In 2016, the United Nations General Assembly’s Political Declaration on Ending AIDS committed countries to the 90–90–90 targets, which aim to bring HIV testing and treatment to the vast majority of people living with HIV by the end of 2020 and to reduce the amount of HIV in their bodies to undetectable levels, so they keep healthy and to prevent the further spread of the virus.

Globally, there have been remarkable gains across the HIV testing and treatment cascade. At the end of 2019, 81% of people living with HIV knew their HIV status, and more than two thirds (67%) were on antiretroviral therapy, equal to an estimated 25.4 million of the 38.0 million people living with HIV—a number that has more than tripled since 2010.

Gains in treatment effectiveness, as well as increases in the number of people who know their status and are on treatment, are reflected in the fact that viral load suppression levels among all people living with HIV increased by 18 percentage points between 2015 and 2019. Almost 59% of people living with HIV globally had suppressed viral loads in 2019. However, achieving the 90–90–90 targets results in a minimum of 73% of people living with HIV having suppressed viral loads, so the global target for the end of 2020 is unlikely to be met.

The COVID-19 pandemic also could have an impact on viral load. Early modelling showed that a severe disruption in HIV treatment could result in additional AIDS-related deaths in sub-Saharan Africa. Some countries have reported reductions in medicine collections of up to 20% in some areas and there have been multiple reports of people living with HIV not having enough antiretroviral medicine for a lockdown of more than 60 days, as well as reports of people having abandoned their HIV treatment due to a lack of food. However, monthly data from January to June 2020 reported by countries to UNAIDS have not shown substantial declines in the numbers of people currently on treatment over the six-month period.

UNAIDS International Goodwill Ambassador urges people to test for HIV and to seek treatment if necessary  

GENEVA, 23 November 2018—A little over one week before World AIDS Day, UNAIDS International Goodwill Ambassador Victoria Beckham has visited the organization’s Geneva, Switzerland, headquarters to support calls for people to know their HIV status and to seek treatment for HIV if necessary.

“I am really happy to be in Geneva to support UNAIDS in the run-up to World AIDS Day,” said Ms Beckham during her visit. “We need to make sure that people feel supported to take an HIV test by ending the stigma and discrimination still too often associated with the virus. Today, we have the medicines to keep people healthy and to stop the virus being transmitted. AIDS isn’t over yet, but it can be.”

UNAIDS estimates that there were around 36.9 million people living with HIV worldwide in 2017, with around 21.7 million people accessing life-saving medicines that keep people alive and well and stop the transmission of the virus. However, UNAIDS also estimates that around one in four people worldwide continue to be unaware that they are living with HIV.

During the visit, the UNAIDS Executive Director, Michel Sidibé, met with Ms Beckham to thank her for her support and to discuss the latest developments in the AIDS response.

“We have made a lot of progress in expanding access to treatment, but the number of people who don’t know their HIV status is still far too high,” said Mr Sidibé. “We have to make sure that people have access to testing services and are provided with treatment immediately if they need it. We also have to make sure that people have access to the full range of HIV prevention options to bring down the number of new HIV infections.”

Thanks to antiretroviral therapy, AIDS-related deaths have been reduced by more than 51% since the peak in 2004. In 2017, 940 000 people died from an AIDS-related illness worldwide, compared to 1.9 million in 2004. In 2017, however, there were 1.8 million new HIV infections.

In many regions of the world, women continue to be the worst affected by the epidemic and every week 6600 young women aged 15–24 years become infected with HIV. In sub-Saharan Africa, three in four new infections among adolescents aged 15–19 years are among girls, and young women aged 15–24 years are twice as likely to be living with HIV than men.

In other regions, the epidemic is concentrated among key populations, such as gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, prisoners and other incarcerated people and migrants.

It is estimated that around 35.4 million people worldwide have died from an AID-related illness since the start of the epidemic.

The Russian Minister of Health, Veronika Skvortsova, has reiterated the commitment to reach the targets agreed at the 2016 United Nations General Assembly High-Level Meeting on Ending AIDS.

“We have to provide every person living with HIV with quick access to the correct treatment. The Ministry of Health plans to increase the coverage of people living with HIV who know their status on antiretroviral therapy to 75% by 2019, and by 2020 the figure should reach 90%,” said Ms Skvortsova at the 28th meeting of the Health Council of the Commonwealth of Independent States, held in Saransk, Russian Federation, on 4 September 2018.

In 2018, the Russian Federation reported for the first time on national progress towards the 90–90–90 targets—in 2017, 81% of people living with HIV in the Russian Federation knew their status, 45% who knew their status were on treatment and 75% who were on treatment were virally suppressed.

In order to improve strategic information and build evidence for decision-making at the local level, the Russian Ministry of Health recently conducted a workshop on HIV estimates for representatives of 10 Russian regions. Regional experts were trained on modelling HIV estimates, which will help to ensure a more complete picture of the number of people living with HIV and of the 90–90–90 targets at the subnational level.

