- By 2020, 90% of all people living with HIV will know their HIV status.
- By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
- By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
UNAIDS, 2014, 90-90-90
It is the last stop, essential to the success of all three 90s to be reached in the next five years, to, as UNAIDS projects, conquer HIV as a global health threat by 2030: That treatment for at least 90 percent of people taking antiretroviral medicine for HIV suppress their virus to undetectable levels. That comes to just 73 percent of people living with HIV receiving effective treatment after the math for the first two 90s, but in a world strewn with obstacles to diagnosis, care, medicine, and sustained treatment, this is considered an ambitious plan. Not the least of the hurdles to reaching that final benchmark is a gap the organizers of a campaign across Africa are highlighting — that testing to determine if treatment is working is out of reach for most people living with HIV worldwide.
The campaign to speed access to viral load testing, which began with a march of about 300 people through Lusaka, Zambia last week, targets policymakers as well as people living with HIV, with a message to make use of a tool taken for granted in the U.S. and other well-resourced countries. It calls on national policy makers to follow 2013 World Health Organization recommendations that viral loads of people living with HIV be monitored once or twice a year to better detect and more quickly respond to failing treatment. The recommendation, included in WHO’s 2013 guidelines for antiretroviral treatment for HIV, acknowledges that “targeted” viral load testing, used after symptoms and other testing has indicated treatment isn’t working, is less expensive, and notes that cost is a consideration in resource-limited settings. The guideline also notes, however, why delays in discovering increases in patients’ viral loads can be more costly, leading to greater risks of illness, transmission and drug resistance. Coordinated by the International Treatment Preparedness Coalition and the AIDS and Rights Alliance for Southern Africa with advocates across Botswana, Cameroon, Ivory Coast, Kenya, Malawi, Morocco, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe, the campaign calls on African governments to make the investments necessary to increase access to viral load tests at health care facilities.
A web site for the Be Healthy — Know your viral load campaign shows that governments of most of the countries currently targeted have adopted the WHO monitoring guideline, but that access to the test is not routine and remains limited.
The campaign includes a video aimed at policy makers, illustrating the importance of viral load testing through the stories of London Chuma, a Zambian man tested after his health deteriorated, and Doreen Nasaala, of Kampala, Uganda, born more than two decades ago with HIV, and still waiting for a viral load test.
The campaign also reaches out to people living with HIV, in a 60-second video narrated by Chuma.
A video of the march, accompanied by the Army Brass Band playing the Zambia National Anthem can be seen here.