HIV Specialist - June 2021 - 14

2020 GLOBAL HIV PLOICY REPORT
Our 2020 Global HIV Policy
Report shows that policy barriers exist
throughout the world that undermine the
quality of HIV treatment and prevention,
undermine access to HIV treatment and
prevention, and increase the vulnerability
to HIV infection and AIDS death. Key
fi ndings from the report shows that:
■ No country in the world has fully
aligned its laws and policies with the
best HIV science and core international
recommendations. In fact, across all 194
UN member states, the median country
has aligned just over half of policies
tracked with international standards.
■ On the whole, the regions and countries
making the most progress have
adopted many or most of the laws and
policies recommended by evidence and
international normative bodies. Every
country, however, has laws and policies
that would need to be updated to align with
international recommendations.
■ Many of those countries and regions that
are furthest off track-those facing growing
epidemics and rising death rates-have
the fewest policies that align with current
evidence.
■ Many countries have not yet fully adopted
upto-date policies on some of the most critical
new interventions, including diff erentiated
service delivery and PrEP.
■ Every country in the world has at least
one law criminalizing same-sex sexual
relations, sex work, drug use, or HIV
exposure/transmission, often all four,
despite evidence that criminalization is
counterproductive.
■ Countries are inconsistent in adopting
recommended policies-the majority of
countries do well in some policy categories
REFERENCES:
1. Hicks, Lucy. Injection of long-acting drug prevents HIV in
women. Science, Nov 9, 2020. https://www.sciencemag.
org/news/2020/11/injection-long-acting-drug-preventshiv-women;
Mugo NR, Ngure K, Kiragu M, et al. Prep for
Africa: what we have learnt and what is needed to move to
program implementation. Curr Opin HIV AIDS
2016;11:80-6; Beyrer C, Birx DL, Bekker L-G, et al.
2. El-Sadr WM, Harripersaud K, Rabkin M. Reaching global
HIV/ AIDS goals: What got us here, won't get us there.
PLoS Med 2017;14:e1002421; Grimsrud A, Bygrave H,
Doherty M, et al. Reimagining HIV service delivery: the role
of diff erentiated care from prevention to suppression. J Int
AIDS Soc 2016;19:21484; Makofane K, Beck J, Lubensky M,
et al. Homophobic legislation and its impact on human
security. African Security Review 2014;23:186-95; Njau B,
Covin C, Lisasi E, et al. A systematic review of qualitative
evidence on factors enabling and deterring uptake of HIV
self-testing in Africa. BMC Public Health 2019;19:1289.
3. UNAIDS, " Evidence ReviewImplementation of the
2016-2021 UNAIDS Strategy: On the Fact-Track to End
AIDS, " July 31, 2020.
4. Abimbola S. Health system governance: a triangle of rules.
BMJ Glob Health 2020;5:e003598; Kavanagh MM. The
right to health: institutional eff ects of constitutional
provisions on health outcomes. Stud Comp Int Dev
2016;51:328-64; Kranzer K, Meghji J, Bandason T, et al.
arriers to provider-initiated testing and counselling for
children in a high HIV prevalence setting: a mixed methods
study. PLoS Med 2014;11:e1001649; Reeves A, Steele S,
Stuckler D, et al. National sex work policy and HIV
prevalence among sex workers: an ecological regression
analysis of 27 European countries. Lancet HIV
2017;4:e134-40.
5. Abimbola S. Health system governance: a triangle of rules.
BMJ Glob Health 2020;5:e003598
2020 Global HIV
Policy Report:
Policy Barriers to HIV Progress
aff ect health out comes in general, and HIV
outcomes in particular, has been demonstrated
by scholars analyzing the " legal
determinants of health " -for example,
showing that eliminating parental consent
policies is linked to increased rates of HIV
testing, countries with a constitutional
right to health have better health outcomes,
and that countries not criminalizing
sex work have signifi cantly lower HIV
prevalence among sex workers.4
Today there are multiple mechanisms
but worse in others.
■ The regions with the highest rates of policy
adoption are Eastern and Southern Africa
and Western and Central Europe and North
America. The country with the highest rate
of policy adoption is South Africa.
■ In general, policy recommendations related
to HIV clinical care and treatment are
adopted at a much higher rate than policies
related to testing and prevention, structural
barriers, or health systems factors. Even
so, quite a few countries still lag behind in
adopting key clinical/treatment policies,
including updating HIV treatment guidelines
to include the latest fi rst-line ART
regimens.
Policy is the indispensable mechanism
by which governments bring eff ective,
evidence-based interventions to scale to
benefi t all. That laws and policies do in fact
in place to disseminate science-based
policy recommendations and support their
adoption by national governments via
technical guidance and fund implementation
through UNAIDS, the World Health
Organization (WHO), the Global Fund to
Fight AIDS, Tuberculosis, and Malaria,
the US President's Emergency Plan for
AIDS Relief (PEPFAR), etc.5
It would be tempting to think that, several
decades into a truly global AIDS response,
most countries have aligned their laws and
policies with current science and evidence,
and that the quality of implementation is
what explains diff erences between countries.
Data from the HIV Policy Lab shows this is
not the case-that policy- and law-reform remain
an essential task of the global AIDS response.
Data also shows that countries have
much to learn from each other. 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. 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. HIV
14 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
https://www.sciencemag.org/news/2020/11/injection-long-acting-drug-prevents-hiv-women https://www.sciencemag.org/news/2020/11/injection-long-acting-drug-prevents-hiv-women https://www.sciencemag.org/news/2020/11/injection-long-acting-drug-prevents-hiv-women http://WWW.AAHIVM.ORG

HIV Specialist - June 2021

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