By Shobha Shukla
Despite having science-based tools for HIV combination prevention, there were 1.3 million people who got newly diagnosed with HIV in 2023 – and also in 2024 – hardly any decline between the two years. Despite having science-backed lifesaving antiretroviral therapy to help every person living with HIV healthy and well (and virally suppressed – which also ensures there is zero risk of HIV transmission because treatment works as prevention), 630,000 people died of AIDS-related illnesses in 2023 – and also in 2024 – hardly any decline between the two years. We clearly need a prevention revolution to drastically bring down new HIV infections as well as a lot more needs to be done to reduce AIDS-related deaths. ‘Business as usual’ is clearly not an option.
In sub-Saharan Africa, one in four (~25%) of new HIV infections occur among key populations, but in Asia Pacific region, four in five (79%) of new HIV infections occur among key populations (such as men who have sex with men, sex workers, transgender people, persons who inject drugs, among others).
In 2024 alone, there were an estimated 800,000 new HIV infections in sub-Saharan Africa, and women and girls accounted for 63% of them. Adolescent girls and young women aged 15-24 are more than twice as likely to acquire HIV as their male peers. These numbers remind us that HIV remains a public health crisis. But HIV is not just a medical or health issue—it is deeply intertwined with social, economic, and legal factors. To truly end HIV as a public health threat, we must look beyond the virus itself and address the broader context in which it thrives,” said Letlhogonolo Mokgoroane, Legal Representative and Head of Strategic Litigation and Research, OurEquity, South Africa; member of Johannesburg Society of Advocates.
“Sexual and reproductive health, rights and justice (SRHRJ) is about more than access to contraception or maternal care. It is about the right of every individual to make informed decisions about their bodies, free from violence, coercion, or discrimination. When people – especially women and girls – are denied these rights, they become more vulnerable to HIV and other health risks. For example, only 40% of young women in sub-Saharan Africa have comprehensive knowledge about HIV prevention. In some countries, less than 50% of women have access to modern contraception. Gender-based violence remains alarmingly prevalent: in South Africa, a woman is killed every three hours, and one in three women has experienced intimate partner violence,” said Letlhognolo.
Letlhogonolo was speaking in SHE & Rights (Sexual Health with Equity & Rights) session co-hosted by Global Center for Health Diplomacy and Inclusion (CeHDI), International Conference on Family Planning (ICFP 2025), Family Planning News Network (FPNN), International Planned Parenthood Federation (IPPF), Asian-Pacific Resource and Research Centre for Women (ARROW), Women’s Global Network for Reproductive Rights (WGNRR), Asia Pacific Media Alliance for Health and Development (APCAT Media) and CNS.
Survivors of violence are at a 50% higher risk of acquiring HIV
“Criminalisation of same-sex relationships and sex work drives key populations underground, away from essential health services. In 31 African countries, same-sex relationships are still criminalised, making it difficult for LGBTQIA+ individuals to access HIV prevention and care. Sex workers, who are 13 times more likely to be living with HIV than the general population, often face harassment and violence, further increasing their vulnerability. Justice is central to this conversation. Laws and policies that discriminate against people living with HIV, LGBTQIA+ individuals, sex workers, and other marginalised groups, not only violate human rights but also fuel the epidemic,” said Letlhogonolo.
“For example, in Nigeria, the Same Sex Marriage (Prohibition) Act has led to a 41% decrease in access to HIV services among men who have sex with men. Justice means ensuring that everyone—regardless of who they are or whom they love—can access the information, services, and support they need to live healthy, fulfilling lives,” added Letlhogonolo.
If HIV funding is not fully restored, new infections and AIDS deaths can increase alarmingly
“Recent global funding cuts could send the world back to levels of HIV infections and AIDS-related deaths not seen since the early 2000s. Next 5-years projection show that new HIV infections and AIDS-related deaths globally can dangerously rise if the lost funding (both this year and in recent years) does not return. Many countries have reduced their investments and domestic funding is often inadequate to fully fund the AIDS response – which has been relying on external support,” said Eamonn Murphy, UNAIDS Regional Director for Asia Pacific, and Central Asia and Eastern Europe.
“Nine countries in Asia and the Pacific region have rising new HIV infection rates. 9 countries in the region have too low coverage of lifesaving antiretroviral treatments. Moreover, the region has been hit with funding crisis – and – overall HIV prevention crisis too. Between 2010 to 2024, there were 9 countries in Asia Pacific which reported an increase in newly diagnosed people with HIV. Fiji has the world’s fastest growing epidemic, new HIV infections increased by over 3091% in Fiji,” said Murphy.
“Along with Fiji, other countries in Asia Pacific where there was an upswing in the number of people newly diagnosed with HIV between 2010-2024 are: 562% rise in Philippines; 187% rise in Afghanistan; 84% rise in Papua New Guinea; 67% rise in Bhutan; 48% rise in Sri Lanka; 42% rise in Timor-Leste; 33% rise in Bangladesh; and 16% rise in Lao PDR. Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%),” said Murphy of UNAIDS.
