‘We Can Do Better' For Pedestrian And Cyclist Safety Worldwide
10 May 2025
These are the exact sort of urban initiatives which the UN Global Road Safety Week – kicking off on Monday – aims to celebrate and promote.
First established in 2007, this year's week is dedicated to the theme 'Make walking and cycling safe.'
' Walking and cycling should be the most ordinary, and therefore, the safest mode of transport,' said Dr. Etienne Krug, who chairs the group known as the UN Road Safety Collaboration and directs the World Health Organization's efforts to tackle social and economic conditions which impact human health.
Stats tell a story
In September 2020, the UN General Assembly passed a resolution which established the Decade of Action for Road Safety 2021-2030 and set a goal to reduce road traffic deaths by at least 50 percent by the end of the decade.
While progress has been made, WHO says that more action is needed across all policy sectors.
Each year, 1.2 million people are killed in road traffic incidents, with pedestrians and cyclists accounting for over one-quarter of these deaths. These deaths are not distributed equally around the world. Rather, 90 per cent of road traffic deaths occur in low- and middle-income countries.
Moreover, the UN estimates that at least 90 per cent of the world's roads do not meet pedestrian safety standards and only 0.2 per cent of roads have dedicated cycle lanes, leaving pedestrians and bikers dangerously exposed.
A holistic approach
Improving pedestrian and cyclist safety has far-reaching benefits for communities, in terms of health, economic and environmental outcomes.
'Walking and cycling improve health and make cities more sustainable. Every step and every ride [helps] to cut congestion, air pollution and disease,' said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
Take, for example, Fortaleza in Brazil - the five-fold expansion of their cycling network led to a 109 per cent increase in pedestrian activity and made children twice as likely to play outside in the areas that were redesigned.
In Norway, the Fyllingsdalstunnelen tunnel which is decorated with murals and protected by security cameras works to reduce carbon emissions and encourage walking and cycling.
To support the continuation of improvements like these during UN Road Safety Week, WHO has provided policy-makers with a toolkit outlining tangible initiatives which include integrating walking and cycling initiatives into other policy sectors and building more extensive infrastructure for pedestrians and cyclists.
'We need [to] and we can do better,' Dr Krug said.
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For example, Dr Gilada shared that risk of impaired glucose and insulin metabolism is double among those with HIV compared to those without the virus. TB, despite being preventable and curable, continues to be the biggest cause of deaths for people with HIV. 'No one needs to die from TB or HIV because we have science-based tools and approaches to avert these untimely deaths,' said Dr Gilada. Dr Gilada and Daxa both advocate for people with HIV to go for adult vaccinations to reduce the risk of or protect themselves from vaccine-preventable diseases. Dr Gilada points to several other concerns that must be considered while caring for people with HIV – and make all efforts to effectively address them in evidence-based and people-centred manner. For example, substance use (tobacco, alcohol, etc), genetics, menopause for women, hypertension, obesity, physical inactivity, poor engagement in healthcare, poverty, among others. 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But her lifesaving HIV treatment began 9 years later (in 2007 onwards), as per then-eligibility criteria of the WHO and Indian government. Recognising the importance of treatment and health literacy and treatment adherence, she has never-ever missed her dose since then. Daxa advises simple ways like setting up daily mobile reminders to take every dose correctly and at the right time. Last month, Daxa had recently led the organising of a national dialogue and stakeholder consultation in India's national capital Delhi along with her colleagues like Pooja Mishra (Secretary NCPI Plus) and Manoj Pardeshi (co-founder NCPI Plus and leader of a successful social enterprise Taal+ Pharmacy) and other members of NCPI Plus. Alongside this meeting, almost 30 eligible women with HIV were also screened for breast cancer onsite (using a point-of-care thermal screening tool of Niramai Health Analytix). NCPI Plus members from across India learnt a lot from experts on human papilloma virus or HPV (a virus which causes around 95% of cervical cancers along with other health issues in all genders), India's first indigenously developed and validated molecular diagnostics for HPV (Truenat HPV-HR Plus developed by Molbio Diagnostics – announced by the Indian government in April 2025), and on ensuring how people with HIV age healthily and with rights. Daxa was speaking at a special event to mark HIV Long-Term Survivors' Awareness Day 2025 and ahead of 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025), 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and 13th International AIDS Society Conference on HIV Science (IAS 2025). Eliminate delays in rolling out scientifically approved and validated health tools According to WHO: 'People living with HIV who have an undetectable viral load using any WHO-approved test and continue taking medication as prescribed, have zero risk of transmitting HIV to their sexual partner(s).' Agrees Dr Gilada: 'Science has proven that if people with HIV are on lifesaving antiretroviral therapy and remain virally