What about the 10-10-10? A call to improve testing and linkage to care
High on the agenda for discussion at this year’s meeting were the 90-90-90 targets as set by UNAIDS in 2014. The narrative calls for countries to get 90 percent of people living with HIV (PLHIV) diagnosed; 90 percent of those diagnosed to be accessing treatment; and 90 percent of people on treatment to have suppressed viral loads by 2020.1
“We need to be thinking about people that don’t fall within the normal spectrum of care – the 10-10-10 – the people that remain undiagnosed, disengaged from care or remain not suppressed on treatment”
– Dr Laura Waters
While considerable progress has been made towards achieving the targets, substantial gaps persist in many countries from the W.H.O European Region.2 Even the United Kingdom (UK) is a little way off, with rates of diagnosis/treatment/viral suppression currently sitting at 88%, 96% and 97%, respectively.3 Treatment initiation and viral suppression have improved significantly; driven in part, by guideline recommendations to start antiretroviral therapy (ART) in all HIV infected persons, regardless of CD4+ cell count.4 However, too many people in the UK are still being diagnosed late, after the point at which they should have started treatment. People diagnosed late spend a longer period unaware of their HIV status with the possible risk of transmission to sexual partners. Furthermore, diagnostic delays increase the risk of serious ill-health in succeeding years.5
Dr Laura Waters, a HIV doctor from London, emphasized that the UNAIDS movement must not forget about the individuals who do not fall into the 90-90-90 category.
“It is important to remember that 90-90-90 is not a tick-box,” she said. Dr Waters stressed that 90-90-90 should not be viewed as the ‘gold standard’ for HIV management but rather the ‘minimum standard.’ “We need to be thinking about people that don’t fall within the normal spectrum of care – the 10-10-10 – the people that remain undiagnosed, disengaged from care or remain not suppressed on treatment,” she said.
According to Dr Waters, the 10-10-10 is likely to be made up of key populations including sex workers, men who have sex with men, LGBTI groups, people who inject drugs, and migrant groups — all of whom are less likely to access HIV services due to social stigma, discrimination, criminalization, and other barriers.
“In order to drive ongoing innovation and investment in HIV care we must focus on reaching the 10:10:10; including them in service design, service development and making sure that they are not left behind as we work toward achieving those goals,” she said.
U=U: Stamping down on social stigma
PLHIV experience stigma and discrimination for several reasons, which predominantly relate to societal perceptions around how HIV is transmitted. There is now a considerable body of evidence to suggest that such experiences can have a direct negative influence on an individual’s psychological and emotional health, including access to health care services.6
In response to the stigma and discrimination faced by PLHIV, AIDS 2018 incorporated promotion of the U=U Community Campaign (Undetectable = Untransmittable).7
“For people living with HIV, U=U means that if you’re taking your treatment for a sustained period of time and you’re undetectable, there’s a near zero risk of passing on the virus to anybody else,” explained Shaun Watson, Chair of the National HIV Nurses Association and Community Specialist Nurse from London.
“It’s a great piece of news,” he said. “It’s good for stigma; it’s good for adherence, and it’s a message I can give to patients that I work with. I’m really looking forward to driving the U=U campaign with my team.”
View the interviews from AIDS 2018
Dr Laura Waters