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The Learning Curve #6

The Learning Curve #6

week #6 of the learning curve is coming right at you but first of all, a great and healthy Tuesday for everybody. This week in the hub we discussed the highly interesting report about the 2025 AIDS Targets of the UNAIDS. The targets focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They put people at the center, especially the people most at risk and the marginalized.

New Year, New World, New Goals

Key Learnings:

  • We need greater focus on integration with other health and non-health services

  • We need greater focus on removing societal and legal impediments to service delivery

  • Providers must tailor their services to reach those who need them most.

The Joint United Nations Program on HIV/AIDS (UNAIDS) established the 90-90-90 targets in December 2013, setting goals to be achieved by the year 2020 to disrupt the ongoing transmission of HIV globally. The first “90” of the UNAIDS 90-90-90 goal is for 90% of all people living with HIV (PLHIV) to know their HIV status. The second “90” is for 90% of diagnosed PLHIV to be on antiretroviral therapy (ART). The final “90” aims to achieve viral suppression among 90% of those on treatment.

When analyzing the completeness of the goal, it is estimated that 81% of people living with HIV knew their HIV status in 2019 and more than two-thirds (67%) of all people living with HIV were taking antiretroviral therapy. However, only a small number of countries have achieved the 90-90-90 targets by the end of 2020. Using the results of the last goals UNAIDS created new and even more challenging goals. The 2025 targets are now more focused on the people themselves and respond to the complexity of HIV control, taking into consideration individuals, vulnerable populations, health services and policy.

Knowing this, the 2025 targets focus on three interlinked areas – the enabling environment (the 10s), service access (the 95s), and service integration – with at-risk communities and people living with HIV at the center.

  1. ‘The 10s’ call for the removal of societal and legal barriers to HIV services. They state that by 2025, less than 10% of countries should have punitive laws and policies in place that target people living with HIV, or marginalized populations; less than 10% of people experience stigma and discrimination, and less than 10% of people experience gender inequality or violence.  

  2. ‘The 95s’ call for 95% testing, treatment and viral suppression targets. As well as 95% access to combination prevention services; 95% access to sexual reproductive health services; and 95% coverage of prevention of mother-to-child transmission services.

  3. Integration, calling for 90% of people living with HIV, and people at heightened risk of HIV, being linked to services important for their overall health. These include mental health, preventing and addressing gender-based violence, sexual reproductive health and rights, communicable and non-communicable disease services.

These new targets shape the way we must face health services, instead of expecting diverse people and communities to adapt to a singular approach for service delivery. The approach is holistic, addressing the wider challenges faced by people living with HIV and individuals at higher risk of HIV infection. It is important that we understand the function of these goals. These goals guide our actions, research and struggles. Appropriating these new guidelines is essential to align our actions at a global level.

References:

Sohail, M., Levitan, E. B., Rana, A. I., Heath, S. L., Rastegar, J., Kempf, M. C., & Long, D. M. (2020). Estimating the First 90 of the UNAIDS 90-90-90 Goal: A Review. Journal of the International Association of Providers of AIDS Care, 19, 2325958220919290. https://doi.org/10.1177/2325958220919290

UNAIDS, JOINT UNITED NATIONS PROGRAM HIV/AIDS. UNAIDS data 2020. 2020. Disponível em: https://www.unaids.org/en/resources/documents/2020/unaids-data.

UNAIDS, JOINT UNITED NATIONS PROGRAM HIV/AIDS. 2025 AIDS TARGETS - UNAIDS. Aidstargets2025.unaids.org. Disponível em: <https://aidstargets2025.unaids.org/>. Acesso em: 12  jul.  2021.