As a member of the Global Health Hub Germany, we invited Peter to share his personal insights from the Conference as one voice from our non-state stakeholder groups. As he notes himself, he writes from the subjective viewpoint of the author and invites readers to look at other opinions and perspectives on the conference.

Upon the silver anniversary of this cornerstone of the international HIV/AIDS-response, the conference slogan – "Putting People First" – reminded us of what this response has evolved into: people should always be at the centre of all efforts to end AIDS. Organised by the International AIDS Society (IAS), the event takes place every two years and is the world's largest gathering on HIV. The German government was represented by Chancellor Olaf Scholz, who spoke at the opening ceremony, and Dr. Sabine Dittmar, Parliamentary State Secretary of the Federal Ministry of Health. 

“One person dies of AIDS every minute. One person every minute! That is something we must change. Our common goal is to end the AIDS epidemic by 2030. While we are making progress, there is still some way to go. That is why we keep on working – together and globally. As one of the largest donors, Germany contributes 1.3 billion Euro into the Global Fund to Fight AIDS, Tuberculosis and Malaria in the current cycle. And we will continue to support it. (…) We also support UNAIDS and the World Health Organisation and will continue to be a reliable partner.” (Chancellor of the Federal Republic of Germany Olaf Scholz at the opening session)

Ahead of the conference UNAIDS held a press conference to launch its new report on the global HIV pandemic: “The Urgency of Now: AIDS at a Crossroads”. Action against AIDS Germany was honoured to moderate the press conference. The report highlights significant achievements, such as the reduction in new HIV infections and increased access to treatment. At the same time, it warns of the persistent challenges that threaten to reverse this progress. Key issues include funding gaps, stigma, discrimination, and inequalities in access to healthcare. The report calls for immediate, intensified efforts and sustained political commitment to end the AIDS epidemic by 2030, emphasizing the need for innovative approaches, inclusive policies, and robust, sustainable international cooperation. Success or failure will be determined by the path that leaders choose.

Winnie Byanyima, UNAIDS Executive Director, presented the new data for 2023: 39.9 million people are living with HIV (PLHIV), 1.3 million were newly infected, 630,000 died of HIV-related illnesses and 30.7 million had access to life-saving HIV treatment (which means that ¼ of all PLHIV still don’t have access). The data demonstrate a significant disparity between adults and children: 77% of individuals aged 15 years and older had access to treatment, whereas only 57% of children aged 14 years and younger did. There are about 5.4 million people infected that don’t know about their HIV status.

It is important to note that treatment and prevention are the same thing: people with a successful HIV therapy and an undetectable virus load cannot transmit the virus. The slogan of the global HIV community is U=U (undetectable equals untransmissible). One of the root causes of stigma and discrimination is the potential transmissibility of the virus: we know that PLHIV with access to treatment can live healthy lives and pose no threat to others. The same applies for those with access to prevention and preventive tools, such as PrEP.  

The information UNAIDS compiled is crucial for the creation of tailored HIV programmes, as almost every country and region have their own specificity of an HIV epidemic, depending on the transmission routes, differences between key populations and (the lack of) political commitment.

“End the discrimination faced by girls and women that is driving the AIDS pandemic especially in Africa. 3 out of 4 newly infected young people (ages 15–24) are girls, one is a boy. There is an injustice there. We must deal with the vulnerability of girls and young women.” (Winnie Byanyima, UNAIDS Executive Director)

We can observe alarming trends in the evolution of the epidemic in the Russian Federation and the Eastern European region. Michel Kazatchkine, Executive Director of the Global Fund from 2007 to 2012, reported in a press conference that the number of PLHIV has increased by 40-50% since 2010. There are now 2.1 million PLHIV in the region, the fastest growing number in the world. Only about 50% of PLHIV have access to treatment. 92% of all new infections occur among key populations, especially people who use drugs and men who have sex with men. This is a dramatic development, caused by a lack of political commitment, harmful laws, limited funding and shrinking spaces for civil society engagement in the region.

Germany showcased its international commitment to the HIV-response at a German Pavilion, organized in close cooperation between the Federal Ministry for Economic Cooperation and Development (BMZ), the Federal Ministry of Health (BMG), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), and representatives from various German NGOs, such as the Deutsche Aidshilfe (DAH). Topics under discussion included the German BACKUP Health Initiative, the Global Fund's ‘Breaking Down Barriers’ initiative, access to TB and HIV diagnostics with Médecins Sans Frontières, the UNAIDS Data Update, and sex workers' health needs organized by DAH.

