POLICY BRIEF

Ending AIDS as a Public Health Threat
as a Cornerstone of Achieving SDG 3.3

The global effort to end AIDS as a public health threat by 2030 is a cornerstone of Sustainable Development Goal (SDG) 3.3. Despite significant progress in reducing HIV incidence and mortality, challenges such as stigma, inequitable access to care, and funding gaps persist. Sustaining the HIV response beyond 2030 requires integrated strategies that leverage advancements in science, strengthen health systems, and address social determinants of health. This Fast-Track Cities policy brief highlights key initiatives, five illustrative case studies, challenges, opportunities, and actionable recommendations at municipal, national, and regional levels to achieve and sustain the goal on ending AIDS as a public health threat.

Differentiated Service Delivery in South Africa: South Africa is at the forefront of implementing differentiated service delivery (DSD) models to optimize HIV care for its large population of people living with HIV. Recognizing that a one-size-fits-all approach to antiretroviral therapy (ART) delivery created inefficiencies and burdened patients and healthcare systems, the country introduced tailored HIV care models. A widely adopted model was multi-month dispensing (MMD), which allows stable patients to receive a six-month supply of ART, reducing the frequency of clinic visits. This approach minimized disruptions to ART adherence, notably during the COVID-19 pandemic, and particularly in rural areas where access to health facilities is limited. Multi-month dispensing contributed to a 95% retention rate in HIV, with marked improvements in viral suppression (South Africa National Department of Health, 2023).

PrEP Rollout in Australia: Australia has been a global leader in the rollout and scale-up of HIV pre-exposure prophylaxis (PrEP), contributing to a decline in HIV incidence among priority populations. The country’s PrEP program was supported by the Pharmaceutical Benefits Scheme, which subsidized PrEP, making it affordable for individuals at risk. Community-based organizations played a crucial role in driving awareness and uptake by running targeted campaigns for gay and bisexual men, sex workers, and transgender individuals. Integration of PrEP services into primary care ensured accessibility and reduced stigma by normalizing its use as part of routine care. By reducing new HIV diagnoses by 23% in key populations over four years, the program highlighted the critical role of removing financial, logistical, and social barriers to prevention tools. Australia’s approach to rolling out PrEP is a model for other countries seeking to scale biomedical prevention (Kirby Institute, 2021).

 HIV Prevention in Kenya: Kenya has prioritized key populations, including sex workers, men who have sex with men, and people who inject drugs, in its HIV response, recognizing their disproportionate vulnerability. The program combines biomedical prevention, such as PrEP and harm reduction, with structural interventions to address stigma and discrimination. Community-based organizations, often led by members of key populations, deliver services tailored to their needs, fostering trust and engagement. Peer educators play a pivotal role, providing information, distributing condoms, and facilitating access to health facilities. Legal and policy reforms, including the decriminalization of some behaviors, have further reduced barriers to care. Over five years, the program has achieved a 30% reduction in HIV incidence among key populations, underscoring the impact of targeted, inclusive interventions. (Kenya Ministry of Health, 2022)

 Promoting U=U in Cambodia: Cambodia achieved the UNAIDS 90-90-90 targets in 2020 and is now striving to reach the 95-95-95 targets by 2030. A key component of this effort has been the integration of the Undetectable equals Untransmittable (U=U) message into national HIV education and treatment programs. The campaign leveraged Cambodia’s network of ART clinics to disseminate information through posters, brochures, and digital media. Radio programs and social media platforms were used to amplify the U=U message. And peer-led support groups provided safe spaces for people living with HIV to discuss the implications of U=U, share experiences, and build confidence in their HIV treatment journey. By 2022, over 85% of people living with HIV surveyed reported awareness of U=U, and 76% of them stated that it positively influenced their commitment to ART adherence. The campaign also contributed to a reduction in HIV-related stigma in healthcare settings, as providers adopted a more empathetic and science-based approach to HIV clinical management (National Center for HIV/AIDS, Dermatology, and STDs, 2023).

 Implement an Anti-Stigma Charter in London, UK: London, UK, launched its Anti-Stigma Charter in 2023, with the aim of eliminating HIV stigma as a barrier to achieving the city’s zero new HIV transmissions target by 2030. Spearheaded by the Mayor of London in partnership with NHS London, community organizations, and advocacy groups, the Charter sets out a framework for tackling stigma through policy, education, and community action. The Charter’s implementation includes training modules for NHS staff, focusing on addressing unconscious bias and ensuring respectful, nonjudgmental care for people living with HIV. More than 10,000 healthcare workers across London have completed the training sessions. London’s employers also embraced the Charter, with businesses signing on to ensure HIV-inclusive workplace policies by conducting anti-stigma training for managers and staff, reducing workplace discrimination, and creating safer workspaces for employees living with HIV (Mayor of London, 2024).

Efforts to end AIDS face several challenges. Persistent HIV and intersectional stigma and discrimination continue to deter individuals from seeking testing and treatment. Funding for HIV programs remains unpredictable, with declining donor contributions threatening gains in all countries, but particularly low- and middle-income countries. Health system weaknesses, including HIV workforce shortages and supply chain disruptions, impede the delivery of HIV services. Geographic and socioeconomic inequities create disparities in access to HIV prevention and treatment tools, particularly in rural and marginalized communities, and exacerbated by high cost. Additionally, the rising threat of antimicrobial resistance, including resistance to antiretroviral (ARV) drugs, poses a critical challenge to sustaining progress.

 Despite these challenges, opportunities abound to accelerate progress toward ending AIDS as a public health threat. Advancements in biomedical prevention, such as injectable PrEP and long-acting ARV drugs, offer new avenues to reduce HIV acquisition and transmission, within the context of freedom of autonomy to initiate oral or injectable formulations based on “patient choice.” Digital health technologies can enhance service delivery, patient engagement, and data management, particularly in underserved areas. Strengthening integration of HIV services with broader health systems and UHC initiatives promotes sustainability and efficiency. Community leadership remains a cornerstone, empowering key populations to lead tailored interventions and reduce stigma. Additionally, global collaborations and innovative financing mechanisms, such as health bonds, can mobilize resources and facilitate equity in HIV responses.