Five key takeaways from the AIDS 2024 conference

1. Unshackled exchange of views and inspirational leadership

AIDS 2024 in Munich was a moment when a rich diversity of stakeholders associated with the global response rubbed shoulders together — from trans activists, to pioneering scientists, youth advocates to public health leaders and a host of major donors.

Munich embodied the contradictions of holding a meeting in the Global North. It allowed for an unshackled exchange of views from all perspectives, including Jay Mulucha, a leading trans activist from Uganda who spoke at the formal opening of the Conference, who, in other contexts, might feel less free to speak out candidly. On the other hand, many delegates experienced major difficulties of representation. Many struggled to get visas and a significant number of participants from the Global South either never made it or arrived after tortuous last-minute or heavily delayed journeys to fortress Europe.

The conference also celebrated the contributions of some of the inspirational leaders who have been at the forefront of collective efforts to end HIV. Andriy Klepikov, Executive Director of the Alliance for Public Health (APH) from Ukraine, one of Frontline AIDS’s partners, was one of the keynote speakers at the conference. He spoke alongside Winnie Byanyima, Executive Director of UNAIDS, and the German Chancellor, Olaf Scholz. It is unsurprising that Andriy’s speech received a standing ovation as there is much in the work of APH to be applauded, from their humble beginnings as a country programme of Frontline AIDS in 2000 to becoming the major player, not only in Ukraine, but in many other parts of Eastern Europe and Central Asia. They have been a pioneer across many aspects of Ukraine’s national response to HIV, TB and Hepatitis C, working at scale and have taken the lead in areas such as harm reduction, as well as innovating in areas such as telemedicine and the use of artificial intelligence. APH is an agile organisation built from its foundations to become a key humanitarian actor providing a range of services to ex-servicemen, particularly those now facing multiple forms of disability.

2. Lenacapavir could be made for just (US) $40 a year

US pharmaceutical giant Gilead’s new long-acting injectable HIV prevention drug, lenacapavir, sold under the brand name Sunlenca, received a lot of attention at the conference. The cost of lenacapavir is a major concern because it is currently too expensive for low and middle-income countries but could substantially reduce new HIV infections if it was affordable. A generic production of lenacapavir could cost US $40 a year for every patient, which is currently sold at $42,250/ year. Those changes could ensure “poor people do not die because of property rights.” Even at the lowered generic drug price, it could still generate a 30% profit for Gilead.

According to results announced by Gilead last month, the drug offered 100% protection to more than 5,000 women in South Africa and Uganda. Its overall effectiveness led some to call it a “vaccine”.

This led Anton Basenko, APH’s Communities, Rights, and Gender Advisor to call lenacapavir a “potentially a game changing drug, which could especially benefit marginalised people facing stigma and discrimination”. This is why I joined over 300 world leaders, celebrities and activists by signing a petition urging Gilead to license cheap, generic versions of lenacapavir.

3. Latest UNAIDS data

The UNAIDS report titled “The Urgency of Now” encapsulates the task in hand. We are making good progress on some of the key metrics: the fewest number of new HIV infections since the late 1980s; fewest AIDS-related deaths since 2004, and the greatest number of people on antiretrovirals. While there has been positive progress, the overall response is falling behind in some aspects with the report characterising the situation as being one where the HIV response is moving ‘at two speeds’: faster in some countries and much slower in countries with fewer resources.

According to UNAIDS data, the number of new HIV infections globally stands at 1.3 million in 2023 — three times higher than the 2025 target. We are just over five years away from 2030; the target date for the world to be free from AIDS. This Sustainable Development Goal made by UN Member States has always been aspirational, but the opportunity to consign the pandemic to history is not impossible. Achieving meaningful progress to this highest of ambitions requires concerted political will and commitment across governments, the private sector and civil society.

4. Middle East and North Africa region

One of the critical dimensions of this bifurcating response can be observed at the regional level. The number of infections is increasing in the Middle East and North Africa, Latin America and Eastern Europe. Similar patterns exist around AIDS-related deaths. While the numbers may not be the highest in these regions, it is important to address these negative trends on a global scale.

At Frontline AIDS, we have, with our partners, put a lot of energy into the response in the Middle East and North Africa (MENA) region, where Frontline AIDS has been the principal civil society recipient of Global Fund support. During the AIDS 2024 conference, Frontline AIDS and some of its key partners, Soins Infirmiers et Developpement Communautaire (SIDC) and Middle East and North Africa Harm Reduction Association (MENAHRA) highlighted the situation in MENA and precipitated moves with a range of key important donors to reverse the decline in support for the region. We intend to keep the situation in MENA in the spotlight.

5. Ensuring the inclusion of key populations

The global HIV response is negatively fueled by inadequate political will to fund prevention programmes for key populations. The toxic environment, which is generating new levels of stigma and discrimination against the LGBTQ+ community in particular, is adding fuel to this fire, unquestionably contributing to the number of people who are not accessing treatment. Frontline AIDS operates a Rapid Response Fund to support marginalised populations experiencing persecution, and the demand for this fund is higher than ever.

Civil society organisations (CSOs) continue to play a disproportionate role in providing services and working in solidarity with key populations. However, they are now facing increased scrutiny and investigation by a growing number of governments across sub-Saharan Africa. CSOs that have provided services to various communities for years are being targeted, for example, for ‘promoting homosexuality’. This situation is leading to a reduction in safe access to life-saving treatment for people who use drugs, sex workers, and the LGBTQ+ community, negatively impacting on the reduction of HIV infections.

As we move on from Munich, our collective focus is on what it will take to meet the 2030 target. HIV is no longer a top global priority, but if we collectively fail to achieve the last mile, it will come back to haunt us. Now is the time to ensure HIV remains firmly on the global agenda.