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WHAT DOES THE POLITICAL DECLARATION ON HIV AND AIDS 2021 SAY ABOUT THE HIV PREVENTION COMBINATION? 

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Underscore that combination HIV prevention is a cornerstone of an effective HIV response and includes the following evidence-based interventions dependent on national and regional epidemic characteristics: male and female condoms and lubricant, treatment as prevention, pre-exposure prophylaxis, post-exposure prophylaxis, voluntary medical male circumcision, harm reduction,15 in accordance with national legislation, comprehensive information and education, including in and out of school, screening and treatment of sexually transmitted infections, quality secondary education, economic empowerment, sexual and reproductive health, reducing risk-taking behaviour and encouraging safer sexual behaviour, including correct and consistent use of condoms, prevention of sexual and gender-based violence, poverty reduction and food security, and blood safety, and in this regard note with alarm the limited scale of combination prevention programmes

Commend progress achieved in research, development and proven efficacy of innovative HIV interventions, including advances in treatment as prevention, pre-exposure prophylaxis, long-acting antiretrovirals for prevention and treatment, antiretroviral-based microbicides and other female-initiated options to reduce the risk of HIV infections, such as vaginal rings, and ongoing initiatives to define and address the threat of antimicrobial resistance in relation to HIV and associated diseases, comorbidities and coinfections, especially tuberculosis;

Welcome the recent scientific evidence related to the preventative benefits of antiretroviral drug therapy, demonstrating no evidence of sexual transmission of HIV within adult couples when the HIV-positive partner is on effective and sustained treatment, with undetectable viral loads, confirmed by routine testing at intervals as recommended by the World Health Organization and reflected in its updated 2021 guidelines, which is known as “Undetectable = Untransmittable (U = U)”, also recognizing the continued need for further research;

Commend the progress achieved in several regions of the world as a result of implementing research which has led to massive and rapid scaling-up of pre-exposure prophylaxis and the use of post-exposure prophylaxis, in conjunction with treatment as prevention, resulting in the rapid reductions in the number of new HIV infections

Welcome that over 26 million people living with HIV are on antiretroviral therapy – a number that has more than tripled since 2010 – but note that, despite this progress, 12 million people living with HIV still do not have access to treatment, especially in Africa, and that these 12 million people are prevented from accessing treatment owing to inequalities, multiple and intersecting forms of discrimination and structural barriers.

Note that viral hepatitis coinfection with HIV, including mortality due to viral hepatitis coinfection, is reported across populations at higher risk of HIV, especially among people who inject drugs;

Note that people living with HIV are at substantially higher risk for many types of cancer, including those caused by the human papillomavirus, that women living with HIV are about six times more likely to develop cervical cancer and that anal cancer rates are substantially higher for men and women living with HIV than their HIV-negative peers.

Recognize the resilience and innovation demonstrated by communities during the COVID-19 pandemic in reaching affected people with safe, affordable and effective services, including COVID-19 testing and vaccination, HIV prevention, testing and treatment and other health and social services;

Express concern over the stagnation and decline in international resources for the HIV response, reaffirm the importance of international public finance as a complement to domestic resources, reiterate that the fulfilment of all official development assistance targets remains crucial and recall the respective commitment of many developed countries to official development assistance, including 0.7 per cent of gross national income provided as official development assistance, with 0.15 to 0.2 per cent allocated to least developed countries

Underscore the importance of enhanced international cooperation to support efforts of Member States to achieve health goals, including the target of ending the AIDS epidemic by 2030, implement universal access to health-care services and address health challenges

Tailoring HIV combination prevention approaches to meet the diverse needs of key populations, including among sex workers, men who have sex with men, people who inject drugs, transgender people, people in prisons and other closed settings and all people living with HIV

Commit to prioritize HIV prevention and to ensure by 2025 that 95 percent of people at risk of HIV infection, within all epidemiologically relevant groups, age groups and geographic settings, have access to and use appropriate, prioritized, person-centred and effective combination prevention options 

(a) Increasing national leadership, resource allocation and other evidence- based enabling measures for proven HIV combination prevention, including condom promotion and distribution, pre-exposure prophylaxis, post-exposure prophylaxis, voluntary male medical circumcision, harm reduction, in accordance with national legislation, sexual and reproductive health-care services, including screening and treatment of sexually transmitted infections, enabling legal and policy environments, full access to comprehensive information and education, in and out of school; 

