State of inequality: HIV, tuberculosis and malaria

State of inequality: HIV, tuberculosis and malaria
Published 2021 :: 260 pages
PDF: English
…Although great strides have been made to expand health services and prevention efforts across the three diseases, progress to date has not been fast enough. The COVID-19 pandemic has disrupted essential health services in many countries, jeopardizing the gains we have made.


HIV, TB and malaria continue to take a disproportionally large toll on the poorest, least educated and most rural parts of society. Certain communities – including sexual and gender minorities, sex workers, people in prisons, people who inject drugs, migrants, refugees, displaced people and indigenous people – face stigma and discrimination, resulting in lower service access and higher disease risk. COVID-19 has further exposed these fault lines.

The World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria are part of a group of agencies working together to accelerate progress towards the health-related SDGs through the Global Action Plan for Healthy Lives and Well-being for All. Understanding patterns of inequalities in these diseases is essential for taking strategic, evidence-informed action to realize our shared vision of ending the epidemics of HIV, TB and malaria.


This report presents the first comprehensive analysis of the magnitude and patterns of socioeconomic, demographic and geographic inequalities in disease burden and access to services for prevention and treatment….

The COVID-19 pandemic has had far-reaching and devastating impacts on health and health systems worldwide. Against the backdrop of the COVID-19 pandemic, the quality and availability of essential care for all conditions, including HIV, TB and malaria, have been compromised. Testing, treatment and prevention programmes have suffered widespread interruptions, and many people have faced changes in routine services and heightened stigma, discrimination and fear. Tackling inequities in HIV, TB and malaria is key to accelerating progress and closing the persistent gaps in access to care and health outcomes across population subgroups.

Identifying and characterizing inequalities through health inequality monitoring lends important insights to inform differentiation in service provision, so that resources are aligned to achieve maximal impact. An understanding of patterns of inequalities can help to promote equity by increasing the availability of essential health services and interventions among groups at higher risk of infection or mortality.

Recognizing instances where countries have reduced inequities to improve access to key services among groups experiencing higher burden of disease provides an important opportunity to dig deeper into understanding how and why actions were successful. The results of health inequality monitoring, alongside consideration of relevant in-depth quantitative and qualitative studies, can be used to inform equity-oriented policies, programmes and practices, which are central to address the underlying conditions that put groups at higher risk for HIV, TB and malaria.

The impact of monitoring activities, however, lies in their application. Developing technical capacity for health inequality monitoring is important to ensure the process is rigorous and impactful and generates change. Capacity-building activities may encompass identifying and implementing changes to data sources to strengthen the data available for inequality monitoring. To ensure the representation of all groups, data collection efforts should take into account subnational and civil society programmes that work with disadvantaged groups. Other activities include conducting training and skills-building sessions for data analysis and for conducting quantitative and qualitative studies; and strengthening reporting approaches to effectively reach diverse target audiences.

Importantly, there is a need to support activities and practices that translate the findings of inequality analyses to inform the development of policies and programmes and to empower the wider use of data. WHO has developed a number of tools and resources to support health inequality monitoring (see https://www.

Media Release
WHO and Global Fund Warn Inequalities Block Progress Towards Ending AIDS, TB and Malaria
09 December 2021
GENEVA – Inequities have been widely acknowledged as barriers to achieving global and national goals and targets in HIV, TB and malaria programs. However, the magnitude and extent of underlying health inequalities have remained poorly documented and understood.
Until those inequalities are better identified, and their consequences better understood, it will be hard for programs to meet people’s real health needs. Now, for the first time, a new report from the World Health Organization and the Global Fund to Fight AIDS, Tuberculosis and Malaria systematically assesses the global an important step forward in understanding how inequalities are hindering the fight against the three diseases. Using the latest available global data for 32 health indicators in up to 186 countries, it shows that while national averages of HIV, TB and malaria indicators have generally improved in the past decade, the poorest, least educated and rural subgroups tend to remain at a disadvantage across most HIV, TB and malaria indicators…