As mentioned in our February 2016 blog post, UNAIDS set an ambitious agenda in October 2014 to achieve fast-track treatment targets to end the AIDS epidemic as a public health threat by 2030. Out of this global strategy came three “90-90-90” goals, to be achieved by 2020: 1) By 2020, 90% of all people living with HIV (PLWH) will know their HIV status; 2) By 2020, 90% of all people with diagnosed HIV infection (PLWDHI) will receive sustained antiretroviral therapy (ART); 3) By 2020, 90% of all people receiving ART will achieve viral suppression. When the targets were announced, none of the United Nations’ member states had yet achieved them.
A recent publication by the New York City Department of Health and Mental Hygiene (NYC DOHMH) Bureau of HIV Prevention and Control examined data from the NYC HIV registry and NYC Medical Monitoring Project and found that New York City had achieved the 1st and 2nd UNAIDS 90% targets for awareness of HIV status and receipt of ART (93% and 95%, respectively), but fell short of the viral suppression goal, with a total of 86% of persons virally suppressed among those receiving ART in NYC. Despite the achievement of meeting two out of three UNAIDS goals, ongoing racial disparities were pronounced. While whites achieved all three targets, Latino/Hispanics and blacks only met the first two, with both groups remaining under 90% viral suppression (84% and 85%, respectively).
New York City’s achievement in meeting the first two UNAIDS goals may reflect the success of expanding HIV testing efforts across the city, the 2010 NYS law requiring the offer of a voluntary HIV test to all persons presenting for medical care, and HIV care clinicians following the guidelines and recommendations to provide ART to all PLWH regardless of their CD4 count.
However, the racial disparities evidenced by lower viral suppression among Latinos/Hispanics and blacks may be caused by lower access to care or adherence to ART due to a variety of individual and structural factors, including but not limited to medical comorbidities, a lower level of trust in the provider/medical establishment, and sub-optimal health literacy. It is clear from these findings that more progress in helping to get persons onto HIV treatment with viral suppression is necessary in order to eliminate the disparities, which are not directly captured in the UNAIDS 90-90-90 metrics. While the third UNAIDS goal is achievable, it will depend on the success of innovative and effective interventions to improve access to care and adherence to ART among all persons living with HIV/AIDS.
Treatment as prevention is the ongoing method for HIV/AIDS management and a critical focus of the ETE initiative. Through improved access to care and strict adherence to ART, a person living with HIV with an undetectable viral load in their blood has a negligible risk of sexual transmission of infection.
Source: Xia Q, Lazar R, Bernard MA, McNamee P, Daskalakis DC, Torian LV, Braunstein SL. New York City Achieves the UNAIDS 90-90-90 Targets for HIV-Infected Whites but Not Latinos/Hispanics and Blacks. JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016; 73 (3): e59-e62.