The Joint United Nations Programme on HIV/AIDS (UNAIDS) and its partners launched the 90–90–90 targets in 2014 with the aim of diagnosing 90% of all HIV-positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020. Despite considerable scaling up of ART across the world, 1.7 million people newly infected with HIV were detected in 2018. Eamonn Murphy, UNAIDS regional director for Asia and the Pacific, tells Sanchita Sharma why countries must retool programmes and focus on prevention, including scaling up pre-exposure prophylaxis (PrEP) for HIV-free persons at high risk of infection, and self-testing, to end AIDS. Edited excerpts:
Do you see the world meeting the 90-90-90 targets by 2020?
The simple answer is no. Some countries are doing extremely well, particularly in eastern and southern Africa. In Asia Pacific, we have a mixed but slowing response. A couple of big countries are holding us back with big epidemics; there are also some new epidemics. In the last nine years, there’s been only a 9% decline in new infections. Our progress is going backwards, that’s the real challenge.
Which are the countries doing well, and which are not?
Thailand is doing extremely well, as are Cambodia, Australia and Vietnam. But then we have the Philippines with a 200% increase in new infections in nine years, with a particularly steep rise in the last three or four years. Pakistan has had a 57% increase in the same period.
What led to the HIV outbreak in Larkana, Pakistan, this year, when at least 800 people were diagnosed with HIV, 80% of them children?
It was infection control procedures, mainly among general practitioners and local medical facilities. There were injection safety issues, including reuse of intravenous (IV) drips for saline to treat dehydration and diarrhoea in children, principally in the private sector and private blood banks. We’ve seen similar situations, but not in that scale, for example in Cambodia in the region, and globally. Pakistan quickly ordered a full investigation and scaled up testing to map it, which in a political world is a bold step.
How would you rank India on a scale of 10?
At seven, there’s been some slippage. In the Asia Pacific region [48 countries], Thailand is number one. Philippines was up there with Thailand; there was complacency and infection is back among the young in super high numbers. That’s the worry, it can happen elsewhere.
India has done a number of amazing things for the world and for its own population. Generic drugs have had the biggest impact globally to get people into treatment. Its focus on key populations (that spread infection), social contracting and putting the community first and equal in the response has been significant, but it needs to be rejuvenated. This is partly because of the lack of political will globally, regionally and at the country level, because AIDS is far from over. And at the rate we’re going, it’s going to start re-emerging in new geographic areas and new populations.
What are the new tools to stop new infection?
PrEP [pre-exposure prophylaxis] and self-testing are the two tools that really need to be scaled up. We’ve got to get prevention moving because we have a new generation that’s taking new and higher risks than the older generation that knew more about HIV. PrEP is an area India could seriously put in place; Australia saw 25% reduction (in new infection) after PrEP was rolled out there.
Should social media be used more actively for prevention messaging?
Yes. Programmes in all countries, including India, need to go through a prevention revolution. We need to retool and re-gear the programmes to target young people.
Aug 11, 2019 23:47 IST