90-90-90 treatment target

Results from population-based HIV impact surveys provide insight into where investments are needed

AMSTERDAM/GENEVA, 22 July 2018—Cameroon, Côte d’Ivoire, and South Africa have released new survey data on progress towards the 2020 targets. The Cameroon and Côte d’Ivoire population-based HIV impact assessment (PHIA) surveys and the South African survey all studied knowledge of HIV status, new HIV infections, condom use, voluntary medical male circumcision, antiretroviral therapy coverage, viral suppression and other indicators. 

In South Africa, which has the largest HIV epidemic in the world with more than 7 million people living with HIV and the largest treatment programme in the world with 4.4 million people on antiretroviral therapy, the new data combined with similar data from an earlier survey indicate that there has been a 40% reduction in the rate of new adult HIV infections between 2010 and 2017.

“These surveys are incredibly important and play a vital role in helping countries to review and refine their HIV programming to make sure that the right services are reaching people affected by HIV,” said Michel Sidibé Executive Director of UNAIDS.

The survey data confirm UNAIDS estimates which indicate that South Africa has also improved treatment coverage and is very close to reaching the 90-90-90* treatment targets. It found that 85% of people living with HIV knew their HIV status, 71% of people who knew their status were accessing antiretroviral treatment and 86% of people who were accessing treatment had supressed viral loads.

Viral load suppression among all people living with HIV in Cameroon and Côte d’Ivoire however was less than 50% reflecting low treatment coverage. The two countries are far from reaching the 90-90-90 targets at 47%, 91% and 80% and 37%, 88% and 76% respectively.

The largest difference between the southern African country and the two western and central African countries is observed in knowledge of HIV status, indicating that HIV testing services need to be significantly scaled up in west and central Africa.

The PHIA surveys provide key information for identifying characteristics of the populations that are not receiving services. In Cameroon, viral load suppression varied by province from 28% to 63%. In South Africa less than 50% of children and young men (ages 15-34 years) living with HIV had suppressed viral load (compared to 67% among the women aged 15-49). These data will provide critical information to allow programme managers to direct their responses to the populations and locations most in need of services.

The PHIA surveys, were led by Columbia University in collaboration with country governments and supported by the United States President’s Emergency Plan for AIDS Relief. The South African survey was conducted by the Human Sciences Research Council

* 90% of people living with HIV know their HIV status, 90% of people who know their status are receiving antiretroviral treatment, and 90% of people on treatment have suppressed viral loads.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Monaco has joined a network of more than 250 cities worldwide by signing the Paris Declaration, making a commitment to Fast-Track its response to the HIV epidemic and adopt the 90–90–90 targets.

The 90-90-90 targets are that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people living with HIV will have access to antiretroviral therapy and 90% of all people on antiretroviral therapy will have viral suppression.     

At a ceremony attended by Princess Stephanie of Monaco, who is also the President of Fight AIDS Monaco and a UNAIDS International Goodwill Ambassador, the Mayor of the Principality, Georges Marsan, stressed the importance of testing as the entry point to getting people on treatment and keeping them healthy.   

Twice a year since 2012, Monaco has taken its HIV testing campaign to the streets of the principality through its Test in the City campaign. In his speech, the mayor also underlined the importance of preventing new HIV infections.   

In his remarks at the event, UNAIDS Executive Director Michel Sidibé recalled visiting South Africa with Princess Stephanie in 2009, when just several hundred thousand people in the country had access to antiretroviral therapy to keep them alive and healthy. Today, he said, that number has expanded to 4.3 million people.

Mr Sidibé added that cities had a vital role to play as hubs of innovation and research and that they could help reach forgotten groups of people at risk of HIV infection.  

Also present at the event were Monaco’s Minister of Health and Social Affairs, Didier Gamerdinger, and the Vice-President of the International Association of Providers of AIDS Care, Bertrand Audoin.

