Programmes to scale-up HIV testing and treatment in countries in sub-Saharan Africa may have had less impact on new HIV infections than hoped, partly because they haven’t paid enough attention to groups that contribute disproportionately to HIV acquisition and transmission, experts say.
Greater efforts should be made to ensure that ‘universal test and treat’ programmes really are universal, they add. Programmes must reach young men, people travelling to look for work, sex workers, men who have sex with men, and other key populations.
Similar arguments are put forward by Dr Stefan Baral and colleagues in the September issue of The Lancet HIV and also by Dr Katrina Ortblad and colleagues in September’s Current Opinion in HIV and AIDS.
A number of countries are close to reaching or have surpassed UNAIDS’ 90-90-90 targets, which aim for at least 90% of people with HIV to be diagnosed, 90% of diagnosed people to be taking treatment, and 90% of people on treatment to have an undetectable viral load. As reaching these targets is projected to bring us to the end of the epidemic, scientists are paying increasing attention to whether achieving this level of coverage always results in meaningful reductions in new HIV infections.
For instance, UNAIDS’ data show that while treatment coverage in Botswana increased from 45% in 2010 to over 80% in 2017, annual infections slightly increased over the same period of time. Rwanda’s even more impressive scale-up of treatment has only been accompanied by a small decrease in new infections.