SEATTLE — UNAIDS intensified its momentum with 90-90-90: an ambitious goal to end the HIV epidemic by 2030. The initiative intends to fight against HIV by mobilizing global solidarity and accountability in the improvement of access to antiretroviral therapy.
While treatment is available for those living with HIV, there are substantial restrictions on the breadth of its coverage. Aid organizations have made impressive progress in the provision of treatment — supplying antiretroviral therapy to 17 million in 2015 — yet even further measures must be taken.
Geographic inequities must be rectified in order to win the conclusive fight against HIV. Eastern and Southern Africa take the lead in treatment coverage at a modest 41 percent. Due to even more considerable gaps in access to antiretroviral therapy, other regions in Africa, the Middle East, Eastern Europe and Asia have made little to no progress in the prevention of mortality related to HIV.
In the past, antiretroviral therapy has only been available to individuals whose CD4 cells were tested to be below a critical amount, leaving many people living with HIV without the benefits of early treatment. Difficulties arise when the responsibility of clinical follow-up and repeated viral load testing are placed in the hands of the patient, as many may not be able to afford the related medical expenses or social stigma.
Eliminating the Limits on Receivers of HIV Testing
HIV testing is critical, yet the key populations who need it the most are often the least likely to seek care. According to studies conducted by UNAIDS, the risk of HIV transmission is much more likely for the communities who already face discrimination within the society, such as drug users, female sex workers and men who have sex with other men.
The members of these populations require additional support, yet they are often faced with hostility and inadequate medical service due to the institutionally condoned discrimination and criminalization of their behavior.
The 90-90-90 target of UNAIDS addresses these barriers, focusing on access to antiretroviral treatment for all in a fast-paced fight against HIV. Ideally, by 2020, 90 percent of those living with HIV will be tested, 90 percent will be on a consistent antiretroviral treatment regimen and 90 percent will already be virally suppressed.
Previous HIV initiatives have had incremental success, yet 90-90-90 is committed to the geographic expansion, patient follow-through and early initiation of antiretroviral therapy. With support from the WHO, new HIV treatment guidelines make antiretroviral therapy available to anyone who has tested positive for HIV, regardless of CD4 cell count.
Transcending Passivity in the Fight Against HIV
While 90-90-90 is ambitious, it emphasizes the need to transcend passivity in the fight against HIV. It achieves this by including the virus in multi-disease health campaigns, by directly bringing treatment to key populations and by advocating against societal stigma.
The quality of HIV testing services is also under improvement, with new tenets of confidentiality, community connection and comprehensive pre-test and post-test counseling. Marketing and community health education also continue to be crucial for the successful implementation of the 90-90-90 target worldwide.
Surpassing Cost for the Greater Cause
Free global antiretroviral treatment, HIV testing and additional preventative care are costly. In 2016, the Political Declaration on HIV and AIDS committed US $26 billion annually to fund the mission of 90-90-90. This amount generously exceeds the US $18 billion that UNAIDS calculated as the annual requirement to meet its target, making 90-90-90 appear even more feasible.
Currently, no country has met the 90-90-90 goal of testing, treatment, and viral suppression, yet Botswana is well on its way. Through home-based HIV testing, supportive organizational partnerships and free antiretroviral treatment since 2002, Botswana is the international exemplar of a successful and attainable response to HIV.
The end of the HIV epidemic is within reach if UNAIDS continues to act fast. With the combination of medical care, human rights-based policy reform, effective educational advocacy and investment in key locations and demographics, the world may finally triumph in the fight against HIV.
– Larkin Smith