Why ending AIDS means ending inequality

New research shows that inequality is making the world more vulnerable to pandemics, including AIDS.  

What is the “inequality-pandemic cycle” and why does it matter for the HIV response?  

Research from the Global Council on Inequality, AIDS and Pandemics shows that inequality and pandemics feed into each other. Inequality in and between countries makes pandemics like AIDS more severe, more harmful, and harder to end. In turn, these things deepen inequality. This is called the “inequality-pandemic cycle”.  

This effect is multiplied when there are multiple pandemics. For instance, during COVID-19, 40% of adolescents with HIV in Kenya were going without food. One third of them were unable to earn money. These adolescents were already disadvantaged. The situation made it even harder for them to take antiretroviral treatment (ART). Hence, putting their health at risk and making them more likely to pass on HIV. So COVID-19 worsened inequalities, and those inequalities helped drive HIV.  

How different inequalities makes the AIDS pandemic worse   

Income inequality   

One of the biggest injustices is wealth inequality between countries. The report states that COVID-19 pandemic pushed 165 million people into poverty. This was all while the world’s richest people increased their wealth by more than a quarter. When national economies are under pressure, people who are already discriminated against due to things like their gender or sexuality will be pushed to the back of the line. This is happening in Nigeria, for instance, where recent USAID funding cuts and rising inflation are pricing LBQ+ women out of healthcare.  

Unequal access to medicines and vaccines  

New medicines like long-acting PrEP are reaching high-income countries first. Many other countries are still struggling to access them. In October, we reported that twice-yearly injectable PrEP (Lenacapavir) will be available for 2 million people in low- and lower-middle-income countries. This is an important step toward fairer access. However, the current cost is still too high. Countries like Zimbabwe cannot offer Lenacapavir to everyone who needs it. This means some groups will miss out. 

Gender inequality  

The link between gender inequality and HIV is visible in many ways. Some women cannot get sexual and reproductive healthcare unless a male partner or relative agrees. Others avoid care because they fear stigma. Research from Zimbabwe shows the same pattern with PrEP. Gender-based discrimination and violence may stop some pregnant women from getting Lenacapavir, even when they are prioritised. 

Why different inequalities must be addressed together to end AIDS  

 Some people face a higher risk of HIV because of inequality. The same inequalities also affect people who are already living with HIV. They can lead to poorer health and worse life outcomes for these groups. 

This means fixing the factors that shape people’s lives. These include access to healthcare, including SRH. They also include unfair cultural norms and harmful laws. Additionally, it includes unequal access to education and work. 

How you can help push the inequality debate up the agenda  

Monica Geingos, Former First Lady of Namibia and Global Council member, says: “Inequality is not inevitable. It is a political choice, and a dangerous one that threatens everyone’s health. Anyone concerned with pandemics and their impact must be concerned with inequality.”  

 Ending AIDS won’t happen until we address the social, cultural, and economic factors that keep people unequal. You can help by reminding others that tackling these inequalities matters just as much as expanding access to ART and PrEP. 

Advocate for policies that make life fairer for people who face discrimination or lack resources. Support community actions that do the same. Collect evidence that shows how inequality is driving HIV infections. Monitor any promises made to address these root causes.