Between 2010-2024, there were 9 countries in Asia Pacific which are also treating less than half of the people living with HIV, such as Afghanistan (11%), Pakistan (16%), Fiji (24%), Philippines (40%), Bangladesh (41%), Indonesia (41%), Mongolia (41%), PNG (46%), and Maldives (48%).
“Compared to the decline in the number of people newly diagnosed with HIV between 2010-2024 worldwide (40%), the decline in Asia Pacific is far behind (17%),” said Eamonn of UNAIDS. In Eastern and Southern Africa, new HIV infections declined by 57% during the same period.
Pam Ntshekula calls for rights and safety of sex workers
“Our mission is clear: sex workers deserve dignity, protection, and full recognition of their human rights. We are calling for the full decriminalisation of sex work because sex workers deserve to work in safe, free, and dignified spaces. Right now, criminalisation puts sex workers at risk – it makes them more vulnerable to violence, police abuse, stigma, and poor health access. Decriminalisation would mean sex workers can report crimes without fear, access healthcare without judgment, and work without hiding. It is not just a legal issue —it is about human rights, health, and safety. Every sex worker deserves to be protected, respected, and free to choose how they live and work,” said Pam Ntshekula is a dedicated advocate for the rights and safety of sex workers and Lobbyist Officer, Sex Workers Education and Advocacy Taskforce (SWEAT), South Africa.
“Many sex workers avoid clinics due to stigma and mistreatment. Full decriminalisation ensures safe, respectful access to SRHR services. Criminalisation limits condom use, outreach, and health education. Decriminalisation creates safer environments for prevention and care. Constant fear of arrest, violence, and shame harms mental wellness. SDG3 includes mental health – sex workers deserve safety and peace of mind,” Pam added.
“Sex workers face high levels of rape, assault, and abuse – often from police or clients. Decriminalisation allows them to report violence and access justice. Gender equality means protecting all genders and identities. My message is: There is no health without rights. There is no equality without decriminalisation. Decriminalising sex work is the single most powerful move to remove legal barriers to health access, justice, and human dignity. It also lets peer educators and health organisations do their work without fear,” said Pam. “We also need to tackle poverty and unemployment by linking sex workers to job training, housing support, and social grants if they choose to exit. Empowerment means choices, not pressure.”
SDG goals and targets are not standalone but interconnected
“Each of SDG goals and targets are interconnected. For example, studies show that countries with higher gender equality have lower rates of HIV infection among women. In Botswana, legal reforms to protect women’s property rights have led to increased economic independence and better health outcomes. We cannot achieve health without justice. We cannot achieve justice without upholding rights. And we cannot uphold rights without addressing the root causes of inequality and exclusion,” said Letlhogonolo.
“It means we must break down silos. HIV programmes cannot operate in isolation from broader sexual and reproductive health services. Legal reforms must go hand in hand with public health initiatives. We must listen to and empower those most affected—young people, women, LGBTQIA+ communities, and people living with HIV—to lead the way,” they added.
“It means investing in education, not just about HIV, but about consent, healthy relationships, and bodily autonomy. In Uganda, the DREAMS initiative, which combines HIV prevention with education and economic empowerment for adolescent girls, has reduced new HIV infections among participants by 25%. Supporting community-based organisations is crucial: in Kenya, peer-led outreach among sex workers has doubled the uptake of HIV testing and treatment. It means holding governments accountable for their commitments to human rights and the SDGs,” stressed Letlhogonolo.
“In 2023, out of 54 African countries, only 16 African countries had fully funded their national HIV responses. We must advocate for increased domestic investment and international solidarity. And it means recognising that justice is not just a legal concept—it is a lived reality. When a young woman can access contraception without fear, when a gay man can seek HIV testing without shame, when a sex worker can report violence without risking arrest, we are moving closer to justice,” rightly said Letlhogonolo.
“Essential health services must include sexual and reproductive health services – including safe abortion and post-abortion care, menstrual health hygiene, and mental health services, with particular attention to women, adolescent girls, persons with disability, indigenous peoples, gender diverse communities, older people, young people, migrant workers, refugees, people living with HIV, sex workers, people who use drugs, among others. They must also include all health and social support services for survivors of sexual and gender-based violence,” said Shobha Shukla, Lead Discussant for SDG-3 at the United Nations High Level Political Forum 2025 (HLPF 2025) in New York. “We have to ensure that health responses are people-centred, gender transformative and rights-based for all, without any condition or exclusion.”
She rightly called upon the government leaders who had assembled at the UN: “With less than 5 and a half years left to deliver on SDG3, we appeal to governments to step up their actions on gender equality and right to health – where no one is left behind.”
(The writer is an advocate and an award-winning founding Managing Editor and Executive Director of Citizen News Service)
