Winning and Losing the War Against AIDS

I was in Paris this week to attend a meeting of the International AIDS Society.  I came home feeling like we are both winning and losing the war against AIDS.

The good news is that from a numeric perspective we are making good progress toward the 90-90-90 targets for 2020 set a few years ago by UNAIDS: that 90% of the people living with HIV will know their status; that 90% of them will be on treatment; and that 90% of them will have achieved viral suppression.  According to a UNAIDS report released two weeks ago, we had achieved 70-77-82 by the end of 2016.  Combining those numbers, 44% of people living with HIV are virally suppressed, meaning that they cannot transmit HIV to someone else.  If we are able to continue this rate of progress, we should be able to reach 90-90-90 by 2020, which will be a major milestone on the way to ending AIDS as a public health threat by 2030.

But, in the words of Michel Sidibé, Executive Director of UNAIDS, "Our progress is very fragile."  One major challenge is resources.  Contributions from donor countries have been slowing down over the last few years.  To a degree, countries with a high HIV burden have filled the gap from domestic sources, but there is still a very high risk that the resources required to sustain the progress simply won't be there.   If the resources aren't there, then we will lose the gains we have made.

The other major challenge involves social issues, such as stigma and discrimination, which continue to be significant barriers that stop many people from being tested and treated.  Many marginalized populations are much further from 90-90-90 than the overall statistics would indicate.  Ambassador Deborah Birx, head of the United States PEPFAR program, stated quite categorically that reaching 90-90-90 can only be reached when all population groups reach it.

I was struck again by the great diversity of the various population groups and communities that continue to be affected by the AIDS epidemic:  young girls, heterosexual couples, injection drug users who share needles, children born with HIV, men who have sex with men, sex workers, prisoners, migrants.  Some are at the margins of society, others are at the center.  But the overwhelming reality is that we are all in this together, and together we can overcome the challenges and win the war against AIDS.