EACS 2019 – Treatment for all: reaching the 90-90-90 goals and going beyond


  • Cristina Ferrario — Agenzia Zoe
  • Conference Reports
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 2.2 million people are living with HIV in the WHO European region (53 countries).
  • New infection rates are still high, especially in the Eastern region.
  • Tools are available to fill the open gaps.
  • Political willingness and efforts against HIV stigma are needed.

Why this matters?

  • The 2020 deadline for 90-90-90 UNAIDS goals is just around the corner.
  • Many countries are not doing well.

 

With 3,059 delegates from 98 countries, the 17th European AIDS Conference was a great opportunity to describe the state of play in fighting HIV/AIDS epidemics. More science, more young researchers and a deeper involvement of the Central and Eastern Europe (CEE) were the key characteristics of the conference, following the motto “exchange, debate, discover”.

HIV epidemiology

Estimated new infections are decreasing in Western Europe, down by 30% in the past decade. While the opposite trend is observed in Central and Eastern Europe where it has increased by 125% and 60%, respectively. About 82% of new diagnoses in 2017 were from Eastern Europe. The transmission risk patterns differ across sub-regions: MSM and heterosexual transmission account for the vast majority of cases in Western and Central Europe, while nearly a quarter of Eastern cases are due to injecting drugs use and a very large proportion due to heterosexual transmission.

Results and concerns

The number of undiagnosed people is decreasing but late diagnosis is still present in 53% of people. Antiretroviral therapy (ART) coverage is increasing although, 1 million people remain untreated and late linkage to care is common. Finally, despite evidence of an increase in people living with suppressed virus, 1.2 million treated individuals are still unsuppressed.

Goals and challenges

The European region is only partially on track to end AIDS by 2030. In the full region 80% of people living with HIV (PLHIV) are diagnosed (goal 1), 50% are on treatment (goal 2) and 44% are virally suppressed (goal 3). Western Europe is closer to the 90% targets (86%, 79%, 73%), while Eastern Europe is much further behind (76%, 34%, 26%). Effective preventive solutions are available for implementation and can be used in combination: test the population, use PrEP/PEP in HIV-negative and treat HIV-positive people, use condoms and reduce harm.

Fight the stigma!

Inequality in care and stigma should be addressed and fought to improve the quality of life of HIV-infected people. The number of HIV non-governmental agencies (NGOs) and clinics vary broadly across Europe and this translates to gaps in quality of care. The gap is magnified by a strong HIV stigma due to fear, lack of information and support, and often leading HIV-positive people into depression. Undetectable=untransmittable (U=U) is the statement to be disseminated through awareness campaigns to the whole population.