(b) Tailoring HIV combination prevention approaches to meet the diverse needs of key populations, including among sex workers, men who have sex with men, people who inject drugs, transgender people, people in prisons and other closed settings and all people living with HIV; 

(c) Ensuring the availability of pre-exposure prophylaxis for people at substantial risk of HIV and post-exposure prophylaxis for people recently exposed to HIV by 2025

1. d) Using national epidemiological data to identify other priority populations who are at higher risk of exposure to HIV and work with them to design and deliver comprehensive HIV prevention services; these populations may include women and adolescent girls and their male partners, young people, children, persons with disabilities, ethnic and racial minorities, indigenous peoples, local communities, people living in poverty, migrants, refugees, internally displaced persons, men and women in uniform and people in humanitarian emergencies and conflict and post-conflict situations;

1. g) Committing to accelerating efforts to scale up scientifically accurate, age- appropriate comprehensive education, relevant to cultural contexts, that provides adolescent girls and boys and young women and men, in and out of school, consistent with their evolving capacities, with information on sexual and reproductive health and HIV prevention, gender equality and women’s empowerment, human rights, physical, psychological and pubertal development and power in relationships between women and men, to enable them to build self-esteem and informed decision-making, communication and risk reduction skills and develop respectful relationships, in full partnership with young persons, parents, legal guardians, caregivers, educators and health-care providers, in order to enable them to protect themselves from HIV infection; 

(h) Considering removing structural barriers and spousal consent requirements for sexual and reproductive healthcare services and HIV prevention, testing and treatment services; (i) Conducting public awareness campaigns and targeted HIV education to raise public awareness about HIV;

Commit to achieve the 95–95–95 testing, treatment and viral suppression targets within all demographics and groups and geographic settings, including children and adolescents living with HIV, ensuring that, by 2025, at least 34 million people living with HIV have access to medicines, treatment and diagnostics 

(a) Establishing differentiated HIV testing strategies that utilize multiple effective HIV testing technologies and approaches, including point-of-care early infant diagnosis and HIV self-testing, and rapidly initiate people on treatment shortly after diagnosis; 

(b) Using differentiated service delivery models for testing and treatment, including digital, community-led and community-based services that overcome challenges such as those created by the COVID-19 pandemic by delivering treatment and related support services to the people in greatest need where they are; 

(c) Achieving equitable and reliable access to safe, affordable, efficacious high-quality medicines, diagnostics, health commodities and technologies by accelerating their development and market entry, reducing costs, strengthening local development, manufacturing and distribution capacity, including through aligning trade rules and global trade that facilitates public health objectives, as well as encouraging the development of regional markets;

 (d) Making HIV viral load testing and monitoring regularly available to all persons receiving HIV treatment at appropriate time intervals, as recommended by the World Health Organization, including through the use of pointof-care viral load testing to deliver results by the end of their clinical visits;

(e) Ensuring that the needs of older persons living with HIV are met through the provision of available, acceptable, accessible, equitable, affordable and quality health care, and related services, free from stigma and discrimination, that support independence and social interaction, health and well-being, including mental health and well-being

Commit to the Greater Involvement of People Living with HIV/AIDS principle and to empower communities of people living with, at risk of and affected by HIV, including women, adolescents and young people

Expanding investment in societal enablers – including protection of human rights, reduction of stigma and discrimination and law reform, where appropriate – in lowand middle-income countries to 3.1 billion United States dollars by 2025;

Working towards the vision of zero stigma toward and discrimination against people living with, at risk of and affected by HIV, by ensuring that less than 10 per cent experience stigma and discrimination by 2025, including by leveraging the potential of Undetectable = Untransmittable;

Ensuring political leadership at the highest level to eliminate all forms of HIV-related stigma and discrimination, including by promoting greater policy coherence and coordinated action through whole-ofgovernment, whole-of-society and multisectoral response;

Ensuring that all services are designed and delivered without stigma and discrimination, and with full respect for the rights to privacy, confidentiality and informed consent

Mobilizing additional sustainable domestic resources for HIV responses through a wide range of strategies and approaches, including public-private partnerships, debt financing, debt relief, debt restructuring and sound debt management, progressive taxation, tackling corruption and ending illicit financial flows, identifying, freezing and recovering stolen assets and returning them to their countries of origin, and ensuring progressive integration of financing for HIV responses within domestic financing for health, social protection, emergency responses and pandemic responses.