As this year marks the end of the 90-90-90 UNAIDS targets, experts from across the globe have come together at the virtual AIDS conference to chart new targets for the year 2025
The 90-90-90 goals aim to have 90% of all people living with HIV will know their status; 90% of those diagnosed with HIV will be on treatment and 90% of those will also be virally suppressed by the end of 2020.
As the year draws closer to an end, new goals need to be formulated towards 2025 and ultimately an AIDS-free 2030. Speaking at one of the presentations at this year’s AIDS, this is what experts had to say about what lies ahead.
Test and Treat
In her presentation, Professor Wafaa El-Sadr who is the director of the Centre for Infectious Disease Epidemiologic Research at Columbia Mailman School of Public Health said that HIV testing may move from voluntary testing and towards self-testing.
El-Sadr says that strengthening HIV testing and treatment needs a more community-based approach.
“Certainly, the importance of differentiated service delivery models and community-led services and the role in potentially improving Both access to antiretroviral therapy, as well as enhancing retention in services and also viral load suppression. Another element that was highlighted in our discussions was the issue of the importance of health system strengthening in order to manage the additional patient load is expected with expansion of treatment and testing, as well as also to avoid the threat of antiretroviral drug stockouts,” she says.
She adds that there was consensus between experts that all countries should have the same 2025 targets and that those who are behind should devise catch up plans.
HIV prevention as a challenge
The world is off target by three-fold in HIV preventions goals says, Professor Quaraysh Abdool Karim, who is the Associate Scientific Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA).
Abdool Karim says that there has been a slight success at each level in some countries and some cities but preventing new HIV infections is a major challenge. Although there are tools available to assist, these are not being used effectively.
“We appreciated that preventing HIV infection is very complex. And we do need to understand the complexity at a very granular level. We need to understand where those infections are taking place who’s infecting who, why are those transmissions occurring? And how do we intervene and you in spite of all of the understandings we have, what we do appreciate because of this granular understanding we need because of the complexity of prevention, some of the progress we’re making is too slow,” she says.
But Abdool Karim says that there is still hope.
“What we also have seen, which is a great benefit of treatment, is that viral suppression also reduces transmission also commonly referred to as u equals u. So, what we are seeing is bridging the gaps between treatment and prevention way investments in treatment also has prevention,” she explains.
However, she also warns that there is a gap in science meeting social science and behavioural change.
“I think the key challenge for us as we think about prevention, is the innovation within and beyond health facilities, and then clearly the admission of the need for human-centred approaches, and particularly healing interventions for those who are being left behind.”
Setting targets by looking at Social Enablers
George Ayala is Executive director of Mpact global action for Gay Men’s Health and Rights. In his presentation, he focused on social enablers that need to be considered when setting the new targets.
Ayala says that the social enablers consultation included social scientists, government officials’ implementers human rights advocates, the leadership of global regional, national and key population networks.
“ We realise that when we are able to address stigma and discrimination, we’re also able to increase viral suppression, increased HIV testing, increase linkage to HIV care, and then increase ART adherence,” he says.
He says that there is a need to bring other actors into the global HIV response actors who are not in the HIV sector but who are working on poverty and education and the other development issues.
“We address gender-based violence, we’re able to reduce new HIV infections among women and then, in addition to that, when we are able to address punitive laws that criminalise the possession of small amounts of drugs, sex work and same-sex behaviour, we’re also able to reduce HIV incidents avert HIV infections among people who use drugs, we can reduce HIV incidence among sex workers and also reduce the time to diagnosis and treatment among gay and bisexual men and transgender women,” he explains.
Ayala says that the approach towards the 2025 goals is set on a that is a society free of stigma, discrimination, gender equality, supportive legal environment and access to justice.
The new targets will have a 10-10-10 social enabler focus.
“We want less than 10% of people living with HIV to report internalised stigma by 2030. Less than 10% of people living with HIV reporting experience discrimination in health care and community settings by 2030 than 10% of key populations, gay men, people who use drugs, sex workers, transgender people, to report that they had experienced stigma and discrimination by 2030,” he says.
He continues: “In gender equality, less than 10% of women and girls experience intimate partner violence by 2030. Less than 10% of key populations reporting that they experienced physical or sexual violence by 2030. And then finally, with the supportive legal environments and access to justice, we’re looking for less than 10% of countries that criminalise sex work, possessions of small amounts of drugs, same-sex behaviour and HIV transmission exposure or non-disclosure by 2030.”- Health-e News.