Those working in the field of HIV, from policy makers to programmers, and national governments to community-based organisations, operate within the framework of global HIV targets.
In the post-2015 era, targets are geared to ending the HIV epidemic by 2030.
Role of international HIV organisations
International organisations working in the HIV response play a key role in advocating for strong HIV and AIDS targets and indicators by which to measure progress. For example, those focussing on human rights and equal access to HIV services for all, call for global indicators to properly include key affected populations.
International organisations like UNAIDS and their partners advocate for national governments to work towards global targets within their national strategic plans. These are vital in the implementation, collection, management and distribution of health information in order to monitor progress towards targets and hold governments to account.
A brief history
Despite falling short of its target, 1.3 million people accessed antiretroviral treatment (ART), tripling the number of people receiving ART and preventing an estimated 250,000 to 350,000 AIDS-related deaths.2
It is widely credited with jump-starting the global effort to provide widespread treatment access to people living with HIV in low- and middle-income countries.
In 2006, the UN General Assembly High-Level Meeting resulted in a Political Declaration on HIV.3 It reviewed the targets of the 2001 Declaration of Commitment on HIV/AIDS and countries signed the declaration to pledge their commitment to tackling the global HIV epidemic.4
Current global HIV targets
Millennium Development Goals
The eight Millennium Development Goals (MDGs) were established in 2000. They have targets ranging from halving extreme poverty, to halting the spread of HIV and AIDS and providing universal primary education by 2015.5
The MDGs are interlinked, with progress on one relating to, and dependent on, progress made on others. The HIV and reproductive health-related targets are:
- Reduce by two-thirds, between 1990 and 2015, the mortality rate of children under five
- Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio
- Achieve, by 2015, universal access to reproductive health
- Halt and begin to reverse, by 2015, the spread of HIV/AIDS
- Achieve universal access to treatment for HIV/AIDS for all those who need it
- Halt and begin to reverse, by 2015, the incidence of malaria and other major diseases.
Political Declaration on HIV and AIDS
The 2011 Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS6, reaffirmed the 2006 Commitment, setting 10 targets to be achieved by 2015.7 Particular focus was on Goal 6 - recognising the importance of rapidly scaling up efforts to integrate HIV prevention, treatment, care and support.
- zero new HIV infections
- zero AIDS-related deaths
- zero discrimination.
The post-2015 framework
Where are we now?
In 2014, 36.9 million people were living with HIV worldwide. New HIV infections in 2014 were estimated at 2 million, and AIDS-related deaths at 1.2 million.9
As of March 2015, 15 million people were receiving antiretroviral therapy, reaching the treatment target nine months ahead of schedule.10
These promising results, together with fast-moving scientific developments such as treatment as prevention (TasP), are fuelling optimism that we can end AIDS by 2030.
UNAIDS Fast-Track strategy
The UNAIDS Fast-Track strategy aims to greatly step up the HIV response in low- and middle-income countries to end the epidemic by 2030.
It states that without rapid scale-up, the epidemic will continue to outrun the response. To prevent this, the number of new HIV infections and AIDS-related deaths will need to decline by 90% compared to 2010.11
The strategy sets targets for prevention, treatment and human rights.
- 90-90-90 targets
The Fast Track treatment targets are known as the 90-90-90 targets:
The 90-90-90 targets refer to the pathway by which a person is tested, linked and retained in HIV care, and initiates and adheres to antiretroviral drugs (ARVs).
New evidence around the use of ARVs has now emphasised the importance of achieving ‘viral suppression’. This is a point where the viral load reduces to a non-detectable amount and a person is unlikely to transmit HIV to someone else.
Following the results of the START (Strategic Timing of Antiretroviral Treatment) study, the WHO’s latest HIV treatment guidelines recommend making everyone living with HIV eligible for treatment, regardless of CD4 count.12
Sustainable Development Goals
In this new framework, MDG 6, which addresses HIV/AIDS, TB and Malaria, as well as the two other health-related MDGs, 4 (reduce child mortality) and 5 (improve maternal health), will be replaced by one overarching health goal:
- Goal 3: Ensure healthy lives and promote wellbeing for all at all ages.
This new goal contains Target 3.3 - which aims to end the AIDS epidemic by 2030, and Target 3.8 - achieve universal health coverage, access to quality health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
Within the 17 proposed new SDGs, other goals relating to the HIV response include a goal on gender, and a goal on reducing inequality between and within countries. Amongst the 169 targets, are a target on sexual and reproductive health and reproductive rights and a target on eliminating discriminatory laws.
What needs to be done to achieve these ambitious new targets?
The UNAIDS GAP Report demonstrates that geographical inequity, as well as continued stigma and discrimination towards key affected populations, is still preventing those most affected from accessing the services they need.
"Even though we have seen new HIV infections drop by 38% since 2001, there were 2.1 million people newly infected in 2013. There are also 22 million people who are not accessing life saving treatment." 14
Many key strategies and targets end in 2015. In the post-2015 framework, international organisations and their regional, national and community partners must ensure that new targets and indicators are backed by financial and political commitment, and that governments deliver health services for all.
Those working in the HIV response need to continue to influence policy makers at all levels to ensure that universal health coverage is based on human rights and equitable access to services, especially for key affected populations. Indicators for success and robust monitoring frameworks need to reflect this.
"Never has it been more important to focus on location and population to be at the right place for the right people." - Michel Sidibe, Executive Director, UNAIDS 14
Photo credit: ©iStock.com/alexsl
- 1. World Health Organisation (WHO) ‘The 3 by 5 initiative’ [accessed June 2015]
- 2. World Health Organisation (WHO) (2006) ‘Progress on Global Access to HIV Antiretroviral Therapy’
- 3. UNAIDS (2006) ‘Political Declaration on HIV/AIDS’
- 4. United Nations (UN) (2001) ‘Declaration of Commitment on HIV/AIDS’
- 5. United Nations (UN) ‘Millennium Development Goals’ [accessed June 2015]
- 6. United Nations (UN) (2011) ‘Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS’
- 7. UNAIDS (2011) ‘Ten targets: 2011 United Nations General Assembly Political Declaration on HIV/AIDS: Targets and elimination commitments’
- 8. UNAIDS ‘UNAIDS Strategy 2011-2015’ [accessed June 2015]
- 9. UNAIDS (2015) ‘Fact sheet: 2014 statistics’
- 10. UNAIDS (2015, 14 July) 'UNAIDS announces that the goal of 15 million people on life-saving HIV treatment by 2015 has been met nine months ahead of schedule'
- 11. UNAIDS (2014) 'Fast Track Strategy'
- 12. World Health Organisation (WHO) (2015) 'Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV'
- 13. United Nations (UN) ‘Sustainable Development Goals’ [accessed June 2015]
- 14. a. b. UNAIDS (2014) ‘The Gap Report’