90-90-90 treatment target

The 2030 Agenda for Sustainable Development takes ​to scale ​what the AIDS response has been working towards for 30 years—a multisectoral, rights-based, people-centred approach that addresses the determinants of health and well-being. The individual stories in this series highlight the linkages between HIV and related Sustainable Development Goals (SDGs), each told from the personal perspective of people affected by HIV. The series paints a picture of how interconnected HIV is with the SDGs and how interdependent the SDGs are with each other. Most importantly, the stories show us the progress we have achieved with the AIDS response and how far we have left to go with the SDGs.  

New Year celebrations took a turn for the worse last year for Welber Moreira. The 23-year-old Brazilian found out he was living with HIV.

He described feeling ill the day after Christmas, so he went to a public health clinic to get some answers. Instead, the doctor posed a startling question. He asked me, “‘Can I see your most recent HIV test result?’” Welber had never thought that a virus from some long-gone biology class would ever affect him. The doctor told him to go to one of the public voluntary counselling and testing centres in his hometown of Ribeirão Preto, north of São Paulo, where he took a rapid HIV test. His positive diagnosis was confirmed by a second test.

“After all the crying in front of the nurse, I thought of my girlfriend, because we had not been using condoms,” Welber said. His girlfriend tested negative for HIV. She began her 28-day prevention treatment even before Welber started taking his own antiretroviral medicine. Brazil’s public health system covers all HIV prevention and treatment costs, which made it easy for both of them to start taking medicines.

Something else worried him. “I was very scared and afraid of the side-effects,” Welber said. Surprisingly, he said, he has felt fine since starting his HIV treatment. Now, before going to bed he takes two pills a night. Shrugging his shoulders, he said, “I can’t imagine what it was like in the past, to take several pills a day, at different times.”

He is among more than 100 000 Brazilians to be given a new HIV medicine called dolutegravir (DTG), which has fewer side-effects and is more effective. The Brazilian Ministry of Health successfully negotiated to purchase DTG at a discount of 70%, bringing down the price per pill to US$ 1.50 from US$ 5.10. As a result, more people will have access to this new medicine within the approved budget for treatment in the country (which stands at US$ 1.1 billion for 2017).

Welber is thankful for his girlfriend’s support and the efficiency of the clinic and centre, all of which helped him overcome the initial trauma.

Bringing up HIV and his status no longer upsets Welber. He said he speaks openly about it to his friends and at work. A small part of his family didn’t cope well with the news but he has not lost hope.

He has big plans with his girlfriend. “We plan to have two kids, starting three years from now,” he said.

He also said that he feels like he has to help others. “Whenever I can, for example, I pass by the local health clinic and grab some condoms for my colleagues at work and my friends,” Welber said. “It’s an opportunity for me to share what I know and to talk about prevention.”

SDG 9: Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

The scale-up of HIV treatment in low- and middle-income countries over the past 15–20 years is one of the greatest success stories of global health. In sub-Saharan Africa at the end of 2002, only 52 000 people were on treatment. Thanks to increased levels of production and full use of patent flexibilities, the number of people on treatment grew to 12.1 million in 2016. Lessons learned from the AIDS response have gone on to increase access to medicines for people living with TB, hepatitis C and noncommunicable diseases.

Researchers and scientists continue to innovate and improve the efficacy of antiretroviral medicines and to pursue a cure for HIV. Antiretroviral medicines have evolved so a person living with HIV who is taking their medicines regularly can now expect to live a normal lifespan.

When the Brazilian Government granted universal access to antiretroviral medicines in 1996 they changed the course of the national epidemic and increased survival rates remarkably. Dire predictions of large-scale AIDS-related deaths never came to pass. Brazil’s Unified Health System is continuing to lead the way and has recently incorporated the most advanced scientific and medical technology into routine HIV services. Welber’s story tells us how much SDG 9—build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation—is interwoven with increasing equitable access to medicines and achieving progress on ending AIDS.

AIDS is not over and it’s time to remove the barriers around access to HIV testing, treatment, care and support once and for all—these were the messages from an event hosted by Sentebale and the London School of Hygiene and Tropical Medicine on 10 July.

Sentebale, which is Sesotho for “Forget me not”, supports young people living with and affected by HIV by making sure that they are not forgotten. Sentebale was co-founded by Prince Harry, who attended the event, entitled Let Youth Lead.

The event, chaired by the Director of the London School of Hygiene and Tropical Medicine, Peter Piot, was held in London, United Kingdom, and brought together global and regional decision-makers in the AIDS response to discuss the barriers that prevent young people in southern Africa from getting tested for HIV.

