Working towards viral suppression

Fighting the AIDS epidemic requires timely HIV diagnosis and treatment to help HIV-positive individuals reduce their viral load to the point where the risks of HIV transmission become negligible.

In 2014 the United Nations introduced targets to stop the spread of HIV and lay the foundation for ending the AIDS epidemic.

The aims of the 90-90-90 programme were that by the end of 2020:1

  • 90% of people living with HIV (PLHIV) know their HIV status
  • 90% of PLHIV who know their status are on sustained antiretroviral therapy (ART)
  • 90% of PLHIV receiving ART are virologically suppressed

These goals have helped drive progress in the diagnosis and treatment of HIV worldwide, but more work needs to be done. With 81% of PLHIV knowing their status by the end of 2019 and 67% of PLHIV receiving ART in 2019,2 around 59% of PLHIV on ART globally were virologically suppressed in 2019.2

Increasing the proportion of PLHIV who know their HIV status requires moving beyond a passive approach to testing, which relies on individuals recognising their own risk and coming forward to be tested, to identifying PLHIV who remain undiagnosed, and providing support and referral pathways to healthcare services.1

Normalising HIV testing and building a culture of early and regular screening is essential for high-risk populations, such as men who have sex with men, transgender people, injection drug users and women.
To achieve this, barriers to testing need to be removed and knowledge about the need for routine testing among healthcare professionals and the community needs to increase.

Key elements in the HIV management cascade:

  • Selecting ART to achieve individual treatment goals
      • Ongoing viral suppression, maintenance of immune function, lifelong good health and prevention of HIV transmission

     

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  • Starting and continuing ART
      • Key considerations when starting and switching ART

     

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