Target-setting: Australia and the global context

HIV Australia | Vol. 13 No. 1 | April 2015

A note from the editors

Since the launch of the first government response to HIV in 1989, successive national HIV strategies have guided Australia’s partnership response in the areas of HIV prevention, treatment, care and human rights.

The Seventh National HIV Strategy

Australia’s Seventh National HIV Strategy builds on these aims by including, for the first time, a set of specific targets as a key step towards the elimination of transmission of HIV in Australia.

The targets outlined in the Seventh National HIV Strategy are to¹:

Reduce sexual transmission of HIV by 50 per cent by 2015
Sustain the low general population rates of HIV in Aboriginal and Torres Strait Islander people and communities
Sustain the virtual elimination of HIV amongst sex workers
Sustain the virtual elimination of HIV amongst people who inject drugs
Sustain the virtual elimination of mother-to-child HIV transmission
Increase treatment uptake by people with HIV to 90 per cent
Maintain effective prevention programs targeting sex workers and for people who inject drugs.

UNAIDS global targets

In 2014, UNAIDS announced ambitious new global targets which aim to strengthen previous commitments outlined in the 2011 UN Political Declaration on HIV/AIDS.

With these ‘Fast-Track’ targets, UNAIDS aims to end the HIV epidemic by 2030.

By 2020, the UNAIDS goals are that²:

90 percent of people living with HIV will know their HIV status
90 percent of people diagnosed with HIV will receive antiretroviral treatment
90 percent of people on treatment will have suppressed viral loads.

In order to meet the ‘90-90-90’ targets, the UNAIDS Fast-Track strategy says action during the next five years is crucial.

UNAIDS estimates that by June 2014, around 13.6 million people had access to antiretroviral therapy, a huge step forward but still a long way off from 90-90-90.³

Other targets include reducing the annual number of new HIV infections by more than 75% – to 500, 000 in 2020 – and achieving zero discrimination. The Fast-Track report highlights how critical investment is to achieving these targets.⁴

But is 90-90-90 really achievable by 2020 in Australia?

Despite the need for political will being expressed in Australia’s key strategic documents, our coordinated partnership response is in danger of being stymied by a still unannounced tender process and persistent funding uncertainty.

Despite having more tools than ever before in our HIV prevention arsenal, we are seeing increasing rates of HIV diagnoses among men who have sex with men, both in Australia and in other countries with high antiretroviral coverage.⁵

In correspondence published recently in The Lancet, three leading Australian researchers warned that available evidence suggests a 90% reduction in HIV globally, in a climate where a cure or vaccine for HIV is still a long way off, may well not be achievable – even by 2030.⁶

They caution against an over-reliance on targets as a measure of success:

‘As successive years fail to align with ambitious HIV transmission targets, campaigns and programmes that may be successfully reducing transmission could be jeopardised if their measure of success is a substantial decline in new cases of HIV.’⁷

US-based advocacy organisation AVAC’s ‘Prevention on the Line’ report calls for a ‘sharper and bolder’ set of global HIV prevention targets tailored to specific interventions in areas including vaccine and cure research, pre-exposure prophylaxis (PrEP), combination prevention, harm reduction, treatment as prevention and human rights.⁸

AVAC argues that while targets are vitally important because they galvanise action, they can only be achieved if they are supported by political will and adequate resources.

The AVAC report stresses the need for more immediate short-term goals, saying that we can’t risk waiting five years to make sure we are on track to ending HIV.

Key recommendations of the AVAC report are to⁹:

Align high-impact strategies with human rights and realities
Invest in an oral PrEP-driven paradigm shift
Demand short-term results on the path to long-term goals.

But does the seeming impossibility of hitting 90-90-90 by 2020 mean that we should abandon ambition?

As many articles in this edition of HIV Australia argue, the focus on targets, whether they are achievable or aspirational, is driving effective programmatic and policy development.

It is essential that we continue to shape these targets and indicators such that they address ongoing policy issues in Australia, especially in the important areas of criminal law reform and stigma and discrimination, to ensure the needs of communities most affected are not left behind.

References

1 Australian Government Department of Health (DoH). (2014). Seventh National HIV Strategy 2014–2017. Commonwealth of Australia, Canberra.

2 Joint United Nations Programme on HIV/AIDS (UNAIDS). (2014). Fast-Track: ending the AIDS epidemic by 2030. UNAIDS, Geneva. Retrieved from: www.unaids.org

3 UNAIDS. (2014, 18 November). UNAIDS reports that reaching Fast-Track Targets will avert nearly 28 million new HIV infections and end the AIDS epidemic as a global health threat by 2030.Media release. UNAIDS, Geneva. Retrieved from: www.unaids.org

4 ibid.

5 Wilson, D., Stoové, M., Hellard, M. (2015), A reality check for aspirational targets to end HIV. The Lancet [Online], 2(1), e11. dx.doi.org/10.1016/S2352-3018(14)00038-1

6 ibid.

7 ibid.

8 AVAC. (2015). Prevention on the Line: AVAC Report 2014/15. AVAC, New York. Retrieved from www.avac.org

9 ibid.