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 order to monitor progress towards targets and hold governments to account.
A brief history
The ‘3 by 5’ initiative, launched by UNAIDS and the World Health Organization (WHO) in 2003, was an ambitious global target that aimed to get three million people living with HIV on treatment by 2005.1
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
Millennium Development Goals
The eight Millennium Development Goals (MDGs) were established in 2000. Their targets ranged from halving extreme poverty, to halting the spread of HIV and AIDS and providing universal primary education by 2015.5
The HIV and reproductive health-related targets were:
- Goal 4: Reduce child mortality
- Goal 5: Improve maternal health
- Goal 6: Combat HIV/AIDS, malaria and other diseases.
Political Declaration on HIV and AIDS
The 2011 Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS[pdf]6, reaffirmed the 2006 Commitment, setting 10 targets to be achieved by 2015.7 As part of the Declaration, the '15 by 15' target was adopted and called for 15 million people to be reached with HIV treatment by 2015.8
- zero new HIV infections
- zero AIDS-related deaths
- zero discrimination.
The post-2015 framework
Where are we now?
In 2015, 36.7 million people were living with HIV worldwide. New HIV infections in 2015 were estimated at 2.1 million, and AIDS-related deaths at 1.1 million.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.
Sustainable Development Goals
In this new framework, MDG 6, which addressed HIV/AIDS, TB and Malaria, as well as the two other health-related MDGs, 4 (reduce child mortality) and 5 (improve maternal health), have been replaced by one overarching health goal.14
- 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. Among the 169 targets, are a target on sexual and reproductive health and reproductive rights and a target on eliminating discriminatory laws.
UNAIDS Fast-Track strategy
The UNAIDS Fast-Track strategy[pdf], launched in 2014, 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 2010.15
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:
In September 2016 Sweden became the first country to achieve these targets.16
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 make everyone living with HIV eligible for treatment, regardless of CD4 count.17
The Fast-Track strategy re-emphasises the need for the global response to be ‘front-loaded’ over the next few years to prevent the epidemic from rebounding. Taking this action would mean that in 2020, there would be:
- fewer than 500,000 people newly infected with HIV
- fewer than 500,000 people dying from AIDS-related illnesses
- elimination of HIV-related discrimination.
To achieve the 90–90–90 targets, UNAIDS emphasises the need to focus on five prevention pillars delivered through a people-centred, combination approach.
To go with these headline targets, there are a number of expanded commitments, including regional targets.18 If these goals are achieved, the response will be on track to reduce new HIV infections to fewer than 200,000 by 2030. This would mark the end of the HIV epidemic as a public health threat.19
“Every five years we have more than doubled the number of people on life-saving treatment. We need to do it just one more time to break the AIDS epidemic and keep it from rebounding.” - Michel Sidibé, Executive Director, UNAIDS 20
In conjunction with Fast-Track, the global health sector strategy on HIV, published by WHO in 2016, sets out a global sector-wide strategy for ending AIDS by 2030. The strategy promotes a people-centred approach, grounded in principles of human rights and health equity.21
Political Declaration on Ending AIDS
In 2016, the Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030 provided the global mandate to Fast-Track the HIV response, with countries committing to invest at least US$26 billion annually in the HIV response by 2020.22
Among the ambitious commitments are the implementation of the 90-90-90 treatment targets to ensure that 30 million people living with HIV access treatment by 2020. HIV prevention targets encourage countries to promote access to tailored comprehensive prevention services for key populations, especially in locations with high levels of HIV transmission.23
However, organisations representing key populations have raised concerns about the lack of explicit language in relation to these groups or explicit recognition of why these groups are at a heightened risk of HIV (such as the criminalisation of same-sex practices, drug use and sex work). In a joint statement, the Global Forum on MSM & HIV and the Global Network of Sex Work Projects said:
“In a 14,000-word document that includes over 76 discrete points, men who have sex with men; sex workers are only mentioned; people who use and/or inject drugs; and transgender people are only mentioned twice” 24
The Declaration also commits to achieving gender equality and highlights the importance of male involvement in achieving this. However, it stops short of including an explicit target for comprehensive sex education. On the subject of the human rights of women and girls, the Global Network of People Living with HIV (GNP+) commented:
“excitement is tempered by the continued failure to get the full language of ’sexual reproductive health and rights’” 25
The Political Declaration also calls for universal health coverage with a number of targets emphasising the continued importance of an integrated health approach to tackle related epidemics such as tuberculosis, hepatitis B and C.26
What needs to be done to achieve these ambitious new targets?
