How Inequalities Slow Progress Against HIV/AIDS

How Inequalities Slow Progress Against HIV/AIDS

Inequalities are behind the lack of progress in the response to HIV, argues the Joint United Nations Program on HIV/AIDS (UNAIDS) in its most recent Global AIDS Update, released on July 14.

Among the main barriers that the agency has identified, based on the 4 decades of the global response to HIV / AIDS, are the lack of education, poverty, and the criminalization of some population groups.


The lack of HIV testing and treatment is more notable among people who live marginalized and those who do not have access to health services.

Additionally, there are inequalities related to age, gender, race, and income level, which are reflected in large differences in access to services and in people’s health status.

Poverty also often drives migration, which has been shown to complicate access to HIV services. Laws in many countries limit access to health services for undocumented migrants, and fear of deportation prevents people from accessing those services.

Some Groups Face More Obstacles

In different regions of the world, there are various groups that are at particular risk of HIV infection. For example, according to a study by Georgetown University, in the United States, those countries where sexual relations between people of the same sex, sex work, and drug use are criminalized, the detection rates of HIV and the suppression of the virus (thanks to the treatment) are much lower than in countries where these practices are not criminalized.

Furthermore, the more anti-discrimination laws, the more respect for human rights, and the more response to gender-based violence there is in a country, the better the HIV-related health outcomes.

Thus, the populations most vulnerable to HIV are:

  • Gay men and other men who have sex with men (MSM): 25 times more risk of contracting HIV than heterosexual men
  • Female sex workers: 26 times more at risk than women in the general population.
  • Transgender women: 34 times more at risk than other adults.
  • People who inject drugs: 35 times more at risk than people who do not inject drugs.

Even with this data, programs that serve these populations are scarce in most countries. Harm reduction services for people who inject drugs are almost non-existent on a large scale in any of the regions. Coverage of programs for gay men and other MSM remains low, even in high-income countries. And prevention programs for transgender people are scarce in the vast majority of countries.