Countdown to 2030: The Challenges of Ending the HIV Pandemic

Examining the 2030 goal: a closer look 

The goal to end the HIV pandemic as a public health threat by 2030 requires careful consideration. Sustainable HIV control is unachievable if the needs of the most vulnerable populations are neglected. As time progresses, these groups may face an even greater disproportionate burden of HIV. 

Integrating HIV care into universal healthcare is often seen as a pathway forward. However, this approach risks diminishing the specific focus and funding required for key populations. 

Currently, only 2% of all HIV funding, and about 9% of resources earmarked for prevention, are allocated to these groups—a majority of which comes from external donors. Without a significant increase in domestic funding for HIV services tailored to key populations, achieving pandemic control in many countries will remain an elusive goal. 

Key populations at the heart of the HIV pandemic 

Since the early days of the pandemic, it has been clear that certain groups are particularly vulnerable to HIV. These include gay and bisexual men, other men who have sex with men, transgender individuals (especially trans women), sex workers, and people who use drugs. Structural factors such as criminalization and stigmatization have been major drivers of HIV transmission within these communities – leading to 65% of new HIV infections occurring within key population groups. This is why the key to an impactful HIV programme is understanding and addressing drivers of the HIV pandemic, including structural barriers; violence against women; discrimination; stigma; harmful social norms; inequalities related to sex, gender, sexual orientation, race, disability, and economic status; criminalization of HIV transmission and certain populations; and restrictive laws and policies. 

The role of these key populations in understanding and preventing HIV transmission is now well-documented. Community-led services, participatory research, and advocacy efforts addressing social and legal determinants have become essential tools in the fight against HIV. The scientific community agrees: centering these communities is crucial if we are to achieve the goal of ending HIV. As IPPF HIV Theory of Change highlights, "working with community stakeholders affected by and living with HIV includes both tailoring services and programmes to address the needs of populations more severely affected by HIV, as well as addressing the needs of all people who would benefit from HIV‑related services". 

However, despite the wealth of knowledge and the ambitious goals set by organizations like WHO and UNAIDS, many of these communities continue to be excluded from vital services and programs. Worse, they are often caught in the crossfire of a global backlash driven by populist and anti-rights forces. 

A backlash against progress 

The conference's final session highlighted a growing and dangerous trend: anti-gender forces are increasingly pushing back against LGBTQIA+ rights, the rights of trans people and sex workers, and Comprehensive Sexual Education (CSE). The promotion of abstinence-only approaches, particularly among adolescents and young people, is contributing to risky behaviors and, consequently, increased HIV transmission. 

In this challenging environment, the International AIDS Conference serves as a timely reminder of the importance of bringing together key actors—researchers, policymakers, communities, and private sector stakeholders—to align their agendas and reinforce the commitment to ending HIV. 

A call to action 

As Anton Basenko, a Ukrainian drug user rights and harm reduction activist, passionately stated in the conference's closing session: 

"I think we simply have no choice, the time of declarations and beautiful conference titles is over. Putting people first is now the sacred responsibility of every government, every policymaker, and decision-maker. And it is these 'people'—representatives of all key affected communities, civil society—who must be included in all processes, as full participants and equal partners. There are no other options. Because nothing about us without us!" 

This powerful statement underscores the urgency of prioritizing the needs and voices of those most affected by HIV. As the world strives to meet the 2030 goal, it is clear that inclusion, collaboration, and a relentless focus on key populations will be critical in the fight against HIV.