Decolonizing Global Health in 2024 and Beyond

February 22, 2024

In the year ahead, staking out a course that will advance the HIV response and global health equity faces serious headwinds.

Several African countries are seeing historic attacks on civil rights aimed at persecuting the LGBTQIA+ community, and most notably, Uganda is embroiled in crises with the enactment of Anti-Homosexuality Act. PEPFAR Re-authorization has been stalled by utter dysfunction in the US House of Representatives, the same body that has proposed massive cuts in domestic HIV fundingNegotiations on the WHO’s Pandemic Accord have so far failed to prioritize meaningful commitments to equity—jeopardizing global preparedness against future health threats. And at least 43 countries are holding elections in 2024, with several countries, including the US, facing serious threats from authoritarian candidates.  

But in HIV prevention, there’s also momentum. The scale-up of PrEP began accelerating in 2021 and has kept apace, with more than 6.2 million people initiated oral PrEP, and another approximately 4000 people have initiated either injectable cabotegravir or the dapivirine vaginal ring. If planning, policies and programs get it right and offer choices in programs that are co-designed by communities that need prevention most, modeling indicates the world could reach UN targets of 10 million PrEP users by 2025. But what does it take to ensure choice, what priorities will ensure policies, programs will serve the communities burdened by HIV? 

Decolonizing global health can and must be a guide star for these efforts. In 2024, it’s time to double down. Decolonizing global health is not a dream. It’s not an “extra” to reach for only when it’s easy. It’s not wishful thinking. Decolonizing global health is a cornerstone in reaching global targets, making prevention a reality, ending the epidemic, and preparing for the next one. 

It demands changes across the field, from research to rollout. AVAC is tracking this progress, developing strategic resources, and supporting the advocates who know that global health will advance or decline depending on progress in key areas:

Empowering Community Leaders & Following Community Priorities

Models of leadership that center communities necessarily involve money but must go beyond the size of the check and whose name is on it. New structures are needed, based on collaboration, transparency, and trust. The COMPASS coalition is pioneering a model to do just that. Read more about this exciting work here.

Pursuing a People’s Research Agenda

A community driven agenda is needed to define research questions and recommendations for HIV prevention research, rollout and investments. With an active HIV pipeline in research and development that is increasingly weighted toward early-phase science, a need for unstinting support for vaccine research, and momentum in cure research, it’s critical for informed and intensive community advocacy to shape the research enterprise. See the pipeline here. 

Program for Choice 

The promise of new options in HIV prevention must not be squandered in siloed programs, or by poorly planned supply chains, or because of disconnected policy decisions. People have diverse needs and face complex challenges; ending HIV depends on finding the option that works best for each individual. Read more about the choice initiatives and the Choice Manifesto and the Global HIV Prevention Roadmap for Key Populations.

Create a New Global Architecture Founded in Equity for Pandemic Readiness

When the next pandemic hits, allocating tools to the most vulnerable is the most effective and efficient way to fight it. County commitments, engagement with civil society, funding levels, and how well planning incorporates equity as a principle has yet to be secured in the Pandemic Accord or other agreements related pandemic planning. Advocates have a role to play in demanding engagement and ensuring equity. Find resources to keep you up to date on the issue here. 

Embrace the Role of Prevention in Global Targets

To end AIDS as a public health threat by 2030, prevention efforts must make dramatic strides to reach fewer than 370,000 new infections by 2025. As the UNAIDS HIV Prevention Roadmap documents, the most successful HIV responses have come from countries who “have directed resources towards high-impact combination HIV prevention programs and supported and worked with community-led responses that reach the populations and places most in need”. UNAIDS targets will continue to falter at the global level if the field fails to learn the lessons of countries such as El Salvador, Kenya or Thailand where incidence saw steep reductions by centering prevention programs around the needs of key populations.   

In the months to come, AVAC will be following progress toward these goals and reaching out to you to discuss, debate, collaborate and unite.