Charting a path to end the AIDS epidemic

Bull World Health Organ 2016;94:408 | doi: http://dx.doi.org/10.2471/BLT.16.176875 Editorials 408 From 8 to 10 June 2016, heads and rep- resentatives of states and governments, along with other key stakeholders, will assemble at the United Nations (UN) in New York, for the High-Level Meeting on Ending AIDS. There are three rea- sons why this meeting is an important milestone for the global response against human immunodeficiency virus (HIV) and acquired immunodeficiency syn- drome (AIDS). First, the meeting will provide an opportunity to reflect on the extent of progress and unprecedented achieve- ments that have been made in respond- ing to the AIDS epidemic, as described in the UN Secretary-General’s report.1 Globally, between 2000 and 2014, the number of people newly infected with HIV each year dropped by more than one-third, from 3 million to 2 million. In the same period, new paediatric HIV infections fell by 58%. Eighty-five coun- tries are close to eliminating mother-to- child transmission of HIV. The global target of millennium development goal 6 of having 15 million people on HIV treatment by 2015 was met nine months ahead of schedule.2 Second, the meeting serves as an occasion to galvanize support from the global community to scale up the AIDS response. The 90–90–90 treatment target calls for 90% of people living with HIV to know their status, 90% of people who know their HIV status to have access to treatment and 90% of people on treat- ment to achieve suppressed viral loads by 2020.3 We need to focus on specific populations and locations where invest- ments will have the greatest impact to ensure that no one is being left behind. Of the estimated 2 million people newly infected with HIV in 2014, nearly half live in eastern and southern Africa, where adolescent girls and young wom- en are disproportionately at risk.3 The number of people acquiring HIV infec- tions is increasing in several countries. Incident infections are also increasing in some cities in North America and western Europe. These increases in new infections are primarily seen in men who have sex with men, transgender people, sex workers and their clients and people who inject drugs. Across Latin America and the Caribbean, most cases occur in men who have sex with men.1 We have less than five years to step up investments in HIV prevention, treatment and care to reach this target. Third, the meeting will be an oppor- tunity to reflect on specific challenges that need to be addressed as we move forward. Among them is a treatment gap and inadequate global investments in prevention.4 Other challenges include how to increase access to diagnostic tests and eliminate HIV-related discrimina- tion. Around half of all people living with HIV are unaware of their HIV status.1 While there is a general decline in discriminatory attitudes towards people living with HIV, in about 40% of countries where studies have been conducted, more than half of adults sur- veyed reported discriminatory attitudes towards people living with HIV.5 Laws, policies and practices that are fuelling vulnerability to HIV and hindering ac- cess to services will need to be addressed as a priority. The UNAIDS 2016–2021 Strategy integrated efforts towards ending the AIDS epidemic fully into Transforming our world: the 2030 agenda for sustain- able development. The strategy sets out the links between the HIV response and several sustainable development goals (SDGs), from SDG 1 on ending pov- erty to SDG 16 on promoting inclusive societies.3 Building on the SDGs, we need a global approach to ending the AIDS epidemic, underpinned by universal principles of social equity and an unwav- ering commitment to human rights. We must pledge to invest at least 26 billion United States dollars a year in low- and middle-income countries by 2020. Diverse sources of funding, innovative forms of financing and increases in both domestic public expenditure and international assistance are all needed. Let us make history at the high-level meeting. Let us commit to charting a path forward that will secure the end of the AIDS epidemic as a public health threat in one generation. ■ References 1. On the fast-track to ending the AIDS epidemic. Report of the United Nations Secretary-General for the High-Level Meeting on Ending AIDS. New York: United Nations; 2016. Available from: http://sgreport.unaids.org [cited 2016 May 6]. 2. How AIDS changed everything. Geneva: United Nations Programme on HIV/AIDS; 2015. Available from: http://www.unaids.org/sites/ default/files/media_asset/MDG6Report_en.pdf [cited 2016 May 10]. 3. On the fast-track to ending AIDS. UNAIDS 2016–2021 Strategy. Geneva: United Nations Programme on HIV/AIDS; 2015. Available from: http://www.unaids.org/sites/default/ files/media_asset/20151027_UNAIDS_ PCB37_15_18_EN_rev1.pdf [cited 2016 May 6]. 4. HIV treatment in Africa. A looming treatment crisis. UNAIDS issues brief. Geneva: United Nations Programme on HIV/AIDS; 2015. Available from: http://www.unaids. org/sites/default/files/media_asset/ HIVtreatmentinAfrica_en.pdf [cited 2016 May 6]. 5. World AIDS Day 2015. On the fast-track to end AIDS by 2030, Focus on location and population. Geneva: United Nations Programme on HIV/AIDS; 2015. Available from: http://www.unaids.org/sites/default/files/ media_asset/WAD2015_report_en_part01.pdf [cited 2016 May 10]. Charting a path to end the AIDS epidemic Michel Sidibéa a Joint United Nations Programme on HIV/AIDS, avenue Appia 20, 1211 Geneva 27, Switzerland. Correspondence to Michel Sidibé (email: executivedirector@unaids.org).