As Science Advances, Countries Do Not Enact Policies to Fight AIDS at Same Pace

Countries around the world are hindering progress against AIDS by not aligning their policies with international standards, according to a report issued by the HIV Policy Lab ahead of World AIDS Day.

The authors of the report aimed to track trends in HIV-related policy around the world this year, painting a picture of which countries have adopted key policies described by the WHO, UNAIDS (the Joint United Nations Program on HIV/AIDS), and other international standards. The authors said that the science surrounding HIV has never been better that this point in history, and yet the AIDS response has not kept up.

The authors first explained that no country in the world has fully adopted the international standard and best practices into their laws and policies. They found that in the 194 UN member states, about half of the states had adopted policies that were aligned with international standards. This includes the failure to adopt the most updated policies on critical interventions, the authors said, including differentiated service delivery and PrEP.

Additionally, countries may do well in some policy categories but worse in others, so the implementation of internationally recommended policies is inconsistent, the authors explained.

The category that is most widely adopted is related to HIV clinical care and treatment. Such policies are adopted at a much higher rate compared to other categories, the authors noted, such as policies related to testing and prevention, structural barriers, or health system factors. Many countries have yet to adopt policies about utilizing the latest first-line ART regimens, they added.

“Achieving an end to AIDS as a public health threat—the global goal set for 2030 by the UN General Assembly—will require more than good science and scaled up programs,” the authors said. “It will require laws and policy aligned with that science. In 2020, the clear message from the HIV Policy Lab data is that there is much work to do to put us on that path.”

The countries and regions who are making the most progress, the authors wrote, were the states that had adopted “many or most” of the laws and policies developed after evidence review and international recommendations. The regions with the highest rates of adopting these endorsed policies are Eastern and Southern Africa, Western and Central Europe, and North America, the authors said. They added that the country with the highest rate of policy adoption is South Africa.

Matthew Kavanagh, PhD, director of the Global Health Policy & Politics Initiative at Georgetown University’s O’Neill Institute for National and Global Health Law and assistant professor of international health, told Contagion® that middle- and low-income countries have done a better job eliminating the barriers to care than rich countries. For example, he cited Malawi, a country that has adopted more HIV-related policies aligned with the international recommendations than the U.S. has. Malawi has made more progress against AIDS than the U.S. has, he said by way of comparison.

The countries that have adopted the fewest policies are the states that are furthest off track from gaining a foothold against AIDS, and are facing a growing epidemic and rising death rates, according to the authors.

There is evidence that demonstrates that laws which criminalize same-sex sexual relations, sex work, drug use, or HIV exposure/transmission – oftentimes all of them – are counterproductive. However, the authors note, every country in the world has at least one of these laws in place.

“During COVID-19 we have seen that policy can change quickly,” Kavanagh told Contagion®. “On everything from how medicines and testing are access to how criminal law is used to fight disease outbreaks, we’ve seen policy change rapidly. That same urgency is needed on these issues—adopting not just the best clinical policies to help people living with HIV get excellent care but also adopting laws that avoid criminalization and ensure affordable medicines for all.”

The HIV Policy Lab describes itself as “a global collaboration of academic, UN, and civil society organizations.”