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.
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.
“Everyone has the right to a long and healthy life. We must take HIV services to the people who are most affected, and ensure that these services are delivered in a safe, respectful environment with dignity and free from discrimination.” - Michel Sidibé, Executive Director, UNAIDS 27
Photo credit: ©iStock.com/alexsl
- 1. World Health Organization (WHO) ‘The 3 by 5 initiative’ [accessed June 2015]
- 2. World Health Organization (WHO) (2006) ‘Progress on Global Access to HIV Antiretroviral Therapy’[pdf]
- 3. UNAIDS (2006) ‘Political Declaration on HIV/AIDS’[pdf]
- 4. United Nations (UN) (2001) ‘Declaration of Commitment on HIV/AIDS’[pdf]
- 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’[pdf]
- 8. UNAIDS (2015, 19 July) 'Success in reaching ’15 by 15’ shows that we can end the AIDS epidemic'
- 9. UNAIDS ‘UNAIDS Strategy 2011-2015’ [accessed June 2015]
- 10. UNAIDS (2016) 'Global AIDS Update 2016'
- 11. 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'
- 12. UNAIDS (2016) 'Global AIDS Update 2016'[pdf]
- 13. United Nations (UN) ‘Sustainable Development Goals’ [accessed June 2015]
- 14. World Health Organisation (WHO) (2015) 'Health in 2015: from MDGs to SDGs'[pdf]
- 15. UNAIDS (2014) 'Fast Track Strategy'[pdf]
- 16. Gisslén, M., et al (2016), 'Sweden, the first country to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90-90-90 continuum of HIV care targets', HIV Medicine
- 17. World Health Organisation (WHO) (2015) 'Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV'[pdf]
- 18. UNAIDS (2016) 'Fast-track commitments to end AIDS by 2030'[pdf]
- 19. UNAIDS ‘Understanding Fast-Track: Accelerating action to end the AIDS epidemic by 2030’ [accessed 27 April 2016][pdf]
- 20. UNAIDS (2015, 24 November) 'Countries adopt UNAIDS Fast-Track Strategy to double number of people on life-saving HIV treatment by 2020'
- 21. The World Health Organization (2016) 'Global health sector strategy on HIV, 2016 - 2021'[pdf]
- 22. UNAIDS (2016, 8 June) ‘2016 United Nations Political Declaration on Ending AIDS sets world on the Fast-Track to end the epidemic by 2030’
- 23. UNAIDS (2016, 8 June) ‘2016 United Nations Political Declaration on Ending AIDS sets world on the Fast-Track to end the epidemic by 2030’
- 24. Global Forum on MSM & HIV (MSMGF) and Global Network of Sex Work Projects (NSWP) ‘Exclusion Kills! Gay Men and Sex Workers Worldwide Express Anger Over Attempts by Governments to Erase Key Populations from the UN Political Declaration on HIV & AIDS’
- 25. Global Network of People Living with HIV (GNP+) (2016, 13 June) ‘Are countries really serious about ending AIDS?’
- 26. UNAIDS (2016, 8 June) ‘2016 United Nations Political Declaration on Ending AIDS sets world on the Fast-Track to end the epidemic by 2030’
- 27. UNAIDS (2015, 24 November) 'Countries adopt UNAIDS Fast-Track Strategy to double number of people on life-saving HIV treatment by 2020'