Faced with an opportunity to end the epidemic within two decades or risk reversing important health gains of the last ten years, the world is at a crossroads in the fight against HIV and AIDS, according to a report released Tuesday by the Joint United Nations Programme on HIV/AIDS (UNAIDS).
The document, Fast-Track: Ending the AIDS Epidemic by 2030 (pdf), outlines a new set of targets aimed at increasing access to treatment, sharply reducing new infections, and "achieving zero discrimination." It warns that while the global community has already made some advances toward these goals—by June of this year, 13.6 million people worldwide had access to antiretroviral medicines, for example—continued investment and aggressive mobilization of human, institutional, and financial resources will be critical to future progress.
"We have bent the trajectory of the epidemic," UNAIDS executive director Michel Sidibé said Tuesday at the launch of the report at the University of California, Los Angeles. "Now we have five years to break it for good or risk the epidemic rebounding out of control."
In 2013, there were an estimated 35 million people living with HIV, 2.1 million became newly infected, and 1.5 million died from AIDS-related illnesses.
UNAIDS is pushing for a new 'Fast-Track approach' that "will allow the world to end the AIDS epidemic by 2030" and by doing so avert nearly 28 million new HIV infections and 21 million AIDS-related deaths by that year.
By 2020, the Fast-Track approach seeks to achieve '90-90-90': 90 percent of people living with HIV knowing their HIV status; 90 percent of people who know their HIV-positive status on treatment; and 90 percent of people on treatment with suppressed viral loads.
"If the world is to end the AIDS epidemic by 2030, rapid progress must be made by 2020," reads the report. "Quickening the pace for essential HIV prevention and treatment approaches will limit the epidemic to more manageable levels and enable countries to move towards the elimination phase. If the response is too slow, the AIDS epidemic will continue to grow, with a heavy human and financial toll of increasing demand for antiretroviral therapy and expanding costs for HIV prevention and treatment."
The report emphasizes that particular efforts are needed in 30 "priority countries" that together account for 89 percent of new HIV infections worldwide—many of them in sub-Saharan Africa.
UNAIDS estimates that to implement the Fast-Track approach will require an investment of $35.6 billion in low- and middle-income countries in 2020, though by 2030 that number would drop by 8 percent to $32.8 billion. These resources could provide antiretroviral treatment to twice as many people in 2020 than in 2015, according to the report, which also acknowledges that making such resources available will be a challenge.
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But the impact could be huge. "If we invest just 3 [US] dollars a day for each person living with HIV for the next five years we would break the epidemic for good," Sidibé declared.
Though the report's targets and overall message are clear and urgent, the overall plan for implementation needs more precision, according to a blog post at AVAC, an advocacy organization geared toward HIV prevention.
"The Fast Track World AIDS Day report is clear on what needs to happen to achieve the "90-90-90" goal," it reads. "It also suggests the components of prevention programming that should also come on line—listing, in various places, male and female condoms, voluntary medical male circumcision, oral pre-exposure prophylaxis (PrEP) for sex workers, men who have sex with men...as well as cash transfers for young girls, harm reduction, structural interventions, mass media and behavior change. These prevention elements appear in different subsets throughout the document, leaving some confusion about what, exactly, is essential."
The post continues:
Everything that the UNAIDS report lists is important. But the details of what goes where—which packages, in which places—and what specific terms mean are missing. Cash transfers, for example, can be delivered in a range of ways, with different objectives and different outcomes.
There are also some elements that receive considerably less emphasis. Research and development of more potent ARVs for treatment and prevention, new prevention options for women and other key populations, vaccine and cure strategies, are fundamental to long-term success in "breaking the epidemic." Within the five-year timeframe set by UNAIDS, there are short-term milestones to set and achieve in each of these areas, even though the ultimate goals may not be reached for many years.
The good news is that this is a solvable problem. We as advocates and activists must use our impatience and collective wisdom to fast-track a process to ensure that clear targets, resources and messages are developed with the same strategy, rigor and urgency as 90-90-90.
World AIDS Day takes place this year on Monday, December 1.