AIDS 2016: can 90–90–90 target succeed?

Experts and leaders have called for increased investment, better access to testing and cheaper drugs if the ambitious UNAIDS 90-90-90 targets are to be met.

The UNAIDS strategy for eliminating HIV, launched in 2014, sets out that by 2020, 90 per cent of all people living with HIV will know their HIV status; by 2020, 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and by 2020, 90 per cent of all people receiving antiretroviral therapy will have viral suppression.

Speaking ahead of AIDS 2016 (18-22 July) in Durban, South Africa, Dr Ade Fakoya, senior advisor on HIV and AIDS at The Global Fund to Fight AIDS, Tuberculosis and Malaria, warned that the 90-90-90 goal may be missed without further investment.  “If we are to attain the 90-90-90 goal, governments must invest in HIV response,” he said.

Fakoya was speaking at pre-conference event at the Durban International Convention Center on Sunday 17 July. He said that there is need for domestic funding and political will, especially from countries with high burden of HIV infection.

Concerns over donor aid cuts

Michel Sidebé, executive director of UNAIDS, expressed concern over donor reduction in funding HIV global response. He said this will affect the gains and interventions made in the fight against HIV, especially in sub-Saharan Africa.

“We have seen a reduction of seven per cent in donor funding toward the global response of HIV and this is really worrying. Something must be done to step up the funding in order to not lose the gains we have so far made,” he said.

Asia Russell, from Health Gap Global Access Project, said since the start of the AIDS epidemic civil society has been at the forefront of the response to HIV, campaigning for access to HIV treatment, respect for human rights and supporting communities affected by the disease.

“Today the role of civil society remains more relevant than ever as the success of community efforts in providing HIV services, particularly to key populations, is becoming more essential to ending the AIDS epidemic,” she said.

Better testing and cheaper drugs

David Rupin from Clinton Health Access Initiative said the HIV response must be taken to the grassroots to make sure everybody knows his or her HIV status. He also called for an increase in self-testing kits in the community, which he said will make the 90-90-90 strategy more visible.

“Testing must be shifted to communities, at home…in workplaces, and mobile and outreach testing, so that we test the right people, at the right place with the right strategy,” he said.

Lelio Marmora, executive director of UNITAIDS, called for cheap and affordable HIV drugs saying this will save more people from dying. “With 37 million people living with HIV, we need cheaper drugs to save more lives,” he said.

Deborah L. Birx, United States global AIDS coordinator, said the President’s Emergency Plan for AIDS Relief (PEPFAR) remains steadfast through its Human Rights Agenda to eliminate barriers to HIV services, including stigma and discrimination, for all people.

She said it will support the UNAIDS 90-90-90 treatment target and focus more resources to ensure 90 per cent of people in high-burden areas have access to treatment by 2020.

“We must break through our current state of measured timidity, and act with measured assertiveness to strategically deploy our resources and win the battle against HIV/AIDS,” she said.

“Based on the science, and a clear human rights imperative, the global AIDS response requires re-focusing so that HIV testing is prioritised along with the immediate offer of antiretroviral therapy, coupled with meaningful engagement in care for all people living with HIV/AIDS.”

Over 18,000 scientists, policymakers, advocates and people living with HIV are meeting in Durban, South Africa, for the 21st International AIDS conference. They will discuss the prospect of developing safe, effective, and globally scalable approaches to curing or achieving sustained remission of HIV infection.