Daniel Reeders

This session addresses efforts to achieve the 95-95-95 targets in low- and middle-income and high-income country settings. Even as countries achieve the cascade goals, inequities persist in key populations as well as vulnerable and socially marginalized groups.

Angeli Achrekar (UNAIDS) describes challenges and opportunities for scaling up treatment access in low- and middle-income countries (LMICs). The world is above the UNAIDS goal for new HIV cases, yet closer to the goal for reducing AIDS deaths. Some countries close to the 95-95-95 goals are missing the mark in key populations. LMIC governments allocate only 2.1% of funding to key populations despite 21% estimated need. Criminalisation of sex work and male-to-male sex remains a widespread barrier to testing and care. A new report, The Path That Ends AIDS, identifies program and policy ‘building blocks’ for effective prevention strategy. Mark Stoove (Australia) reports on HIV cascade outcomes for Melbourne under the Fast Track Cities framework. The ACCESS initiative reports accelerated progress through the cascade, with the median time from diagnosis to viral suppression decreasing from 252 to 51 days during 2012-19. A 1% increase in population viral suppression corresponds with a 5% decline in HIV incidence; with incidence declining by 54% during 2010-19. This decline is concentrated among Australian-born, permanent-resident gay and bisexual men, with an increasing proportion of heterosexuals and temporary residents being diagnosed in low-HIV–caseload clinics. Work is needed to address these inequities and close the gaps.

Angeli Achrekar (UNAIDS) notes that disparities in pharmaceutical pricing pose a barrier to achieving cascade goals. Prices are almost 2.5 times higher in LMICs outside of western and central Africa. The UNAIDS Global Update ‘The Path to End AIDS’ mentions legal challenges by the Make Medicines Affordable campaign against patents that maintain monopolies on medication access, saving an estimated US $473 million in Argentina, Brazil, Thailand and Ukraine alone. We should not shy away from analyzing the role patents and global capital play in sustaining health inequities in HIV, or from mobilizing affected communities to demand transformative change.

Immaculate Owomugisha Bazare

This session tracked 95 95 95 targets using data disaggregated by gender and age. Countries that have achieved these targets include Zimbabwe, Botswana, Eswatini, Rwanda, and the United Republic of Tanzania. The numbers of young people living with HIV and failures to initiate children with HIV into care were highlighted

In a symposium chaired by Eamonn Murphy, global progress on achieving 95 95 95 targets was reported, together with reflection on how data is informing the progress towards the targets and where gaps still exist. The panellists included a representative from UNAIDS who discussed the risk practices that can increase HIV incidence in communities, especially among the young people. These include inequalities that increase vulnerability, discriminatory attitudes toward people living with HIV, structural barriers such as criminalization laws, psychosocial factors, HIV drug resistance preventing people with HIV from attaining undetectable viral loads, and non-supporting health systems. Discussants in the session raised concerns about addressing new infections, including discussants from Indonesia, reflecting on how 30 % people living with HIV are married women.

While some countries especially those in southern and eastern Africa have progressed in achieving the 95 95 95 targets, there remains a need to create and maintain enabling environments that addresses structural barriers to HIV prevention and care services, reduce inequalities, address stigma and retain people living with HIV in care. The systematic use of data to regularly track progress toward global goals can assist in goal-setting and service planning to achieve targets.