AIDS 2024: Hitting Targets

Joseph J. Amon

Greetings again from AIDS 2024.

One underlying theme at the conference is attention to global targets and if the “global HIV strategy” (if there is such a singular thing) is on track or off.

First, on targets. If you don’t pay close attention, it’s easy to think that HIV target setting is about swapping one set of jargon for another, every five years or so. UNAIDS introduced its 2025 AIDS targets (Putting people living with HIV and communities at risk at the center) in 2021, acknowledging the “close” of the “Fast-Track” era and anticipating the 2030 Sustainable Development Goal (SDG) targets, including SDG 3.3 “to end AIDS by 2030”.

The 2025 targets emphasize removing societal and legal impediments to service delivery, and “linking or integrating the provision of HIV services with the other services needed by people living with HIV and communities at risk to stay healthy and build sustainable livelihoods”. The latter was seen at the time (at least by some) as an effort to keep HIV relevant during the COVID pandemic, and as a broadening of the response, recognizing that the HIV response “sits within a wider effort to end poverty, fulfill the right to health and other human rights and other goals.” But one issue already raised at the conference is that integration HIV services often moves people from spaces with less stigma and discrimination to places with more.

A key set of targets to achieve 95-95-95:

  • 95% of people who are living with HIV (PLHIV) know their HIV status
  • 95% of PLHIV who know their HIV status are on antiretroviral therapy
  • 95% of people who are on antiretroviral therapy have suppressed viral loads.

But another set of targets is related to removing societal and legal barriers to HIV services:

  • Less than 10% of countries have punitive legal and policy environments that deny access to justice
  • Less than 10% of countries criminalize sex work, possession of small amounts of drugs, same-sex sexual behaviour, and HIV transmission, exposure or non-disclosure by 2025
  • Less than 10% of countries lack mechanisms for people living with HIV and key populations to report abuse and discrimination and seek redress by 2025
  • Less than 10% of people living with HIV and key populations lack access to legal services by 2025
  • More than 90% of people living with HIV who experienced rights abuses have sought redress by 2025.

Within this set of targets, specific goals include, by 2025:

  • Less than 10% of people living with HIV report internalized stigma
  • Less than 10% of people living with HIV report experiencing stigma and discrimination in healthcare and community settings
  • Less than 10% of key populations (i.e., gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs) report experiencing stigma and discrimination
  • Less than 10% of the general population reports discriminatory attitudes towards people living with HIV
  • Less than 10% of health workers report negative attitudes towards people living with HIV
  • Less than 10% of health workers report negative attitudes towards key populations by
  • Less than 10% of law enforcement officers report negative attitudes towards key populations.

And related to gender inequality and violence, by 2025:

  • Less than 10% of women and girls experience physical or sexual violence from an intimate partner
  • Less than 10% of key populations experience physical or sexual violence
  • Less than 10% of people living with HIV experience physical or sexual violence
  • Less than 10% of people support inequitable gende
  • Greater than 90% of HIV services are gender responsive .

These are a lot of ambitious goals!

So how much discussion at the conference is around these goals? So far, I’ve seen one session that examined laws and policies around criminalization of key populations, but during the Q&A there was a lot of concern that the data isn’t accurate or up-to-date.

Whether presented comprehensively or selectively, I am hoping that there will be more sessions this week that tackle where we are on each of these indicators, which countries are doing well, and which are being left behind.

Joseph J. Amon, PhD, MSPH, is editor-in-chief of Health and Human Rights, and director of the Office of Global Health and a clinical professor at Drexel University Dornsife School of Public Health, Philadelphia, United States.