Are the UNAIDS 90-90-90 targets achievable?

CHILUFYA KASANDA writes: I’m a Zambian HIV prevention advocate. My country is one of many that are the epicenter of the HIV/AIDS epidemic. According to UNAIDS, 1.2 million people are currently living with HIV in Zambia, yet just over half are currently receiving antiretroviral treatment. The adult prevalence rate is 12.9%, and there are an estimated 20,000 deaths each year due to AIDS-related complications.

This past week, I attended my very first International AIDS conference. In fact this is the first time I ever attended such a big conference. I had really high expectations, especially considering the conference theme of “Access Equity Rights Now”.

Over the last several months, I’ve been hearing a lot about the UNAIDS targets of 90-90-90 by 2020 – whereby 90% of people are tested, 90% of those who test HIV positive are put on antiretroviral treatment, and 90% of those on treatment are able to suppress HIV. I’ve also been hearing a lot about the new UNAIDS fast track commitments – for instance elimination of new HIV infections by 2020, the target of initiating 3 million people on pre-exposure prophylaxis by 2020, eliminating gender inequalities and violence against women and girls, and circumcising an additional 27 million men and boys in the priority countries where male circumcision prevalence is low and HIV prevalence and incidence are high.

I was hoping to hear concrete commitments that match with the said targets. And session after session, I waited. ‘Maybe I’m going to the wrong sessions’ – I told myself. I consulted with other advocates and even random conference delegates – and it seems like I wasn’t alone. The only thing I kept hearing were activists and advocates asking funders, governments and other key players for satisfactory answers on how the identified targets and gaps will be addressed.

I know that there have been many gains since the last International AIDS Conference in Durban in 2000 – for instance 17 million people are now receiving treatment globally (compared to just over 1 million 16 years ago); 12 million men and boys have been circumcised (the goal was to circumcise 20 million); we now have PrEP etc. That’s all good. But, these gains are seriously threatened if funding for the HIV/AIDS response keeps dwindling; if some groups like adolescents, young women and girls, key populations are being left behind.

And what was disheartening to me was seeing how flashy and posh some of the stands of the donors and pharmaceutical companies looked at the conference. Every time I passed one, I couldn’t help but wonder how many more people could have been put on treatment and provided comprehensive prevention therapies instead of building some of those spacecraft-looking stands. Where are the priorities? Whom do we represent? Whose lives do we work so tirelessly to improve? How many lives could be saved if our priorities are set right? My main take home message coming out of Durban is that we – all of us, activists, governments, donors and other stakeholders must hold ourselves to greater account – we must walk this big talk we’re talking, otherwise our targets will just remain in the publications we write and in the speeches we make.