ABSTRACT
The global HIV epidemic has been a catalyst for ground-breaking biomedical development and has significantly influenced how sexual and reproductive healthcare is delivered globally. Recent public health strategies such as HIV treatment as prevention and pre-exposure prophylaxis, have substantially reduced viral transmission, and improved the quality of life for many people living with HIV. While each new drug generates renewed optimism that the end of AIDS is within reach, success is limited by global and local inequalities, leading to huge disparities in HIV incidence and fatality within and between contexts. Increasingly, empirical data demonstrate that entrenched systemic inequalities are reinforced and often exacerbated by inequitable access to life-changing HIV treatment and prevention strategies. Most often, the oversimplification and lack of political will to adapt biomedical technologies to meet the demands of the social, economic and political contexts within which they are implemented limits their effectiveness and ability to reach vulnerable and marginalised populations. The focus of future HIV prevention must be to tackle the inequalities that render some populations especially vulnerable to HIV acquisition and poor HIV-related health outcomes, and deliver locally adapted interventions in ways that enable these groups to use them.
