Urbanization is changing the way we live and work and how we approach problems and think about the future. Already the majority of the world’s population lives in urban areas, and by 2050 it is projected that seven in 10 people will live in cities and municipalities.
There are important reasons why people are choosing to live in urban areas. Cities are sources of economic growth and prosperity, serve as centres of innovation and offer extraordinary educational, cultural and recreational opportunities. Urban areas often have greater success in tackling difficult challenges, due to cities’ comparatively greater concentration of services, creativity and productive capacity.
Yet urbanization is also closely linked to another, more concerning trend that characterizes life in the early 21 st century. As urban areas grow and evolve, they also reflect profound social and economic inequalities. Although millions of city dwellers have been lifted out of poverty over the last 15 years, the number of people living in urban slums and disadvantaged areas continues to increase each year.
Informal settlements, slums and disadvantaged areas contain high levels of inequality that affect people’s health and well-being and diminish their security and future prospects. People who are economically and socially marginalized are substantially less likely to have meaningful access to critical health and social services including HIV prevention, testing, treatment and support.
Cities gave rise to the first cases of HIV infection ever recognized, and the role of urban areas in the global AIDS response has only intensified over time. Globally, 200 cities account for roughly 25% of all people living with HIV. In many countries, a single city accounts for 40% or more of all
people living with HIV.
As the world embarks on a historic quest to end the AIDS epidemic as a public health threat by 2030, it is plain that this fight will largely be won or lost in urban areas. Cities have unique strengths in the response to HIV, offering opportunities for innovative and visionary partnerships, more inclusive and participatory responses, and effective action to address the social, economic and legal determinants of HIV risk and vulnerability. Only by harnessing the unique advantages of urban life – and by effectively addressing the challenges that urbanization presents – will it be possible to end the epidemic.
As urban areas work to scale up the services that reduce HIV-related illness and death and prevent new HIV infections, they will need to develop innovative service models that take account of the evolving nature of HIV.