June 5 marked 40 years since the U.S. Centers for Disease Control and Prevention first described cases of what came to be known as AIDS. Since then, UNAIDS estimates nearly 33 million people have died from HIV/AIDS, and about 38 million people currently live with HIV.
Millions of those deaths and infections could have been prevented because we have had the tools and medicines to control HIV/AIDS since 1996, when we introduced highly active antiretroviral therapy (HAART) at the 11th International AIDS Conference in Vancouver. HAART stops HIV replication, thus restoring health and preventing progression to AIDS and premature death. At the same time, HAART renders HIV undetectable in biological fluids, which in turn renders HIV untransmissible; in other words, HAART stops HIV transmission. These findings led us to propose the expansion of HAART to all HIV-infected individuals under the Treatment as Prevention (TasP) banner in a landmark Lancet article in 2010, and B.C. led the world in implementing TasP.
In 2014, working with the United Nations joint AIDS Program (UNAIDS), the B.C.-Centre for Excellence in HIV/AIDS (BC-CfE) developed the TasP-inspired 90-90-90 Target, designed to “End AIDS as a Pandemic by 2030” – defined as decreasing AIDS-related mortality and HIV new infections globally by 90 per cent using 2010 as the baseline. The goal was to ensure at least 90 per cent of people living with HIV were diagnosed, at least 90 per cent of those diagnosed were on HAART, and at least 90 per cent of those on HAART had undetectable HIV levels by the end of 2020. In 2015, the target was formally adopted by the United Nations and Canada, and became known as the UN 90-90-90 Target.
On the most recent World AIDS Day (Dec. 1, 2020) the BC-CfE was proud to announce, alongside B.C.’s Minister of Health Adrian Dix, that B.C. had surpassed the 90-90-90 Target, with 92 per cent of people living with HIV in B.C. diagnosed, 91 per cent of them on HAART, and 95 per cent virally suppressed. As a result, B.C. has seen a decrease in AIDS-related morbidity and mortality of over 90 per cent and a decrease in new HIV infections by over 85 per cent. These findings provide irrefutable proof that the TasP strategy works.
However, as of the end of 2020, most of the world had failed to meet the UN 90-90-90 Target. UNAIDS estimates that failure to meet the UN 90-90-90 Target globally by 2020 led to an additional one million AIDS-related deaths, and three million new HIV infections. While we don’t yet fully know the extent to which COVID-19 has worsened the situation, preliminary reports are concerning, as COVID-19 has had direct impact on the lives of people living with HIV and their access to life-saving health programs.