The International AIDS Society (IAS) welcomes the emphasis that the World Health Organization (WHO) places on universal health coverage (UHC), tuberculosis (TB) and vaccines in the agenda for the 72nd World Health Assembly. The IAS commends the prioritisation of efforts to ensure that no one is left behind in reaching the health targets set out in the Sustainable Development Goals.
Across the world, for a variety of cultural, social, political and religious reasons, accessing services is still not simple for many people. UHC has the potential to address this injustice, and reinvigorate the universality and indivisibility of human rights. It can advance the right to health for people living with HIV and key and vulnerable populations, including gay men and other men who have sex with men, sex workers, people who use drugs, transgender people, migrants and people in prisons and other closed settings. In order to realize this potential, UHC efforts must engage communities and address structural barriers impeding access to health and other services.
HIV has demonstrated that effective treatment and prevention, while essential, will not triumph without a robust community response, resource mobilization and political will. Meaningful engagement of people living with and most affected by HIV has critically informed and improved the response. Healthcare workers will be the backbone of effective and inclusive UHC; they shape and influence how and where marginalized and criminalized communities seek services. The aspirations of UHC will not be realized if stigma continues to deter people from accessing health services. Getting to the heart of stigma will be essential to ensure that UHC is really universal, and that personal and structural barriers are overcome to enable access for all people to health and other services.
HIV remains one of the world’s most important health and development challenges. TB is still the leading cause of death among people with HIV, and people living with HIV have an increased risk of drug-resistant TB. People living with HIV are six times more likely to have a co-infection with hepatitis C than people who are HIV-negative. The integration of service delivery for TB, HIV and viral hepatitis exemplifies how a scale-up of people-centred and complimentary approaches could strengthen health outcomes within the framework of UHC for millions more people. UHC would strengthen health systems across the spectrum: from comprehensive prevention, including preparedness for the rollout of effective vaccines for HIV and TB, and a continuum of care that ensures quality experiences by service users and positive health outcomes that do not expose service users to financial hardship.
Appropriate data disaggregation by age, gender identity, sexual orientation, geographical location, HIV status, co-infections and co-morbidities will be critical in tracking progress towards UHC. What counts gets counted, and systematic monitoring of service user experiences, quality of service provision and disaggregated public health surveillance will be essential in ensuring accountability.
The International AIDS Society (IAS):
- Urges Member States to ensure that human rights are central to UHC discussions and commitments
- Encourages WHO to support Member States in monitoring UHC with disaggregated data and robust public health surveillance
- Commits to celebrating frontline healthcare workers who are “doing the right thing” and tackling stigma and discrimination in healthcare settings to ensure that UHC leaves no one behind.
Access the Journal of the International AIDS Society's World Health Assembly 2019 Virtual Issue