/ 8 December 2020

The global HIV response needs to get back on track

Safrica Health Hiv
Zero in: HIV self-testing kit and vending machines with medicine are ways people get treatment. Targets were not being met before Covid, but the pandemic is exacerbating problems. (Photo: Mujahid Safodien/AFP)


This year’s World Aids Day was unique in that 2020 is the milestone year for global targets. We also face the double effect of the dual pandemics of HIV and SARS-CoV-2, the virus that causes Covid-19.  

Global 90-90-90 targets are that by December 2020, 90% of all people living with HIV will know their status, 90% of those HIV-positive are getting treatment and 90% of those on treatment have reduced replication of the virus in their body (suppressed viral loads). 

Separately, the “three zeros” targets are to achieve the following by 2030: zero new HIV infections, zero HIV-related deaths and zero discrimination. Interim milestones for the “three zeros” targets are that by December 2020, we: reduce new HIV infections to fewer than 500 000, reduce Aids-related deaths to fewer than 500 000 and eliminate HIV-related stigma and discrimination. 

Achieving the 90-90-90 and “three zeros” interim targets this month would have meant that we were on track to end HIV as a public health threat by 2030. The reality is that these 2020 targets have been missed. 

As the 2020 World Aids Day report shows, progress towards meeting the 2020 HIV/Aids targets was off track before the Covid-19 pandemic. By December 2019, only 81% knew their HIV status, 67% were getting treatment and 59% were virally suppressed. And for the “three zeros” interim targets, 1.7-million people acquired HIV worldwide, a figure three times higher than the milestone of 500 000 that was set for 2020. 

The effect of Covid-19 has blown us further off course. Covid-19 continues to overwhelm health systems, and lockdowns strain economies. Supply chains for key commodities have been stretched.  

This is especially so in sub-Saharan Africa, where more than two-thirds of the 38-million people living with HIV reside. A survey conducted in five countries found that HIV medication stock availability for key drugs was down to three months or less, with reasons including failure of suppliers to deliver on time. 

Estimates suggest that total disruption of HIV medications for six months could lead to more than 500 000 additional deaths from HIV-related illnesses (including tuberculosis) in sub-Saharan Africa in 2020–2021. 

To get the global HIV response back on track and to build on the gains made so far, the Joint United Nations Programme on HIV and Aids (UNAids) is proposing a new set of targets for 2025 that, if achieved, will make it possible to end the epidemic by 2030. 

These new targets focus on a high coverage of HIV and sexual and reproductive health services, with new HIV service delivery targets aiming to achieve 95% coverage for each subpopulation of people living with, and at increased risk of, HIV.  

We know it is possible for countries to reach these targets. Botswana and Eswatini have achieved the 90–90–90 targets (with Eswatini exceeding the 95–95–95 benchmarks). These high-performing countries have created a path for others to follow.

The new targets put people at the centre, especially the marginalised and those most at risk such as young women, sex workers, transgender people and people who inject drugs.

The new targets seek to promote a conducive environment for an effective HIV response and include ambitious anti-discrimination targets so that there will be only a few countries with punitive laws and policies and a small number of people living with and affected by HIV experience stigma, discrimination, gender inequality and violence.

Continuing to strongly support HIV prevention is as critical as providing treatment. Taking Zimbabwe as an example, although the 90-90-90 (treatment) targets have largely been achieved (87-97-90), the number of new infections has remained constant, stalling progress on one of the “three zeros” targets — reducing new HIV infections. 

Although 2020 HIV/Aids milestones have been missed, lessons learned from the HIV response have informed how to deal with Covid-19, including the need to put people at the centre of any epidemic response.  

Webster Mavhu is a linguistic anthropologist, social scientist and global health practitioner who has been conducting research to inform programming for the past 16 years. He is a @aspennewvoices fellow.