On 4 April, Bordeaux became the latest city to sign up to the Paris Declaration to end the AIDS epidemic in cities. The Mayor of Bordeaux and former French Prime Minister Alain Juppé signed the declaration alongside UNAIDS Executive Director Michel Sidibé at the opening of AFRAVIH, the international francophone HIV and hepatitis conference being held in Bordeaux, France, from 4 to 7 April.

In signing the Paris Declaration, mayors commit to putting their cities on the Fast-Track to ending the AIDS epidemic. Mr Juppé committed to achieving the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—in Bordeaux in the next two years. He also committed to eliminating stigma and discrimination and developing a people-centred approach to the AIDS response. In addition, he said, it was crucial to educate young people on HIV, citing a lack of knowledge among French young people.

Since its launch on 1 December 2014, more than 250 cities and municipalities have signed the Paris Declaration. Leaders in those cities have recognized that their strategies for responding to the AIDS epidemic also offer them a platform to address the need for social inclusion, protection, safety and health.

With more than half of the world’s population currently living in cities and urban areas accounting for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases, cities will play an essential role in ending AIDS. The risk of contracting, and vulnerability to, HIV and TB is often higher in urban areas compared to rural areas, owing to a number of reasons, including migration, unemployment and social and economic inequalities.

The AFRAVIH conference will focus on the 90–90–90 targets as well as innovations on HIV treatment and prevention and on scientific advances.

Morocco marks 30 years of its response to HIV in 2018, with much to celebrate. Concerted efforts in the country have resulted in a 42% reduction in new HIV infections since 2010, significantly greater than the decline across the Middle East and North Africa of just 4%. HIV treatment coverage has also increased in the country, from 16% in 2010 to 48% in 2016.

Morocco has also managed to keep HIV prevalence low among the general population (0.1%). However, there are areas of serious concern. Data show that HIV prevalence is high among populations at higher risk of HIV infection, such as female sex workers (1.3%), people who inject drugs (7.9%) and migrants (3%), showing the need to do more to reach key populations with HIV services. Morocco is scaling up efforts to reach key populations through combined prevention programmes, substitution treatment for people who use drugs and increasing HIV testing.

The Executive Director of UNAIDS, Michel Sidibé, visited Morocco to show his support to the 30-year response to HIV. During the visit he met with the President of the National Council of Human Rights (CNDH), the Secretary-General of the Ministry of Health, the Minister of Foreign Affairs and International Cooperation and the United Nations Resident Coordinator and Country Team.

He stressed the importance of the United Nations Country Team’s commitment to United Nations reform and to responding to HIV through the Joint Plan. He noted the importance of having a national strategy on human rights and HIV and congratulated the CNDH as a pioneer in the region. He praised the initiative of the CNDH for carrying out training in human rights and citizenship and highlighted the important role that Morocco can play in efforts to recruit 2 million community health workers in Africa and in encouraging the local production of medicines.

Mr Sidibé congratulated the Minister of Foreign Affairs and International Cooperation on the progress of the AIDS response under the leadership of King Mohammed VI, the government’s partnership with civil society and the increase in domestic funding for HIV.  

Mr Sidibé took part in the opening ceremony of the 12th meeting of the Association for the Fight against AIDS (ALCS) to celebrate the 30-year response. ALCS has been at the forefront of the response to HIV in Morocco, working on prevention for key populations, HIV counselling and testing, psychosocial support, advocacy, resource mobilization and introducing new innovations, including community screening and pre-exposure prophylaxis.

At the end of 2016, there were estimated to be 22 000 people living with HIV in Morocco, fewer than 1000 new HIV infections and fewer than 1000 AIDS-related deaths. UNAIDS is working closely with Morocco to expand innovative approaches to HIV prevention and testing for key populations, expand antiretroviral treatment services and their integration into the health system, implement a road map to eliminate mother-to-child transmission of HIV and implement a strategy for zero discrimination. UNAIDS also coordinates the United Nations Joint Support Plan and works to ensure the availability of strategic information and mobilize and implement grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.