When the U.N. met its goal to provide 15 million HIV-affected people with treatment by 2015, it did not pause to celebrate its victory. Two years prior, in 2013, the organization had already crafted a new goal in the fight against the HIV/AIDS epidemic. By 2020, UNAIDS hopes to see a world that has accomplished something miraculous: 90-90-90.
90-90-90 is a target comprised of three interconnected objectives:
- By 2020, 90 percent of people living with HIV will know their diagnosis.
- By 2020, 90 percent of all HIV-positive individuals who have been diagnosed will receive antiretroviral therapy.
- By 2020, 90 percent of all HIV-positive individuals undergoing treatment will achieve viral suppression.
While the plan is straightforward and succinct, UNAIDS has self-awarely deemed it a “bold new target,” which may seem impossible to achieve to some. However, many countries around the globe are well on their way to achieving the elusive 90-90-90.
Most of the nations closest to 90-90-90 are part of the developed world, including Australia, Denmark and the UK. Unfortunately, poverty and weak healthcare systems make developing regions particularly vulnerable to the transmission of HIV. In fact, HIV is the second leading cause of death in developing countries.
HIV is more prevalent in Africa than in any other continent. Since the start of the AIDS epidemic, African countries such as Zimbabwe, Uganda and Botswana have exhibited average life expectancies up to 20 years lower than the rest of the world.
Despite HIV’s lethal presence in the developing world, there are methods that can be implemented to decrease HIV transmission and facilitate treatment in all nations.
In order to increase the amount of HIV-positive people who know their status, HIV testing must become more proactive. Some individuals infected with the HIV virus may not present symptoms and, therefore, will not be tested for the disease and never learn their status. Health campaigns in Uganda have increased their coverage of HIV status by 72 percent, simply by incorporating HIV tests in routine healthcare visits.
In many countries, HIV treatment is flawed due to its reliance on CD4 cell count. CD4 T-cells are the immune cells destroyed by the HIV virus. Ordinarily, HIV treatment is only given to people whose CD4 levels are low enough to put them at risk of developing AIDS. However, without treatment, anyone with HIV can pass on the virus, regardless of CD4 levels.
In 2002, Botswana began offering antiretroviral treatment to anyone infected with HIV. Botswana is now closer to 90-90-90 than almost any other country in Africa.
HIV treatment must be sustained in order to reach viral suppression – the final objective. In the Caribbean, 66 percent of individuals receiving treatment attain viral suppression. The ability to ascertain viral suppression status is reliant on viral load testing, which analyzes the amount of the HIV virus in the blood. Unfortunately, the medical technology required for viral load testing is not easily accessible throughout the globe. Recent data shows that the ability to perform these tests will likely inhibit viral suppression in the developing world. However, the work of Diagnostics Access Initiative, which creates sustainable medical labs, has successfully decreased the global price of viral load tests by 40 percent, which will make them more accessible in impoverished regions.
While 90-90-90 may seem like an ambitious or overly optimistic dream, the methodology of efficiently diagnosing and treating HIV has proven successful in many countries. If strategically implemented on a global scale, these methods could feasibly eradicate HIV/AIDS and eventually heal the world of this epidemic.
– Mary Efird