Is it possible to end new cases of HIV by 2030?
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we really end new cases of HIV globally by 2030? It's a goal that's been set by the United Nations, but with millions still affected by the disease and progress being threatened by cuts to USAID funding, how close are we to making it a reality? That's what we're going to be talking about today on What in the World from the BBC World Service. I'm Hannah Gelbart.

Joining us from Lagos, Nigeria to talk about this is BBC reporter Makochi Okafor. Hi, welcome back to the podcast. Hi, Hannah. Can you start by just outlining what the symptoms are of HIV?

Okay, so HIV is a sexually transmitted disease. It attacks a person's immune system. Once it attacks the immune system, the body is weak and can no longer protect itself. So other diseases, you get infected easily from things like malaria, tuberculosis, and other infection, any infection that is sort of in your locality, in your area. What are some of the main things that people believe about HIV and AIDS that actually just aren't true?

There are many wrong information people have out there. For example, that HIV can easily be contacted through physical contact like handshake or hugs. These are wrong. And this sort of makes

You know, when people have HIV or do know a family member that have it, they don't quickly seek care because they're trying to keep it hush-hush. And also there's this assumption that when you have HIV that means you're promiscuous, you're keeping multiple sex partners. There is also this wrong assumption that HIV is a punishment from God, you know, because people feel like you're not moral enough and that's why you're being punished. These are sort of the few very popular and prevalent misinformation around HIV and AIDS. And HIV is in a death sentence.

Thankfully, we have lots of tools to help people survive. So sometimes people think that once you get HIV, oh, this means you're going to die. But this isn't accurate because we've seen lots of people live over decades with available tools and treatments around HIV. As you say, there is treatment for HIV so that it can now no longer even be detectable in people's blood, right? Yes, you're very accurate. So there are drugs called antiretroviral drugs, which people living with HIV can take.

Now, this sees that when you're taking this drug, you do not pass on the virus to, for example, a partner. There are drugs that prevent mothers from passing on HIV to their unborn kids. There are also drugs like PrEP, which sort of protects people who feel like they might be getting in contact with them.

And then there are things like contraceptives that to an extent can also protect you from things like condoms, protect you from getting HIV or AIDS. So there are lots of tools now. So it's not as scary, quote unquote, as it was many years ago. Where are cases of HIV highest in the world right now?

Globally, the African region is the region with the highest HIV prevalence, particularly South Africa, with about 8 million people living with HIV in the country. Globally, compared to where we were 10, 20 years ago, the cases are reducing. Countries like Africa,

Botswana and Malawi in Africa have seen a considerable reduction. But also the European continent has seen slight increase recently. But in Africa, the Tigray region in Ethiopia has seen increase in cases of HIV and this has been because there's been prolonged conflict there and there's also cases of sexual violence being used in this conflict that has impacted lots of people living there.

What about PrEP? How is that contributing to changing rates? You said that they've gone down quite a lot in the last 10, 20 years. Yeah.

Yeah, PrEP is a medication people take, especially at-risk communities take, to see that they don't transmit HIV to people or even those who feel like they might get HIV need to take just to protect themselves. This has been such a strong tool in preventing and protecting people from getting HIV. And what people have done, or what some countries have done, is include PrEP in their primary health care services.

And lots of countries, it's either subsidized or it's free. So it also kind of increases and improves access to getting it. Discrimination and stigma is a huge problem for lots of people. I'll give you an instance. I know and I've heard people say that once they see someone taking PrEP, they assume the person is HIV positive. And this is not accurate. And there's so much stigma tied to HIV. So that means even those who do have HIV or who should be taking PrEP are discriminated

courage from taking it because they feel like, oh, people are going to see me taking it or people are going to see me walking into the hospital to pick PrEP and they wouldn't take it. And then there is also this issue where people think that if you're taking PrEP, you are associated with the LGBTQ community. And this is very wrong because PrEP is for everyone who should be taking it as prescribed. Now we're going to hear from someone who is taking PrEP. That stands for pre-exposure prophylaxis.

Hi, my name is Ben. I started taking PrEP in 2020 and I stopped in 2021. I started again this year but now only take it around the time I plan to have a social activity both before and after the act. It's just an extra precaution to ensure I stay safe.

Accessing PrEP isn't a problem for me, since it's free at most public health centres in the country. And one of the issues, of course, is going to be funding. At the start of the year, the US President Donald Trump said that he is dismantling USAID, which is the US foreign aid. What effect is that having on HIV treatment on the continent? It's definitely impacting HIV treatment and even prevention on the continent.

