The time is now to raise the ambition in the fight against HIV

Neil Mulcock, vice president, EMEA government affairs, Gilead Sciences | Gilead Sciences

HIV in Europe has come a long way since the 1980s: back then, being HIV positive was considered a death sentence. Today, the epidemic has dramatically changed. We now live in a world where HIV can be a manageable condition.

Jane Anderson, consultant physician in HIV medicine at Homerton University Hospital in London, U.K., was at the front line of HIV care during the 1980s and offers an insight into the state of care for people living with HIV at that time and the progress achieved to date. She says: “Treatment in the early days was about fire-fighting the many severe acute infections that inevitably led to death for those affected. Thanks to progress over the years, people living with HIV can now expect to live as long as the general population. We have moved from death to life.”

However, despite the significant scientific progress made, aging with HIV brings new challenges for those affected. Compared with the general population, people living with HIV are more likely to develop additional coexisting medical conditions (comorbidities)^1,2, with cancer³, heart conditions and kidney failure⁴, bone fractures⁵ and mental health issues⁶ (particularly depression) being the most common. Additionally, people living with HIV continue to face stigma and discrimination across Europe, both within the health systems and in wider society. This can discourage people from seeking care and also negatively affects mental health and quality of life.

The fight against HIV is not over yet. New approaches are needed to address the long-term challenges related to living with HIV and to eliminate HIV-related stigma and discrimination.

The fight against HIV is not over yet. New approaches are needed to address the long-term challenges related to living with HIV and to eliminate HIV related stigma and discrimination.

The UNAIDS 90-90-90 goals⁷ aim to end the epidemic by 2030 by improving diagnosis, access to therapy and viral suppression. These goals successfully accelerated efforts to address HIV for many people in Europe, with some countries, particularly in western Europe, making significant progress^8,9, while others lag behind. To meet the 2030 deadline, more needs to be done to address the difference in pace at which countries progress in the fight against HIV.

As pointed out by Jane Anderson: “Although achieving long-term viral suppression is essential, we know that on its own it’s not enough. It’s clear we must go beyond 90-90-90, with the goal of ensuring that people with HIV live long and live well. Now is the time to build on all the progress that has been made and increase the level of ambition in Europe.”

When global meets local: tackling HIV at all levels is key

Successful initiatives at the local level have enabled some cities to exceed the UNAIDS targets. Gilead Sciences is involved with and supports the Fast-Track Cities initiative, a global network of cities committed to accelerating their local response to HIV. This aligns with the UNAIDS vision of ensuring zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2030.

It’s clear we must go beyond 90-90-90, with the goal of ensuring that people with HIV live long and live well.

One of the successful Fast-Track Cities is the French city of Nice, which joined the network in November 2018. Through its Objectif SIDA zero initiative, a project led by medical and other local authorities, Nice set up a series of measures encouraging prevention, testing, diagnosis and sexual education, as well as addressing addictions, mental health issues and discrimination around HIV. In 2018, the initiative also contributed to a 40 percent reduction in new HIV infections in the Nice and Alpes-Maritimes region when compared with data from 2015. Nice also collaborated with Paris on a pilot project called the VIHTest, which ran from July 2019 to June 2020 and offered free HIV testing, without the need for an appointment or a prescription.

Raising ambitions beyond viral suppression

To move successfully towards ending the HIV epidemic, it is critical to address the long-term health needs of people living with HIV. The HIV Outcomes multistakeholder coalition, of which is a co-chair, advocates for a fourth UNAIDS 90 goal on good health-related quality of life¹⁰.

The initiative, which brings together patient and community organizations, medical professionals, academics, public institutions and the private sector — including Gilead Sciences — has developed evidence-based recommendations and advocates for national and European policymakers to move “beyond viral suppression” to improve the lives of people living with HIV.

HIV Outcomes’ most recent Call to Action urges European policymakers to develop a multidisciplinary, people-centered and outcomes-focused approach to long-term HIV care; a strategy that would support people living with HIV to access health services that go beyond HIV treatment, such as services for the prevention, treatment and management of comorbidities, mental health support and sexual health advice.

HIV Outcomes members | Gilead Sciences

The Call to Action also advocates for an EU action plan to support EU member countries to achieve the 90-90-90 goals and ensure that all people living with HIV have a good health-related quality of life. As Jane Anderson notes: “If we are going to make a difference to quality of life, we must have the right data and that means the right monitoring systems must be in place.”

In 2018, the European Centre for Disease Prevention and Control (ECDC) collected information on how countries monitor quality of life for the first time. “The ECDC needs a strong mandate to make progress in this area,” says Dr. Anderson. “As UNAIDS and WHO HIV strategies come up for renewal in 2021, there is a real opportunity for leadership at the above-country level to not only place a new focus on prevention strategies, testing and early diagnosis, but simultaneously raise the ambition for the long-term health and wellbeing of people living with HIV.”

Now is not the time for complacency. European policy makers need to raise their ambition.

While tackling the current COVID-19 pandemic is imperative, it is critical for health systems to stay committed to the fight against HIV. The high debt and unemployment rates of the 2008 financial crisis particularly affected vulnerable population subgroups (for example young men), resulting in higher substance abuse¹¹. Such behavior may be a risk factor for an increased incidence of infectious diseases¹², including HIV.

Ahead of the anticipated economic downturn due to COVID-19, governments need to take steps to avoid heading for a similar trajectory. “We cannot go backwards despite the current crisis,” cautions Professor Anderson. “We need to make sure that HIV remains a priority. Today’s pandemic has highlighted the need for effective, joined-up health systems that can be agile in responding to new evidence and new technologies. This may prove to be a turning point in our approach to health and care, and policymakers must use this opportunity to develop the health and care systems that are needed for tomorrow.”

A new understanding of what it means to live with HIV in today’s world is needed.  “We need to up our game,” she concludes. “Now is not the time for complacency. European policymakers need to raise their ambition. The HIV epidemic is far from over and more effort is needed so that people with HIV can live long and live well.”

Job number: BE-HIV-2020-06-0013

Date of preparation: June 2020

References:

1. https://www.who.int/hiv/topics/comorbidities/about/en/
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8. Carter, aidsmap.com/news/sep-2016/sweden-first-country-achieve-unaidswho-90-90-90-target
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