The aim of the 90-90-90 targets against HIV established by UNAIDS, the United Nations agency especially dedicated to the fight against HIV infection and AIDS, is that there are less than 90% of HIV-positive patients who are undiagnosed, untreated and with a detectable viral load 90%. The United Kingdom is one of the first countries in the world to have achieved these in the fight against HIV/AIDS epidemic: in 2017, 92% of HIV-positive persons were diagnosed, 98% had been treated, and in 97% of those treated, the viral load had been suppressed. The success has been attributed substantially to the efforts made to implement prevention, the suitability of tests to improve the diagnosis, and the promptness of implementing treatment. The extension of prophylaxis to reduce the infection may also have had an effect (BMJ 2018; 363).
HIV prevention. Global state of the art and goals
Health UK secretary Matt Hancock promised that by 2030 there would be no new cases of HIV in England. His Welsh counterpart Vaughan Gething made a similar pledge at the end of last year. And in his State of the Union address US president Donald Trump took many people by surprise by promising the same thing.
But how achievable are these goals? Many in the UK HIV/Aids community believe that, in this country at least, the target is easily within reach.
What is pre-exposure prophylaxis (PrEP)
One of the game changers in recent years has been pre-exposure prophylaxis (PrEP), a pill which, when taken daily by people in high-risk groups, can reduce the risk of infection with HIV by up to 86 per cent.
In this sense, a large study has been made. Its Chief Investigator said : “These results are extremely exciting and show PrEP is highly effective at preventing HIV infection in the real world. Concerns that PrEP would not work so well in the real world were unfounded. These results show there is a need for PrEP, and offer hope of reversing the epidemic among men who have sex with men in this country. The findings we’ve presented today are going to be invaluable in informing discussions about making PrEP available through the NHS.”
The UK’s success tackling HIV comes as infection rates continue to rise in Europe, largely due to skyrocketing cases in Eastern Europe where some 130,000 were diagnosed last year. Russia and Ukraine shoulder the brunt of the burden, contributing 75 per cent of all new cases in Europe in 2017.
But they warn that Eastern Europe and Spain is lagging behind. In the region, just 76 per cent of people with HIV are diagnosed, 46 per cent are on treatment and 78 per cent have the virus suppressed.
STOPAIDS shows a global less optimistic view: we’re not even sustaining the gains we’ve made
“What’s happening in Russia, of course, is a government that criminalises key populations and don’t provide any services for them,” said Mike Podmore, director of STOPAIDS ( network of UK agencies working together to secure an effective global response to HIV and AIDS) and organiser of the ENDAIDS2030 Festival. “So infection rates are going through the roof.”
Global HIV/AIDS epidemic brief review
“Ultimately to end Aids by 2030 we have to make progress in every region of the world, in every continent. It’s a real worry – we can’t end Aids if we’re not even sustaining the gains we’ve made.” he added.
The reports have been released ahead of World Aids Day on Saturday, the theme of which is ‘Know Your Status’. According to UNAids (the Joint United Nations Programme on HIV/AIDS), over nine million people who are HIV positive around the world have not yet received a diagnosis. It is the main bioethics issue to resolve.