We commemorate World AIDS Day each year on 1 December, a tradition that goes back to 1988. On World AIDS Day we remember those who have fallen to AIDS, take stock of all the years of hard work that has and is still being undertaken to reduce HIV/AIDS and to take an honest look at what is still needed to be done to achieve the ‘three zeros’—zero new HIV infections, zero discrimination and zero AIDS-related deaths.
You would be forgiven for thinking that ‘getting to zero’ was one of the Government’s aspirations for ‘levelling up’. The idea behind the levelling-up strategy is that people and communities that feel they have been left behind get a chance to catch up. ‘Getting to Zero’ is an initiative introduced by the Joint United Nations Programme on HIV and AIDS (UNAIDS) (2010), which aims to reduce HIV infections and HIV/AIDS-related deaths to zero. In 2019, the UK Government committed to ending new HIV transmissions in England by 2030. A new goal was set to eradicate HIV transmission, and to have no new infections in the next decade, so that the UK becomes one of the first countries to reach the UNAIDS zero infections target by 2030.
The UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths comes with the principle of leaving no one behind. In order to meet the target set by UNAIDS, a series of fast-track commitments, including treatment for all, eliminating childhood AIDS, ensuring access to HIV prevention, championing the rights of girls, women and key populations, financing the AIDS response and realising human rights have been proposed (UNAIDS, 2010).
A positive picture for HIV in England is emerging, with a dramatic fall in the number of people who are living with undiagnosed HIV. It has been estimated that England is on target to reach 95% diagnosed by 2025 and to eliminate HIV infections by 2030. However, there are areas outside London that have not seen as steep a decrease in the prevalence of undiagnosed HIV and there is evidence of missed opportunities to diagnose HIV infections among some population subgroups. Gay, bisexual and other men who have sex with men and black African heterosexuals are still disproportionately affected by HIV (Presanis et al, 2021).
The increasing use of pre-exposure prophylaxis among those who are at higher risk of HIV has strengthened the response to end HIV transmission. However, a further reduction in the number of people who remain undiagnosed with HIV will become challenging, particularly for heterosexuals who may believe they are not at risk.
AIDS/HIV remains a real public health threat. There are inequalities, power imbalances, violence, marginalisation, taboos, stigma and discrimination where there is HIV. The impact on the lives of those who are living with HIV, stigma and discrimination prevent many from accessing the services that they need. Women, girls, people who use drugs, prisoners, sex workers and many other vulnerable groups struggle without access to life-saving services because of who they are or what they choose to do. Nurses and communities have a central role to play in holding decision-makers to account and demanding political leadership to address the unacceptable inequalities that people living with HIV/AIDS may endure.
Despite the scale of the challenges and the journey that is still left to travel in the AIDS response, there is hope. Already the AIDS response has demonstrated what is possible when people come together and exert leadership. When communities organise and people empower each other, it is possible to deal with oppression and replace this with rights and fairer access to HIV services. Nurses, other health and care professionals and commissioners have key roles to play in the response to HIV, ensuring that services are relevant to and reach the people who require them the most.