In 2014, an ambitious new strategy was developed, under the leadership of BC Centre for Excellence in HIV/AIDS (BC-CfE) Executive Director & Physician-in-Chief Dr. Julio Montaner with the support of the BC-CfE, under the auspices of the United Nations Joint AIDS Program (UNAIDS). This was formally endorsed by UNAIDS after extensive international consultations. The new strategy had the specific goal of ending AIDS as an epidemic concern by 2030, defined as decreasing AIDS related mortality and HIV new infections globally by 90% using 2010 as the baseline. The short-term goal of the strategy was to ensure that at least 90% of people living with HIV (PLHIV) were diagnosed, at least 90% of those diagnosed were on antiretroviral therapy (ART), and at least 90% of those on ART were virally suppressed (meaning they cannot transmit the virus) by the end of 2020.
The new ambitious goal thus became known as the UN 90-90-90 Target. By the end of 2020, B.C. and a few other jurisdictions around the world had met or surpassed the target, with consequent significant favourable impact on their respective rates of AIDS related morbidity/mortality as well as HIV transmission. The original plan called for the UN 90-90-90 Target to become the UN 95-95-95 Target as of the end of 2020.
Of note, by World AIDS Day, Dec. 1st 2020, the BC-CfE was proud to announce, alongside BC’s Minister of Health Mr. Adrian Dix, that BC had surpassed the 90-90-90 Target, with an estimated 92% of PLHIV in BC diagnosed, 91% of them on ART, and 95% virally suppressed; and as a result BC had decreased AIDS related morbidity and mortality by over 90% and HIV new infections by over 85%. This provided tangible proof that the strategy works as originally intended.
However, as of the end of 2020 most of the world had failed to met the UN 90-90-90 Target. Regrettably, the were a number of factors that contributed to this, most notably insufficient international political leadership, flattening of global investments following the 2008 economic crisis, and more recently the COVID pandemic, Failing to meet the UN 90-90-90 Target by 2020 created significant anxiety in the field, as well as considerable concern regarding next steps. The new report, titled Addressing inequalities and getting back on track to end AIDS by 2030, details how the global HIV response which was unfortunately already off track in 2019, has been further undermined by COVID-19. Currently, 38 million people are living with HIV and more than 12 million people are awaiting life-saving HIV treatment. In the report, UN Secretary-General Guterres calls for enhanced global solidarity to close the HIV resource gap and increase annual HIV investments in low and middle-income countries to $29 billion (USD) by 2025 with a renewed aim to achieve the UN 95-95-95 Target globally.
“It is imperative to break out of an increasingly costly and unsustainable cycle of achieving some progress against HIV but ultimately not enough to bring about an end to the pandemic,” said Guterres in the report. “Inequalities are the key reason why the 2020 global targets were missed. By ending inequalities, transformative outcomes can be achieved for people living with HIV, communities and countries.”
The United Nations General Assembly High-Level Meeting next month will be a key moment for Member States like Canada to recommit towards the goal of ending the AIDS epidemic as a global public health threat. As UNAIDS Executive Director Winnie Byanyima said, “No country can defeat the colliding pandemics of HIV and COVID-19 on its own. Such global challenges can only be defeated through global solidarity and shared responsibility.”
Canada’s Federal Minister of Health Hon. Patty Hajdu voiced her support for the targets saying “We remain committed to our 95-95-95 targets, moving toward reconciliation with Indigenous peoples, and to reducing stigma and discrimination. By bringing together domestic and international partners, we can redouble our collective efforts to improve the health of all our citizens and finish the fight against HIV and AIDS.”
“Ending AIDS as a public health threat by 2030 is still within reach—many countries are showing that rapid progress against HIV is possible when evidence-informed strategies and human rights-based approaches are adopted,” said Byanyima. “But it requires bold political leadership to challenge and address the social injustices and inequalities that continue to make certain groups of people and entire communities highly vulnerable to HIV infection.”