UNAIDS bids farewell to Fast-Track era with new HIV targets for 2025
New 2025 targets aim to put the world back on track to end AIDS by 2030 following the news that Fast-Track targets were missed.
This month, UNAIDS agreed on a new set of global HIV targets for 2025. Their aim is to create a new pathway to meet HIV-related targets within the Sustainable Development Goals (SDGs), which call for the end of AIDS as a public health threat by 2030.
The 2025 targets focus on getting high-quality HIV, sexual and other key health services to people living with HIV and people who are marginalised or most at-risk of HIV – including young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men. They also aim to ensure that people feel that they can access these services in a safe environment.
End of the Fast-Track era
The new targets were set following the realisation that the world would miss the targets set out in the ‘Fast-Track’ strategy – a realisation made before this year’s COVID-19 pandemic, which has pushed the response further off-track.
Adopted by the UN General Assembly in 2016, the Fast-Track vision sought to reduce new HIV infections and AIDS-related deaths to fewer than 500,000 by 2020, and eliminate HIV-related stigma and discrimination. The idea was to heavily scale-up investments in key areas to 2020 and then maintain these to 2030.
To achieve this, they committed to getting 90% of people living with HIV knowing their HIV status, 90% of people who know their status on treatment, and 90% of people on treatment with suppressed viral loads by 2020 (known as the 90-90-90 targets) – along with nine other commitments around HIV treatment and prevention.
Getting large amounts of people onto treatment was the major success story of the Fast-Track era. By the end of 2019, 81% of people living with HIV knew their status, 82% of this group were accessing treatment, and 88% of this group were virally suppressed.
Despite this, 1.7 million people became infected with HIV and 690,000 people died from an AIDS-related illness in 2019. Prevention interventions like eliminating vertical transmission and ensuring that children are diagnosed and on treatment, condom promotion, harm reduction, pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC), fell far too short.
The 2025 targets
Fast-Track critics point to an overemphasis of the 90-90-90 targets, which came to mean ‘Fast-Track’, with unequal progress between countries and towards the other commitments. Following a three-year consultation, UNAIDS took lessons from countries that did well and created the new 2025 targets.
“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Winnie Byanyima, Executive Director of UNAIDS.
“Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”
Knowing this, the 2025 targets focus on three interlinked areas – the enabling environment (the 10s), service access (the 95s), and service integration – with at-risk communities and people living with HIV at the centre.
- ‘The 10s’ call for the removal of societal and legal barriers to HIV services. They state that by 2025, less than 10% of countries should have punitive laws and policies in place that target people living with HIV, or marginalised populations; less than 10% of people experience stigma and discrimination, and less than 10% of people experience gender inequality or violence.
- ‘The 95s’ call for 95% testing, treatment and viral suppression targets. As well as 95% access to combination prevention services; 95% access to sexual reproductive health services; and 95% coverage of prevention of mother-to-child transmission services.
- Integration, calling for 90% of people living with HIV, and people at heightened risk of HIV, being linked to services important for their overall health. These include mental health, preventing and addressing gender-based violence, sexual reproductive health and rights, communicable and non-communicable disease services.
Towards a new political declaration
These new goals will form part of UNAIDS’ new strategy, which they hope to ratify in early 2021, in advance of the United Nations General Assembly High-Level Meeting on Ending AIDS in June.
Just like in 2016, the meeting will result in a new political declaration, where UN Member States re-commit and re-mobilise towards ending the AIDS epidemic as a public health threat by 2030.
Whereas in 2016, saving the lives of people living with HIV through scaled-up treatment access was a simple and easy message to get behind, next year’s meeting will need to acknowledge the inequalities experienced by some communities, who don’t have access or feel unable to access services. Importantly, the difficult work of HIV prevention still needs prioritising.
“The past decade, including the 90–90–90 targets of the 2016 political declaration, has seen an important investment in the provision of antiretroviral therapy,” stated Byanyima at the opening of the 47th meeting of the UNAIDS Programme Coordinating Board (15 December 2020).
“The saving lives aspect is key and easy to communicate, which has made this prioritization easy in many countries. It is critical that the global AIDS strategy and the 2021 political declaration become a vehicle for a similar momentum to scale up and invest in HIV prevention.”