Achieving a world without AIDS: Scale must give way to focus, details

January 27, 2015, NIH/National Institute of Allergy and Infectious Diseases

The global AIDS community has its sights set on three new goals, known as the "90-90-90" targets. That is, by 2020, 90 percent of people living with HIV should know their HIV status, 90 percent of those who test positive for HIV should begin antiretroviral therapy (ART), and of those who begin ART, 90 percent should achieve virologic suppression, meaning their virus levels are not detectable using standard tests. Meeting these targets would be an enormous step toward a world without AIDS. However, to meet these targets, the traditional approach of broad, population-based treatments, prevention messages, and technologies must give way to more specific and focused approaches, according to a new commentary from Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and colleague Hilary D. Marston, M.D., M.P.H.

First, the global AIDS community needs to determine the geographic distribution of HIV transmission and to identify those geographic areas with the highest incidence. Additionally, identifying at-risk subpopulations within these areas and understanding what drives that risk is crucial. For example, men who have sex with men (MSM) are at most risk for HIV infection in the United States, yet within that subgroup, HIV seroprevalence is four times higher among black MSM than among white MSM, and virologic suppression is 50 percent lower, according to the authors. Additionally, prevention tools must be tailored to each population's risk profile. For example, pre-exposure prophylaxis along with other interventions could be appropriately targeted to MSM. Finally, researchers must develop innovative tools and technologies to better suit the needs of each at-risk population.

To reach the 90-90-90 goals—and a world without AIDS—the global AIDS community must focus on the populations most vulnerable to HIV, target interventions that are most effective and sustainable, and improve the continuum of care for people with HIV, the authors conclude.

Explore further: Study shows dire consequences from elevated HIV cases among US black gay men

More information: AS Fauci and HD Marston. Focusing to achieve a world without AIDS. Journal of the American Medical Association, DOI: 10.1001/jama.2014.17454 (2015).

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