The start of December, which kicks off with World AIDS Day, is always a good time to reflect on where we’re at in terms of the evolving landscape of HIV.

HIV is a pretty overwhelming topic. There’s a lot to get your head around. One approach to help you process all of the information about HIV is to think of the virus at three levels – global, local, and personal.

HIV – a global perspective

Around the world, HIV remains a major health issue. According to UNAIDS – the agency that leads the work of the United Nations in this area – since the first cases of HIV were reported almost 40 years ago, 78 million people have contracted the virus, and 35 million people have died from AIDS-related illnesses.

The UN aims to end AIDS as a public health threat by 2030, but the challenge ahead remains considerable.

In 2013, UNAIDS led a consultation process to set specific goals to help make progress towards ending the public health threat of AIDS. This resulted in the 90-90-90 target, which all member countries of UNAIDS committed to achieving by the year 2020. What these targets mean is that by 2020:

• – 90% of all people living with HIV will know their HIV status.
• – 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
• – 90% of all people receiving antiretroviral therapy will have viral suppression.

Despite advances in the effectiveness of prevention strategies, at the global level the rate of new infections has not materially decreased. In 2016, there were 1.8 million new HIV infections around the world. The aim of the UN is to bring that down to an annual level of 500,000 new infections by the year 2020.

UNAIDS has identified three interconnected reasons as to why some countries appear to not be making progress towards the 90-90-90 targets.

• – Lack of political commitment and inadequate investment.
• – Reluctance to address sensitive issues relating to the sexual needs of young people.
• – Lack of systemic prevention implementation.

HIV – a local perspective

The good news is that when you look at HIV statistics at a country level, we can see that some parts of the world are making progress towards achieving these targets. Seven countries have reported that they have already achieved the 90-90-90 targets. Botswana, Cambodia, Denmark, Eswatini, Namibia, the Netherlands, and the UK have already exceeded the commitment made for 2020.

The UK have recently released their analysis of the data available as at the end of 2017. That analysis reveals that in the UK, the current position is:

• – 92% of people living with HIV have been diagnosed
• – 98% of people diagnosed are receiving treatment
• – 97% of people receiving treatment are virally suppressed
• – 87% of people living with HIV have an undetectable viral load and are therefore unable to pass on the infection

“We’ve not only hit the UNAIDS targets for tackling HIV – we’ve smashed them!” confirms Matthew Hodson – Executive Director of UK health information organisation National AIDS Manual, or NAM. “It’s incredible to think that in the UK, 87 percent of people who have HIV can’t pass it on to sexual partners.”

Analysis from UK health experts confirms that it’s the implementation of Combination HIV Prevention which is the principal explanation for the fall in new HIV infections in gay and bisexual men in the UK.

Combination HIV Prevention is the term used to describe simultaneous implementation of complementary prevention strategies. This includes use of condoms, PrEP, expanded testing to enable early detection of HIV, and availability of treatment if diagnosed.

It’s the pincer movement of Treatment as Prevention and PrEP that has helped to significantly reduce the rates of new infections in places such as the UK.

“We are seeing similar falls in new infections in some countries…” confirms Matthew Hodson, reflecting on the UK data. “However, it seems to be particularly evident when we look at specific cities. Cities such as Sydney, New York, and San Francisco are making real progress in reducing new HIV infections. The roll-out of PrEP in Sydney has been something like six-times what we’ve been able to deliver in the UK, and they’ve seen a staggering drop in new infection rates.”

HIV – a personal perspective

In order to understand where you fit within today’s HIV landscape, it’s important to be clear how you can personally contribute to Combination HIV Prevention in your community.

“Safer-sex isn’t a one-size-fits all message for gay and bisexual men…” explains Matthew Hodson of NAM. “Condoms are great, but the results from places such as the UK demonstrate that combination prevention is what helps us to reduce new infections.”

What’s your perspective on HIV?

• – If you don’t know your HIV status, it’s important to get tested.
• – If you are HIV-negative, PrEP or condoms will help to prevent you from acquiring the virus. Test regularly.
• – If you are HIV-positive, Treatment as Prevention or condoms will help to prevent you from transmitting the virus.

We all have a role to play in ending the public health threat of AIDS.