is vital to ensure women and girls have the knowledge and agency to protect their health and wellbeing. Educating girls should be a top priority. A girl who finishes her secondary education reduces – by 50 percent - her chance of contracting HIV. Keeping adolescent girls and young women in school also reduces their risk of gender-based violence which can contribute to HIV. To end AIDS, we must reach everyone, everywhere. UNAIDS’ new report shows success is possible by 2030, if we move together, with urgency and follow the examples set by countries like Rwanda. The author is the UNAIDS Deputy Executive Director, Policy, Advocacy and Knowledge.