Eastern Europe and central Asia is the only region in which the numbers of new HIV infections and AIDS-related death are still on the rise. At the end of 2017, the number of new HIV infections in the region reached 130 000. At the end of 2017, it was estimated that the 90–90–90 cascade in the region was 73%, 50% and 72%.

“The Russian Minister of Health’s statement is another important step in a series of consistent actions undertaken by the Government of the Russian Federation to accelerate the country’s Fast-Track approach to reach 90–90–90 by 2020,” said Vinay P. Saldanha, Director of the Regional Support Team for Eastern Europe and Central Asia.

Health situation rooms—software platforms designed to support decision-making on countries’ health responses—are opening up across Africa, bridging data and decision-making in order to improve the health and lives of tens of millions of the world’s most vulnerable people.

Data integration, data warehousing and data visualization are the core of the situation room concept, providing transparent and improved information on a range of diseases. While situation rooms are virtual working space, some countries also use physical rooms in which the analytics can be discussed and acted upon.

The idea of a health situation room is that data—whether on the availability of HIV medicines, the effects of a strike by health-care workers or diagnoses of cervical cancer—are centralized, yet accessible to everyone. Whereas in the past health data on different diseases would be spread around several databases in assorted government ministries, disease-specific organizations, etc., situation rooms collect the data in one place, on one system, in a form that is easily shared. The information held by the situation room can be utilized on tablets or computers throughout the country.

“We must continue to innovate in our response to HIV,” said Michel Sidibé, the UNAIDS Executive Director. “Having reliable and up-to-date information is vital if the world is to meet its commitment to end AIDS and reach the Sustainable Development Goals.”

By pooling the health data in the virtual situation room, better and more focused health services can be made available to the people who need them. For example, having data on specific parts of a city helps to drive a location–population approach to HIV prevention services, ensuring that the right people are reached in the right place with the right services.

Through combining data on, for example, HIV, tuberculosis and cervical cancer, interlinkages between the diseases can be seen and responded to. Data can be viewed in real time, so, for example, levels of HIV medicines can be monitored in order to anticipate and respond to medicine stock-outs. Studying the effects of HIV test and treat campaigns in Uganda, the effectiveness of cervical cancer screening in Côte d’Ivoire and malaria testing and new diagnoses in Zambia are other examples how health situation rooms are benefiting health responses.

Five countries—Côte d’Ivoire, Kenya, Lesotho, Zambia and Uganda—have launched situation rooms. Data on indicators, including on HIV, tuberculosis, malaria, noncommunicable diseases and reproductive, maternal, newborn and child health are gathered, with different countries collecting different information depending on the local situation. Namibia, Mozambique and Zimbabwe are preparing to launch situation rooms, and several other countries are in the planning stage.

As part of its work, UNAIDS has been helping countries to set up their situation rooms, with UNAIDS working with countries to select the specific indicators and connecting data in the country to their situation room. Countries with existing data collection systems, that collect data separated by age and sex and at the local level, that have good Internet connectivity and that have qualified local staff are best placed to establish their own situation rooms.

The situation room programme has resulted in UNAIDS’ support to countries being enhanced, with UNAIDS able to support health information systems in a way unique in the United Nations system. UNAIDS is therefore supporting country and programmatic monitoring in a more meaningful way in those countries that have invested in situation rooms.

“For us, its strength is in bringing multiple data sets together, and sharing powerful analytics in a visual and understandable way,” said Andrew Kashoka, Deputy Director of Information Technology, Zambia Ministry of Health.

For the future, UNAIDS plans to ensure that countries have technical support so that they can continue to operate their situation rooms without support from UNAIDS. UNAIDS will also work with partners, including the Africa Centres for Disease Control and Prevention, the private sector and others, to reduce the dependency of countries on UNAIDS’ support in setting up and running the platforms.

Such investments in technology and collaboration between UNAIDS, governments and partners are driving innovative approaches to responding to AIDS and to ultimately ending the AIDS epidemic as a public health threat by 2030.

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.

Seventy-seven per cent of all adults living with HIV are virally supressed in Namibia

AMSTERDAM/GENEVA, 26 July 2018—UNAIDS welcomes new survey data showing that 77% of all adults living with HIV in Namibia are virally suppressed. The Namibia Population-Based HIV Impact Assessment (NAMPHIA) survey included 24 000 people from 0–64 years old. Participants were offered HIV counselling and testing as well as linkage to care and treatment for people who tested positive for HIV.

“Namibia’s concerted efforts to reach people with HIV testing and treatment are producing extraordinary results,” said Michel Sidibé, Executive Director of UNAIDS. “UNAIDS will continue to support Namibia in reaching all people living with HIV with testing and treatment and in boosting Namibia’s HIV prevention efforts to further bring down new HIV infections.”

NAMPHIA was a widespread household HIV survey funded by the Government of the United States of America and conducted by the Centres for Disease Control and Prevention, Columbia University and local government and nongovernmental partners from June to December 2017.

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.