December 1, 2017 — The first World AIDS Day was December 1, 1988. That same year, the Harvard T.H. Chan School of Public Health AIDS Initiative (HAI) was established to help end the epidemic. Max Essex, Mary Woodard Lasker Professor of Health Sciences and Chair of HAI, looks at the progress of UNAIDS’ 90-90-90 goals.
In 2013, UNAIDS announced ambitious 90-90-90 goals: By 2020, 90% of all people living with HIV will know their status; 90% of all people diagnosed with HIV will receive antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will achieve viral suppression. Are we on target to meet those goals?
We have essentially reached this goal already in several countries, and are close to reaching it in quite a few others. But we are also way behind in some countries, and for many of these we don’t even have good data to indicate the rate of progress. We are on target to reach the goals by 2020 in quite a few countries, including most of those in southern Africa, the region with the highest infection rates.
What is the rationale behind the 90-90-90 goals?
The rationale is both saving lives and preventing transmission. A few years ago, we realized that our best approach to prevention was to aggressively treat all HIV-infected people to keep them from infecting others. It is projected that reaching the 90-90-90 goals by 2020 would result in a 90% reduction in new infections by 2030.
Can we realistically treat our way out of the AIDS epidemic?
It is still unclear whether we can treat our way out of the AIDS epidemic. But almost all experts agree that treatment has been more successful than anyone dreamed was possible at the peak of the epidemic. And recognizing that the same drugs can also be used as PrEP (pre-exposure prophylaxis) in the high-risk uninfected to prevent new infections, there is little doubt that the value of treatment should not be underestimated.