AIDS 2018: The way to 90-90-90 success against HIV (and more) can be found in Amsterdam

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Science Speaks is covering the 22nd International AIDS Conference this week live from Amsterdam, the Netherlands, with breaking news, updates and analysis of new research findings, evidence-based responses, and community action for global access to HIV treatment and prevention.

AMSTERDAM – While global momentum remains insufficient to reach testing and treatment goals deemed critical to controlling HIV, cities with coordinated, localized responses are nearing, have met and even exceeded those goals, data presented here Saturday showed.

One is Amsterdam, where, by 2016, 94 percent of all people living with HIV knew it, 93 percent of them were on antiretroviral treatment, and that treatment was effective and consistent enough in 95 percent of those to suppress the virus to undetectable — and untransmittable — levels. Amsterdam has halved its numbers of new infections since 2010, according to the data.

UNAIDS has projected that if, worldwide by 2020, 90 percent of people living with the virus are diagnosed and informed, 90 percent of them are receiving treatment, and treatment is suppressing the virus in 90 percent of them, HIV would be ended as a global public health threat by 2030. Data released by UNAIDS in the week preceding the conference, however, showed efforts to make that happen on a global scale are falling far short, particularly in reaching traditionally marginalized populations that include people who inject drugs, sex workers, men who have sex with men and transgender women, as well as among adolescents and young adults.

In addition to long-standing laws and policies reducing harms from drug use and sex work, Amsterdam forged partnerships between government, community and clinical networks to maximize data collection and use, and to develop health services meeting patient needs, Dr. Paula Munderi of the International Association of Providers of AIDS Care said.

The host city of this conference, Amsterdam was among the first of cities around the around the world to sign on to the Fast-Track Cities initiative launched in 2014 by IAPAC, UNAIDS, and the United Nations Human Settlements Program committing to accelerated and comprehensive efforts to meet the 90-90-90 goals.

New York, Paris, and Melbourne (assumed to have advanced since 2017 when data showed 88 percent of those with the virus aware of their status, 95 percent of those receiving treatment, and viral suppression in 94 percent of them) also have reached the goal, Dr. Munderi said. In addition she highlighted efforts in Kiev, the first city in Eastern Europe to sign on to the initiative, which has since increased its budgeted funds for antiretroviral treatment by 132 percent, and Nairobi, one of the first cities in Africa to adopt pre-exposure prophylactic use of antiretroviral medicine — PrEP — in accordance with World Health Organization guidelines.

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