Christopher Akolo

While many countries have reached epidemic control or epidemic transition, specific gaps exist, particularly in relation to the heterogeneity of HIV responses for key populations by gender, age, and geographic location. Ending AIDS will require political courage in addressing inequalities, and in ensuring country ownership and sustainable programming.

Significant progress has been made in the quest towards reaching epidemic control. However, while PrEP has been scaled up, decline in new HIV infections has stagnated. Children remain behind as only 52% of children living with HIV are on treatment compared to 76% of adults. Therefore, we are likely to miss the 2025 target unless treatment coverage is accelerated, effective prevention efforts re-invigorated, communities, including key populations are better engaged, and barriers to inclusion are removed. Since country systems are critical towards achieving impact goal, ending AIDS will require political courage. The inequalities faced by key populations are expressed across three main domains: inequality around access to HIV services (exacerbated by the COVID-19 pandemic), inequality around justice and human rights mechanism (such as stigma and discrimination, criminalization, etc.), and inequality around investments towards key populations-led organizations and not just an increase in investments in key populations programming. Refilwe PHASWANA-MAFUYA (University of Johannesburg, South Africa) shared strategies across four domains that South Africa is adapting for ensuring country ownership and sustainable programming: political ownership and stewardship; institutional and community ownership; capabilities; and mutual accountability, including finance. These efforts must be directed towards addressing the gaps along the HIV service cascade.

As we strive towards achieving epidemic control, greater investments will be required for sustaining or maintaining the gains. The level of effort or investment will vary based on the context, including the nature of the epidemic within each country, and the populations and geographical areas that need specific focus. We already know what works, but these evidence-based interventions and strategies should be optimized and institutionalized while we continue to avoid complacency. Beyond the numbers, the quality of life of people living with HIV should be factored into the metrics for defining epidemic control.