To make progress on HIV/AIDS, we must make universal health coverage a reality

“Access to HIV prevention, treatment and care services will remain inadequate as long as universal health coverage is not achieved. The global HIV response and UHC are interlinked. The success of both depends on strong systems for health that deliver quality, people-centred care,” says Dr Khuat Thi Hai Oanh, Executive Director of the Center for Support Community Development Initiatives (SCDI) in Viet Nam.

Dr Khuat, a member of the Advisory Group of the Civil Society Engagement Mechanism for UHC2030 (CSEM), was speaking at a multistakeholder hearing held in preparation for the UN High-Level Meeting on HIV/AIDS which will take place from 8 to 10 June 2021. The complete statement from CSEM calls for ambitious commitments for health equity from global leaders at the High-Level Meeting.

Also speaking at the multistakeholder hearing was Dr Githinji Gitahi, CEO of Amref Health Africa and former Co-Chair of UHC2030, who added, “Integration of HIV testing, treatment and care into universal health coverage is not only a people-centred approach to UHC but also the guarantee of continuity of services for all, leaving no one behind.”

UHC is the principle that everyone, everywhere should have access to quality health care – a principle that world leaders committed to making a reality in  the 2019 UN political declaration on UHC. Currently, at least half the world’s population does not have access to essential health services and nearly 100 million people are driven into poverty each year by catastrophic health expenses.

One of the topics raised during the hearing was the need to fully resource and sustain efficient HIV responses. Forty years after the first case, the HIV epidemic continues to affect every region of the world. Progress in the fight against the disease has slowed in recent years, at least partially the result of the decrease in international donor funding. Integrating HIV prevention, treatment and care services into a strong national health system based on a primary health care approach is essential to ensure that everyone has access to the services they need and that the world continue to make progress against the AIDS epidemic.

Panelists also highlighted the critical role that communities play in service delivery, emphasizing that communities should be directly involved in the design of services. They also spoke to the role that communities play in advocacy and in holding health systems accountable – a role which became even more evident during the Covid-19 pandemic. As Ambassador Mitchell Fifield of Australia noted in his concluding remarks at the event, “Strengthening HIV-sensitive universal health coverage that is equitable, holistic and integrated is key. The [Covid-19 pandemic] has also spurred innovative approaches in health and social protection that can serve the HIV response well.”

Civil society stakeholders, including members of the CSEM, have been working to input these messages, especially those on the importance of people-centered health systems, into the draft declaration through country, regional and global networking. There will be continued advocacy from civil society across the sector – including affected communities, HIV service delivery organizations, primary health care-focused organizations, UHC advocates and others – for comprehensive commitments to strong health systems in the lead-up to the UN High-Level Meeting.

A summary of the event will be shared with Member States who will be negotiating the Political Declaration on HIV and AIDS, a set of commitments that serve as an outcome document of the UN High-Level Meeting in June. The 'zero draft' of the declaration acknowledges that primary health care is the cornerstone of UHC. The draft declaration goes on to note that strong health systems based on a primary health care approach deliver quality services to all, including vulnerable or marginalized populations. By investing in strengthening their health systems, countries will be better placed to reach all who need services and attain their public health goals, including the goals to reduce HIV infections and AIDS-related deaths by 2030.

The draft political declaration will be finalized ahead of the High-Level Meeting. Civil society will continue to call for commitments to accelerating the integration of HIV services into UHC through, among other things, supporting strong primary health care systems, building on the resilience and innovation demonstrated by communities during the Covid-19 pandemic, and investing in robust, resilient, and publicly funded systems for health and social protection.