Action against AIDS Germany welcomed the good cooperation in preparing all activities at the Pavilion. In times of shrinking spaces, one would wish that other countries would follow this path. It is a good example of Germany’s efforts to involve civil society. It was encouraging to see that all discussions included the voices of community members from LMICs. The principle of “nothing about us, without us” was translated into reality. Many thanks to all involved!

One of the hot topics throughout the conference was related to the results of a study published in the New England Journal of Medicine. The study found that two injections of lenacapavir per year are an effective method of preventing HIV infection. This approach differs from vaccination but is similar in its efficacy. The study was conducted in South Africa and Uganda with more than 5,000 HIV-negative participants. Of the 2,134 individuals who received lenacapavir, none contracted HIV.[i]

At the opening ceremony, a “game changer” for the global HIV response. She called on the pharmaceutical company Gilead, which owns the intellectual property rights and charges US$ 42,000 per person per year for the treatment, to make it widely available and affordable, especially in Asia, Latin America and Africa. The drug would give those who are unable to negotiate condom use, or who are unable to take pills regularly due to stigma and discrimination, an appropriate tool to prevent HIV.

This will only be possible if Gilead cooperates with the Medicines Patent Pool and if the price comes down. The production costs of the drug stand at about € 40 for an annual supply, as Dr. Andrew Hill of the Liverpool University, succinctly noted at the conference. From civil society’s view, this case demonstrates the need for transparency in the pricing of drugs.

For Action against AIDS Germany it is a recurring theme that Gilead lets shareholder value override the human right to health, as could be seen in the case of the Hepatitis C drug sofosbuvir. When I had the opportunity to ask Jared Baeten, a senior representative from Gilead, some challenging questions about the exact price and the list of countries that Gilead would consider to be eligible for voluntary licensing agreements, I found the responses to be vague and unsatisfactory. It is perhaps for these reasons that Gilead was the focus of activist protests throughout the conference.

In my view, the announcement of the second AIDS patient cured in Berlin (globally the 7th reported case), which was presented with much fanfare as a major milestone in the fight against HIV/AIDS, may have been overstated. This patient achieved sustained HIV remission following a stem cell transplant, which was necessitated by cancer, from a donor with a rare genetic mutation that renders him resistant to the virus. Personally, I do not see this as a true innovation; it seems to simply reaffirm the already existing concept of a stem cell transplantation as a possible cure from HIV. Moreover, the procedure is far too dangerous for widespread use. Regrettably, in my opinion, we remain far from any realistic hope of a cure.

Chancellor Scholz gave an encouraging speech at the opening session of the conference providing important impetus for achieving the health-related Sustainable Development Goals, in particular ending AIDS as a threat to public health. This is particularly important given the existing US$ 9.5 million annual funding gap of yearly $US 9,5 million in the global effort to end AIDS. Chancellor Scholz's announcement to join the UNAIDS Global Partnership for Action to End HIV-Related Stigma and Discrimination was welcomed. UNAIDS is currently facing a funding shortfall of US$ 20 million of its US$ 160 million operating budget. Germany's contribution to UNAIDS this year is € 6.75 million. According to calculations by Action against AIDS Germany, the fair contribution should be € 15 million, based on needs and financial capacity.

Next year, the 8th replenishment conference of the Global Fund will take place, where funding for the next three years will be secured. For the last replenishment, the German government provided €1.2 billion from the BMZ budget for the years 2023 to 2025. A further €100 million has been mobilised through debt-for-health swaps, bringing Germany's total contribution to Global Fund programmes to €1.3 billion. In order to continue the important work of the Global Fund, funding volumes must be secured. The current cuts in the budget of BMZ will not help, as Action against AIDS wrote in a letter to Chancellor Scholz welcoming his positive remarks at the conference. 

[1] See for the full results and control groups here.

Contact: wiessner@aktionsbuendnis-aids.de

Image: Peter Wiessner

Feel free to also check out more information on the Living 2024 pre-conference where a global coalition of people living with HIV addressed topics such as PrEP (pre-exposure prophylaxis), community-led monitoring, HIV cure and vaccine research, integrated services and approaches, the role of faith-based organizations, and ageing with HIV.