UNAIDS is working with countries to achieve the commitment in the 2016 United Nations Political Declaration on Ending AIDS of ensuring that 90% of young people have the skills, knowledge and capacity to protect themselves from HIV and have access to sexual and reproductive health services by 2020, in order to reduce the number of new HIV infections among adolescent girls and young women to below 100 000 per year.

The United Nations Economic and Social Council (ECOSOC) has adopted a resolution urging Member States to Fast-Track the AIDS response. They agreed to meet the 2020 milestones and targets as a prerequisite for ending the AIDS epidemic by 2030 and to invest the necessary financial resources.

During a meeting on 7 July, Member States considered the significant progress and outstanding challenges in the AIDS response and the work of the Joint Programme, before adopting the resolution. The meeting was chaired by the ECOSOC Vice-President, Marie Chatardová, Ambassador of Czechia to the United Nations. Ghana and the United Kingdom of Great Britain and Northern Ireland, the Chair and Vice-Chair of the UNAIDS Programme Coordinating Board, co-facilitated Member State negotiation of the resolution and introduced it to ECOSOC.

Free and anonymous HIV testing and counselling were available from the Test to Win pavilion in Kazan, Russian Federation, during the Fédération Internationale de Football Association (FIFA) Confederations Cup, held between 17 June and 2 July.

The pavilion also included an exhibition on HIV and sports and was the scene for workshops, training and appearances by sports celebrities, during which visitors could learn more about HIV. Fatma Samoura, the FIFA General Secretary, visited the pavilion, as did 2018 FIFA World Cup Ambassador Alexey Smertin, Miss Russia 2017, Polina Popova, and the photographer Serge Golovach.

During the two weeks of the competition, more than 3500 people visited the pavilion and received counselling on health issues—more than 1000 of whom were tested for HIV.

The campaign was led by the nongovernmental organization New Century, in partnership with Svetlana Medvedeva’s Foundation for Social and Cultural Initiatives and with support from the Ministry of Health of the Russian Federation, the Republican Center for Prevention and Control of AIDS, the Ministry of Health of Tatarstan and UNAIDS.

On 26 and 28 June, Kazan hosted FIFA’s Forum 'Football for Hope' to promote and develop the use of football as a tool for social development in the Russian Federation and abroad. The forum brought together representatives of nongovernmental organization supported by FIFA’s Football for Hope from all over the globe to share their experiences and successes working in social development in football. The programme included panel discussions with the participation of UNAIDS and others on how football can help to achieve the Sustainable Development Goals.

The Executive Director of UNAIDS, Michel Sidibé, has spoken out about the need for continued leadership in global health from the United States of America to end the AIDS epidemic. During a speech at the Foundation for AIDS Research (amfAR) Capitol Hill Conference, Mr Sidibé said, “What scares me is the move to a conspiracy of complacency. People think that AIDS is done, that we can move on. Now is not the time to lose our momentum.”

Senior United States officials, researchers, implementers, policy-makers and advocates were present at the event, which was held to review the substantial progress in the response and what is required to end the AIDS epidemic by 2030.

The conference, Making AIDS History: a Roadmap for Ending the Epidemic, was chaired by Susan Blumenthal, amfAR’s Senior Policy and Medical Advisor and former United States Assistant Surgeon General. Speakers acknowledged the strong bipartisan commitment and leadership of successive United States Administrations and the Congress, which have saved millions of lives and made it possible to begin envisaging a world without AIDS. It was noted that cuts to international assistance, multilateral organizations and United States global AIDS programmes would have irreversible and devastating consequences.

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, presented data illustrating dramatic results, including progress towards reaching the 90–90–90 targets among adults in Malawi, Zambia and Zimbabwe and corresponding declines in new HIV infections.

“It is remarkable what we have achieved, bringing together governments and communities, with the support of UNAIDS and collaboration with the Global Fund to Fight AIDS Tuberculosis and Malaria,” said Ms Birx. “These essential partnerships make hard-earned United States taxpayer dollars go so much further and amplify our results.”

Mr Sidibé emphasized that partnership and global solidarity are paying off—in both economic terms and in the number of lives that have been saved. “The generosity and compassion of the American people has helped us move from despair to hope,” he said.

Kenneth Cole, Chief Executive Officer of Kenneth Cole Productions, Chairman of amfAR and International Goodwill Ambassador for UNAIDS, referred to commitments made by governments to Fast-Track the response to the epidemic and said that strong, continued United States leadership is essential to seizing the moment and dramatically scaling-up access to HIV treatment and prevention services. “We are at a tipping point and tipping points can go one of two ways—we have to end up on the right side. We have come too far to see 35 years of hard won progress grind to a halt,” said Mr Cole.

UNAIDS is leading global efforts to end the AIDS epidemic and is working with countries, donors, civil society and partners to increase action and Fast-Track the response to HIV over the next four years to end AIDS as a public health threat by 2030.