suppressed, then there is zero risk of any further transmission of HIV from them to anyone else. This is referred to as #UequalsU or undetectable equals untransmittable.' But, in 2023, over 1.3 million people were newly diagnosed with HIV worldwide – despite the science-backed tools to prevent HIV transmission. We can do better to save lives, says Dr Gilada. We need to bridge the deadly divide between 'what we know works' and 'what we do.' Dr Ishwar Gilada is part of the International AIDS Society (IAS) Governing Council, serves as President-Emeritus of AIDS Society of India (ASI – India's network of medical doctors and scientists of HIV and co-infections and co-morbidities), and CEO of Unison Medicare and Research Centre (UMRC), India. He is the longest serving HIV medical expert in India who had established India's first HIV clinic in government-run JJ Hospital when first HIV case got confirmed in the country. Government of India's National AIDS Control Programme began in 1992, seven years after a civil society group (People's Health Organisation – PHO) was consistently raising HIV awareness. There was a 9-years delay in rolling out government-run programme to prevent HIV transmission from mother to the child in 2001 despite PHO-Wadia safe motherhood model had demonstrated evidence and impact since 1992. Medicines like zidovudine was first used in rich nations over 30 years ago to reduce HIV risk of the unborn child of HIV positive parent(s) – and PHO-Wadia model had rolled these out back then in India too (though government's rollout took another 9 years to do so). Today we have far more effective treatment regimens available to ensure children are born free of HIV - and both mother and the child live healthy and normal lives. Likewise for the rollout of lifesaving antiretroviral therapy: In private sector it began 9 years before the government's programme in India (from 7 April 2004 onwards). Rollout of Dolutegravir - one of the most promising antiretroviral medicines - began 3-4 years later in government-run programme (2020) than private sector in the country (2017). Dr Gilada says we have a long journey ahead to pay adequate attention to quality of life too while we test and treat, care and support for people with HIV. He also points out that new HIV prevention methods that are validated and approved years back have not been rolled out in the country. For example, Pre-Exposure Prophylaxis (PrEP) is a HIV medicine that is for people who are HIV negative to reduce their risk of getting infected with the virus. PrEP is not part of India's HIV programme but available on online shopping websites. Likewise, HIV self-test is not yet rolled out as part of government's programme. HIV stigma has reduced but still lurks HIV stigma has reduced considerably over the last 4 decades but still lurks, says Daxa. 'Over the decades, life expectancy of people with HIV has increased due to improved efficacy of the treatment. CDC estimates that around half of all people with HIV are older than 50 years now. By 2030, 70% of all those with HIV would be over 50. With ageing comes new challenges (HIV-associated and non-HIV associated too),' said Dr Gilada. 'Sometimes I believe that people with HIV live better than non-HIV because they are always constantly under health supervision, monitoring and proactively seeking healthcare services which people who do not have HIV may not be getting.' Dr Gilada's Unison Medicare and Research Centre in Mumbai has several people living with HIV under care for over three decades. 'So, in a way we have provided paediatric to geriatric care for those with HIV.' Dr Gilada says that HIV stigma still exists but when he looks at socio-economic background of his patients under care, he often finds that those who are more educated and privileged are more likely to stigmatise and discriminate. 'We need to have a non-judgmental approach in all healthcare settings,' said Dr Gilada. Daxa shared that almost 23 years back, she was asked a whooping INR 16,000 to for pregnancy and child-birth related healthcare services. 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'But there is not a single case which has been filed under this law since 2017,' said Dr Gilada who had earlier mobilised several associations in the last 30 years to demand such a law. Dr Gilada cites a Mumbai High Court ruling according to which people living with HIV do not even have to disclose their identity (to maintain confidentiality) while seeking legal recourses for justice. We can do better! Managing HIV co-infections and co-morbidities is vital Dr Gilada reminds that along with lifesaving and effective antiretroviral therapy, healthcare workers need to regularly screen people with HIV for a range of co-infections and co-morbidities. Before beginning treatment for any other illness, drug to drug interaction needs to be considered for example. People with HIV are at a higher risk of some non-communicable diseases, such as, cardiovascular diseases, cancers, diabetes and related complications, chronic respiratory diseases, mental health issues, and others. 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Find your inner light: Purposeful and peaceful living is key Daxa Patel shares that we all need to care for our mental wellbeing and try to remain stress-free. Engaging with purposeful and spirited work to help others with HIV since 2002 onwards has helped her remain busy and meaningfully involved. 'It saved my life,' she said. We need to keep ourselves healthy and ensure that we do not let outside stigma and discrimination effect our sensibilities and wellbeing in any way. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
