When it comes to HIV/AIDS, how can the global community accelerate progress towards the fourth 90?
Continuous advances in science and access to treatment have transformed HIV into a long-term chronic disease
Since 2014, the world has been working towards the 90-90-90 targets set by UNAIDS. These targets aim for 90% of people living with HIV to know their HIV status by 2020, 90% of those who know their HIV status to receive treatment, and 90% of those on treatment to have a suppressed viral load.
These ambitious goals have led to record gains: 75% of all people living with HIV now know their status; of those who know their status, 79% accessed treatment in 2017, and of those who accessed treatment, 81% had suppressed viral loads.
However, there is a growing belief that the 90-90-90 target falls short of optimizing care for people living with HIV. To truly meet all the needs of people living with HIV, we must also strive for a fourth "90," where 90% of people living with HIV also enjoy a good health-related quality of life.
Living with HIV presents unique challenges: people with HIV age between 5 and 14 years faster than people without HIV, which can lead to an earlier onset of some chronic conditions. Furthermore, age, HIV, and antiretroviral treatment increase the risk of cardiovascular, kidney, and liver diseases, as well as bone loss and certain types of cancer.
How to address HIV/AIDS stigma in health centers to achieve universal health coverage
Reducing stigma and discrimination related to HIV/AIDS is crucial to achieving the 90-90-90 target by 2020. Devex explores some of the most impactful strategies.
Along with these medical concerns, people living with HIV often continue to face many of the same challenges that made them vulnerable to HIV in the first place, including limited health literacy, lack of access to care, stigma related to their sexual identity, and drug use.
These factors are further aggravated for those living in countries where health systems are fractured, and stigma and discrimination are often prevalent and accepted.
That's why the fourth "90" has so much potential for people living with HIV. It goes beyond the goal of viral suppression to encompass HIV-related health challenges and factors that affect quality of life, such as mental well-being and experiences of HIV-related discrimination.
Efforts already underway around the world demonstrate how focusing on quality of life can yield significant gains for people living with HIV. For example, India has a national initiative called Vihaan that goes beyond access to HIV treatment by integrating programs that reduce stigma and discrimination and improve quality of life.
A key part of its successful model centers on an innovative tablet-based tool that helps streamline case management, track quality-of-life metrics, and connect clients with additional health and non-health services. To date, Vihaan has linked nearly 600,000 people living with HIV to social programs such as nutrition and pension plans and has facilitated the reporting of more than 6,000 cases of discrimination related to family and health services.
What is "the 90th room"?
Similarly, in London, an innovative government-run clinic called 56 Dean Street integrates a wide range of services—HIV treatment and therapy, mental health, and substance use—into one location to simplify access to care and address the holistic needs of the community it serves. For transgender people, the facility also provides links to sexual health and wellbeing services.
Pharmaceutical companies, including Gilead Sciences, where I work, can play an important role in accelerating progress toward the 90s. For example, we recently established the Gilead Asia Pacific Rainbow Fellowship to fund innovative projects that put people and their communities at the heart of HIV care.
An estimated 5.9 million people are living with HIV in the Asia-Pacific region, and the scale of the epidemic and the local response vary considerably from country to country. Fewer than half of young people in most countries in the region have a comprehensive understanding of HIV due to stigma and discrimination.
The Asia Pacific Rainbow Grant aims to accelerate progress toward the 90s by helping people living with HIV achieve healthy and fulfilling lives. These programs include holistic healthcare projects, research incorporating person-centered care, and efforts to address discriminatory policies, unfair workplace practices, and social stigma.
The story of HIV is one of overcoming overwhelming odds time and time again. The fourth 90 is within reach, but only if we collectively pool our resources and willpower.
In practice, this means factoring health-related quality of life into national and local plans to end HIV. For companies like Gilead, it means supporting initiatives that promote physical and mental health, celebrate diversity, and end discrimination and stigma in the workplace. On a smaller scale, all healthcare providers are moving beyond viral load and asking questions about overall health and well-being when treating people living with HIV.
We all have a role to play in helping people with HIV live well, recognizing that HIV is part of their lives among many other facets that contribute to their overall health and well-being.
From: https://www.devex.com/news/sponsored/opinion-how-to-achieve-the-fourth-90-for-hiv-95638
By Amy Flood // September 19, 2019