THE updated UNAIDS targets for 2025 (95-95-95) aim for 95 per cent of those living with HIV to know their status, 95 per cent of those who know their status to be on treatment and 95 per cent of those on treatment to be virally suppressed.
While the previous 90-90-90 targets for 2020 were met by some countries, they were not met globally. The goals of fewer than 500,000 annual new infections and 500,000 AIDS-related deaths was also not in sight in 2019, with an estimated 1.7 million new infections and 600,000 AIDS-related deaths.
Achieving the Fast-Track milestones will put the world on a trajectory to end the AIDS epidemic by 2030, but country-specific challenges continue to impede that progress.
Jamaica AIDS Support for Life (JASL), in a recent Jamaica Observer Monday Exchange, said the global targets are ambitious, but while Jamaica did not meet the 2020 targets there was consistency in the treatment cascade.
“At JASL we have not seen a fall-off in our treatment cascade. Of the 942 people we have accessing treatment services at JASL, 89 per cent of those are retained on treatment and of those, 85 per cent have reached viral suppression. That is very good when we compare to what is happening nationally. We have been able to stay above the national cascade,” said Kandasi Levermore, JASL executive director.
But, despite maintaining the treatment cascade, Levermore said the team observed challenges in rural areas, where the tourism sector suffered a setback due to COVID-19. She said several clients depend on the sector to survive and where livelihoods were disrupted, it posed a challenge.
Further, monitoring and evaluation officer at JASL Xavier Biggs said the challenges in meeting the new targets are varied and affect each pillar of the cascade.
“In the very first pillar, which is the number of people living with HIV (PLHIV), there is the issue of access to testing with the number of people who are willingly coming in to be tested. As we get closer to the 90, it means it become more difficult to find those who are at risk. There is also a challenge with perception of risk. A lot of individuals are in their single partner relationship and they think they are fine and safe. And so, they don't see themselves as being at risk, despite the fact that they might have a partner who might have other sexual partners,”Biggs said.
“There are issues around the church and other spaces that are conservative and might have a negative view on testing. Getting to that last subset of individuals who need to know their status continues to be problematic. Beyond that it's getting people on treatment. So there's an entire subset of people who know their status but have so far not turned up in a treatment site and the methodologies needed to contact these individuals are just not available. This, we believe, is tied to the stigma and discrimination associated with the virus. People are afraid to know that they are positive and they don't want anybody else to know so they don't show up in a treatment site,” Biggs added, pointing out that people have a genuine fear of how they might be viewed if they test and the backlash they might receive from community and workplaces if they test positive and word gets out.
At the viral suppression stage, JASL's monitoring and evaluation officer said a more comprehensive model of care works better.
“If you focus on a biomedical approach, a lot of people won't get to viral suppression and so we've had to plug those holes with psychologists and adherence counsellors, case managers, nutritionists, psychiatrists as people don't live single issue lives. If your intervention only responds to a single issue, you're going to lose some people along the way. Where we've had the best outcomes with viral suppression is where we've been able to address the multiple needs of individuals,” Biggs said.
Meanwhile, Tisha Keane, JASL regional programmes manager for St James, said misinformation, trust, plus stigma and discrimination were the main hindrances to meeting treatment targets.
“You have people in the population, mostly men, who think because their partner is negative, they are negative. Case in point – we would have gone into communities and in a particular community, a young man's comment was that he sends his girlfriend to get tested and when she comes back, she has to show him the paper. When she comes back and shows him the paper, and she is negative, he is also assuming that he is negative. For reasons like that, you'll find that persons don't want to be tested. For the ones that are willing to be tested, they don't want to test in their communities because they feel if they come back positive, their community members, family and friends will know their status. Then for those who know their status and are on treatment, non-disclosure is an issue. High-risk communities tend to shy away because of the stigma associated to their groups.”