AIDS 2016 hot topic: Reaching the 90-90-90 targets

20 July 2016
Michel Sidibé at AIDS 2016

Progress towards the 90-90-90 Fast-Track targets is a hot-topic at this week’s 21st International AIDS Conference in Durban, South Africa. Success towards the 2020 targets, which call for 90% of people living with HIV to know their status, 90% on HIV treatment, and 90% virally suppressed, is being demonstrated across the board. However, progress is by no means uniform, with underfunding and a lack of commitment impeding the road to end AIDS by 2030. 

First introduced at the last International AIDS Conference in Melbourne in 2014, the Fast-Track targets were met with some scepticism – some thought they were too treatment focussed, whilst others believed the targets to be unrealistic. 

Despite the initial scepticism, there has already been some progress. At a pre-conference workshop in Durban, UNAIDS showed that the targets are achievable, but acknowledged that gaps need to be filled and efforts redoubled if we are to meet them by 2020. The UNAIDS report 90-90-90: On the right track towards the global target, shows that globally 57% of people living with HIV are aware of their status, 46% of all people living with HIV are on treatment, and 38% are virally supressed.

In sub-Saharan Africa, where 69% of all people living with HIV live, Eastern and Southern Africa are faring very well. Botswana is already on track to achieve 90-90-90 targets, with reports showing that 70% of all people on treatment are virally suppressed. In Rwanda, 86% of people knew their status, 63% were on treatment and 82% were virally suppressed. PEPFAR-funded programmes in Malawi, Swaziland, Lesotho and Kenya are also on their way to achieving the Fast-Track targets.

The Asia region is also making good progress, with Thailand and Cambodia set to achieve 90-90-90 ahead of 2020. China moreover showed remarkable achievements, with 91% of all people on treatment virally suppressed.

Latin America and the Caribbean have the highest regional treatment coverage in the world – increasing from 39% in 2012 to 55% in 2015. In Brazil, 83% of people were aware of their status, with 80% of people being linked to HIV treatment and care. 

Over just three years, a number of diverse countries have more than doubled their treatment coverage, including Uzbekistan, Burundi, Uganda and Tanzania. This proves that impressive gains can be made from sound national approaches and embracing the Fast-Track strategy.

Sadly, the success has not be uniform. West and Central Africa, and Eastern Europe and Central Asia are lagging behind. UNAIDS warned that if major changes are not made in these regions, the 90-90-90 targets will not be met.

UNAIDS stressed that adequate funding is essential for achieving the Fast-Track targets, including the 90-90-90. Funding of the HIV response will need to increase by roughly one-third by 2020 – to US$ 26.2 billion. But donor contributions towards the HIV response actually decreased in 2015. Whilst many countries have stepped up funding for their own responses, this may not be enough.

At the workshop, UNAIDS Executive Director Michel Sidibé told  “If we take our foot off the pedal I am convinced that we will be unable to double the number of people on treatment again, and we will not see the major decline that we are expecting. Because of competing priorities, 13 countries out of 14 reduced their contribution to the HIV response globally. If this trend continues we will have a rebound, we will not be able to achieve our goals of 90-90-90 and [a reduction in incidence] by 2030.”

Also at the conference, the SEARCH study – a large scale ‘test and treat’ health campaign delivered within a multi-disease prevention approach – exceeded the 90-90-90 targets in just two years. Other studies presented demonstrate marked gaps in reaching the 90-90-90, particularly among key populations. Studies from southern Africa showed that men in particular are unlikely to access treatment, and thus achieve viral suppression.

The last time the AIDS conference was held in Durban was in 2000, which gained worldwide attention for an emotive speech by Nelson Mandela, and loud cries for treatment access for people in low and middle income countries. At the opening press conference of AIDS 2016, United Nations Secretary-General Ban Ki-moon said, "We call for AIDS 2016 to finish what we started in 2000… We must close the gaps that keep people from accessing services and living with dignity. We can end stigma and discrimination, prevent the spread of HIV and save lives."

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