For example, the WHO was saying that countries like Nigeria or Kenya could run out of medication. And that's because most countries have relied on aid in having these drugs available for their citizens.

There's an NGO in Nigeria that used to offer free PrEP for citizens and for people. Sometime in the wake of this cut, they put out an announcement to say they won't be doing that anymore because they no more have access to bringing in these drugs. And this means that people now have to either rely on getting it over the counter and paying out of pocket. For many people, this would be too high. I do know that the drugs, for example, in Nigeria go as high as 70,000 naira, and that is a lot for many people.

to afford in a country like Nigeria. There's data from South Africa saying that there's been reduced testing in lots of communities and this has been because both the testing and the treatment have mostly relied on aid from the US, for example. It's true that some part of PEPFAR was resumed, but it's not all and that means that the space and the gap that has been left needs to be filled and while that is happening, people's lives are being impacted.

You mentioned PEPFAR. That is the US's HIV program. It stands for the US President's Emergency Plan for AIDS Relief. So there's PEPFAR, there's USAID. And it's all a bit confusing because they were frozen, then unfrozen for a bit. So now we are going to go to the US to explain a bit more.

Hi, my name is Atalia Jimenez and I'm a BBC journalist in New York. So earlier this year, President Trump put a pause on all funding for USAID. That's the US Agency for International Development.

And their main job is to send money abroad for things like health programs, especially in low-income countries, and especially for things like HIV. So when this 90-day funding freeze took effect, a lot of these programs took a hit because they could no longer rely on U.S. support.

And one of these programs is PEPFAR, and it's credited with saving 26 million lives, with allowing 7.8 million babies around the world to be born without HIV. So Congress went ahead and stepped in. They issued a waiver that allowed them to access funding immediately.

But even by then, it was already too late and a lot of these systems were dismantled. That means that clinics were closed and doctors were relieved of their duties and a lot of people stopped taking their medication because they just didn't have access to it anymore.

So with all of these funding cuts, are any countries on the continent stepping in to try and fill that gap? Well, the truth is the cut was a bit unprecedented and I'm sure many countries didn't make provision for it in their budgets. But what has happened is at the wake of this cut, countries like Nigeria, Malawi and Uganda have sort of made quick

quick adjustments in their budget or made provisions to help see that people living with HIV are cared for and protected and even those you know communities who might be at risk are also given the care that they need. It'll be interesting to see how this rolls out and if it can fill up the gap already existing after this cut. At the start of the episode I mentioned the UN's goal which is to completely get rid of all new cases of HIV by 2030. Are there any countries that are on track to do that?

Well, countries like Uganda had achieved over 97% coverage for their target in reaching both preventions and testing for HIV. Even South Africa had also done quite well in over 90% or about 90% in their targets towards reaching this coverage in terms of both treatment and prevention. So yes, many countries or some countries have been on track, but with this sudden cut, it's a bit worrisome.

worrisome how this will be and what could play out because lots of experts have raised their concerns about how the impact this cut would have in the progress being made. Apart from the international funding they were getting, what kind of strategies were they using to get, you know, you mentioned 97, 90% elimination rates?

Okay, so first of all, what some countries did was to integrate their HIV treatment and prevention and testing programs to the primary health care. So that means it was easy to walk into any primary health care and get the care you need and even get your medication or get tested. And not only were these available, for most countries it became subsidized or completely free. So you didn't have to think of paying out of pocket to access these programs. What other countries also did was to move their programs

their treatment or their programs to communities so you don't have to think of going to the hospitals. That also provided an avenue to ensure that there were public health awareness in those communities, teaching people about prevention, teaching people about what treatments are available, teaching people about what misinformation is accurate and what is inaccurate. So these are sort of the programs or strategies that some countries did implement.

So what do you think it would take for us to reach that target globally to get rid of all new cases of HIV by 2030? It's tricky to say, but some of the experts I've spoken to have told me that things like increased funding would totally help, increased funding in HIV and AIDS programmes, but also even funding research around finding new ways to either combat HIV or reduce HIV. But also there is also a need to make more efforts around stopping or eliminating

reducing stigma and misinformation around HIV and AIDS. These are sort of the things that can help us get there by 2030. Makoachi, thank you. Thank you so much, Hannah. And thank you for joining us. This is What's in the World from the BBC World Service. I'm Hannah Gelbart and we'll see you next time. Bye.