SHOBHA SHUKLA – CNS
Despite having science-based
tools for HIV combination prevention, there were 1.3 million
people who A collage of people with text
AI-generated
content may be incorrect.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.
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“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.”
Shobha
Shukla – CNS (Citizen News Service)
(Shobha
Shukla is a feminist, health and development justice
advocate, and an award-winning founding Managing Editor and
Executive Director of CNS (Citizen News Service). She was
also the Lead Discussant for SDG-3 at United Nations High
Level Political Forum (HLPF 2025). She is a former senior
Physics faculty of prestigious Loreto Convent College;
current President of Asia Pacific Regional Media Alliance
for Health and Development (APCAT Media); Chairperson of
Global AMR Media Alliance (GAMA received AMR One Health
Emerging Leaders and Outstanding Talents Award 2024); and
coordinator of SHE & Rights (Sexual Health with Equity
& Rights). Follow her on Twitter/X @shobha1shukla or
read her writings here
www.bit.ly/ShobhaShukla)
