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WEEKLY EXPLAINER
Ahead of World AIDS Day on Dec. 1, Xtra spoke to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Canadian AIDS Treatment Information Exchange (CATIE) about their 2020 priorities for the treatment and prevention of HIV/AIDS.
But first, here are some facts to catch you up Since the start of the AIDS epidemic in the 1980s, more than 70 million people worldwide have become infected with HIV and over 30 million have died of AIDS-related symptoms. In 1997, new HIV infections peaked at 2.9 million and have since declined by 40 percent to 1.7 million in 2018, according to a recent report by UNAIDS. The same report noted that the number of AIDS-related deaths have also declined worldwide. However, researchers pointed out some areas to focus on in the global fight against HIV/AIDS.
While speaking with Xtra, Peter Ghys, director of UNAIDS’ Department of Strategic Information and Evaluations, said the U.N.’s goal is to achieve its 90-90-90 targets in all countries by the end of next year.
The 90-90-90 target means that 90 percent of people living with HIV are diagnosed, 90 percent of those diagnosed are provided with antiretroviral therapy (ART) and 90 percent of those people achieve viral load suppression by the end of next year.
How will they do that? Ghys said that there’s no universal strategy when it comes to the prevention and treatment of HIV. However, knowledge and access to medications and testing centres are key. This sentiment is reflected in the latest report, Power to the People, released by UNAIDS on Tuesday.
The report “shows that [in places] where people and communities living with and affected by HIV are engaged in decision-making and HIV service delivery, new infections decline and more people living with HIV gain access to treatment.”
It also highlights how “game-changing approaches, such as medicine to prevent HIV (like pre-exposure prophylaxis or PrEP), integration of contraceptive services with HIV testing, viral load suppression (U=U), harm reduction and comprehensive sexuality education give people the power to protect themselves from HIV and, for people living with HIV, the power to thrive.”
In a release, Executive Director of UNAIDS Winnie Byanyima said, “When people and communities have power and agency, change happens. The solidarity of women, young people, gay men and other men who have sex with men, sex workers, people who use drugs and transgender people has transformed the AIDS epidemic—empowering them will end the epidemic.”
So what are the U.N.’s priorities in 2020? Aside from the 90-90-90 goal, Ghys said that UNAIDS wants to highlight the concept of U=U or “undetectable equals untransmittable” because having that knowledge, according to Ghys, “has been very liberating to people living with HIV.” An “undetectable viral load” means that antiretroviral treatment has lowered the levels of HIV virus in the body to the point that blood tests cannot detect it.
“If you do have good treatment and achieve suppressed viral load, you’re also much freer when it comes to relations with other people,” Ghys said. “It takes away stigma and stress from people living with HIV.”
When it comes to primary prevention, Ghys said there’s also an effort to promote the use of pre-exposure prophylaxis (PreP), condom use and, in some areas of the world, male circumcision, which has the potential to reduce the risk of HIV transmission through sex in heterosexual men by up to 72 percent.
What about Canada? Sean Hosein, science and medicine editor at CATIE, echoed Ghys’ stance on the effectiveness of treatment. He said, “HIV treatment is highly effective, simple to take, and many people with HIV, therefore, can live a long and healthy life.”
But he also mentioned some of the challenges: The Public Health Agency of Canada estimates that 14 percent of people living with HIV aren’t aware of their status. Hosein said in order to address this we must look at the way we conduct HIV testing.
“We need to break down barriers to testing,” he said. “For example, I think we as a society need to consider the option in the many testing options of maybe HIV home testing.”
In terms of primary prevention like the use of condoms or PreP, Hosein said there are still some improvements to be made. “More people need to know about PreP exists [and if they do], more people need to get a prescription in a timely manner, and more people need coverage because it can be expensive.”
Hosein emphasized the importance of giving people access to treatment because “when people are in effective treatment people with HIV can’t pass on the virus to their sexual partners.”
Speaking of treatments, Hosein said that a long-acting combination treatment “will become approved in Canada in the latter half of 2020.”
“For over 20 years, treatment has been largely about pills for HIV, initially taking a handful of pills several times a day. And right now, for the most part, it’s down to complete treatment in a pill once a day,” he said. “But something revolutionary is going to come next year sometime. This will be an injection that [people] get once a month and it will remove the need for taking HIV treatment every day.”
According to Hosein, there’s still no name for the long-acting HIV treatment as it’s still undergoing Health Canada reviews. As soon as details are finalized, it will be reported on CATIE’s website.
For now, Hosein said he wants to remind people that “what we know from HIV treatment today is people on effective HIV treatment can’t pass on the virus to their sexual partners.”
“More people need to know that. It’s really wonderful news,” he said.
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