Is 2020 the Year Some Cities Will Stop HIV?

It’s been five years since the Fast-Track Cities initiative was launched in Paris on World AIDS Day 2014, when 26 mayors from cities around the world signed a bold declaration to address the HIV epidemic.

Since then, that number has expanded to over 300 cities and municipalities — all vowing to continue the fight against HIV and aiming to achieve the UNAIDS 90-90-90 targets by 2020: 90 percent of people living with HIV knowing their status, 90 percent of people who know they’re HIV-positive being on treatment, and 90 percent of those on treatment reaching suppressed viral loads.

London, which accounts for 38 percent of all people living with HIV in the United Kingdom, was one of the first cities to exceed the 90-90-90 targets, having achieved 95-98-97 in 2017 — much sooner than the proposed target year.

At this year’s Fast-Track conference, London mayor Sadiq Khan confirmed his commitment to ending the epidemic entirely: “I am proud of what we have achieved, but we need to go further,” Khan said. “I wholeheartedly support the United Kingdom’s bold ambition to get to zero new HIV infections, zero AIDS-related deaths, and zero discrimination.”

Sindhu Ravishankar, senior director of technical programs at the International Association of Providers of AIDS Care, presented data showing that 14 cities have surpassed the first 90 target (awareness of HIV status), 16 cities have surpassed the second 90 (treatment initiation), and 23 cities have surpassed the third 90 (sustained viral suppression). In total, four cities have surpassed all 90-90-90 targets: Amsterdam and the U.K. cities Brighton (including Hove), Manchester, and London. One of those, London, has also surpassed 95-95-95.

While other cities have seen massive improvements, Ravishankar argued that they could do more to end HIV sooner than expected — some as quickly as next year. According to IAPAC models, Zambia’s capital city of Lusaka (not yet hitting the 90-90-90 goals) could  actually end its local HIV epidemic (defined as fewer than one new HIV infection and one AIDS-related death per 1,000 adults each year) as early as 2020 rather than its original projection of 2050 if it instituted an aggressive antiretroviral therapy scale-up.

Ravishankar noted in a statement to the press, “implementing aggressive ART scale-up, including annual testing for anyone at risk and immediate ART initiation, has the potential to end urban HIV epidemics many years sooner compared to business as usual, contributing to the global goal of ending the HIV epidemic as a public health threat by 2030.”

Adding to the global efforts to stop HIV is RADIAN, a groundbreaking initiative by the Elton John AIDS Foundation and Gilead Sciences aimed at parts of Eastern Europe and Central Asia (EECA).

Building on the existing collaboration between EJAF and Gilead, RADIAN seeks to help create a greater understanding of the region’s needs to build solid action and address specific challenges.

“Every day, more than 400 people in EECA become infected with HIV and 100 die from AIDS,” Elton John said in a statement. “My Foundation’s work in establishing the Eastern Europe and Central Asia Key populations fund with Gilead and others a couple of years ago forcefully underscored for us the need to drastically expand our efforts in the region. So, I’m delighted that the Foundation is once again working with Gilead through RADIAN to provide much-needed support and funding to reverse trends and reach some of the world’s most vulnerable people. Together, we can create change, save lives, and ensure no one is left behind in the fight to end the epidemic.”