We have identified six critical issues and targets that are not reflected in this report and that we would like to see included in the Political Declaration:

1)    HIV Prevention:  The SG report is missing two critical targets from the Global AIDS Strategy in relation to prevention:

• an almost two-fold increase in resources for evidence- based combination prevention, from US$5.3 billion per year in 2019 to US$9.5 billion in 2025 and
   
• 80% of service delivery for HIV prevention programmes for key populations and women to be delivered by community-, key population-, and women-led organizations.

Both targets are key to include in the Political Declaration to ensure accountability on prevention commitments.

2)   HIV testing and treatment: The Global AIDS strategy states that investments must increase by 18%, from US$8.3 billion in 2019 to US$9.8 billion by 2025, but the number of people on treatment will increase by 35%, due to efficiency gains from the price reductions in commodities and costs to deliver the services.

This financial commitment and specification is missing from the SG report and needs to be included in the Political Declaration. Reaching such a target will contribute to additional reductions in new HIV infections, and, in turn, to reductions in resource needs for testing and treatment in the second half of this decade.  

Though the document speaks about need for price reduction and does mention TRIPS flexibilities, we would like to see patent barriers explicitly mentioned as an important obstacle for treatment access. Interventions such as patent oppositions and compulsory licensing need to be spelled out as response to these barriers.  

3)   Societal Enablers: We welcome the inclusion in the SG report of the recommendation to expand investment in societal enablers in low- and middle-income countries to US$ 3.1 billion by 2025. We would like to see this target included into the Political Declaration while specifying that these investments focus on establishing an enabling legislative and policy environment and that societal enablers will need to be co-financed by the HIV response and non-health sectors. Another critical omission in the SG report is the target from the Global AIDS Strategy of “60% of the programmes supporting the achievement of societal enablers to be delivered by community-led organizations”, which we would like to see included as well.
 

4)   Paediatrics: the language included in the SG report is comprehensive and strong, however we believe there is a need for the Political Declaration to specifically stress the importance of community and civil society-based and led interventions in the area of paediatrics, such as demand creation treatment literacy, peer-to-peer programmes, mentoring etc.
 

5)   Intersectional approach: The SG report does not address intersectionality in relation to inequalities and HIV vulnerabilities. An intersectional approach to HIV vulnerability recognises that the most marginalised people have multiple intersecting identities and compounded vulnerabilities. The intersection of these identities within complex social systems exacerbates their experiences of stigma, discrimination and human rights violations.

Therefore, the intersectional approach should be included in the Political Declaration as key to ending inequalities as this requires addressing a broader web of compounded vulnerabilities and their effects on access and enjoyment to a full range of rights and services.
 

6)   Self-care: A missed opportunity in the SG report is not mentioning the importance of scaling up self-care as a crucial means to end AIDS and achieve universal health coverage for all through a people-centered approach to supporting and empowering vulnerable and marginalized people in safe and enabling environments. Solutions such as condoms, HIV self-testing, pre-exposure prophylaxis (PrEP), self-sampling for sexually transmitted diseases and digital health solutions offer new options for people who are most affected by HIV and who tend to avoid clinic-based HIV services for fear of stigma or other obstacles to accessing the clinic, for example due to COVID-19 related restrictions.

These self-care interventions provide ways to access healthcare from the privacy of people’s own home, using their phones or through convenient delivery and distribution sources. 

The Political Declaration should refer to the 2019 WHO Consolidated Guideline on Self-Care Interventions for Health and recommend countries to advance self-care at the global, regional national and local levels as a critical contribution to ending AIDS.