Advances in the HIV prevention and treatment have increased the likelihood of eliminating the HIV epidemic, although changes in the disease management guidelines have yet to be implemented. Indeed, the HIV experts always emphasize the importance of accessible HIV testing campaigns, effective prevention procedures and strategies targeted at high-risk communities, availability of free treatment, and elimination of discrimination and stigma in fighting the HIV epidemic.1
There are many evidence-based approaches available for eliminating HIV transmission and prolonging the lives of patients infected with HIV. To prevent the sexual transmission, individuals could use condoms, take pre-exposure prophylaxis (PrEP), early antiretroviral therapy (ART) and voluntary medical male circumcision.2 Populations at high-risk who inject drugs could enroll in harm reduction programs, such as opioid substitution therapy and needle-syringe programs, to stop the HIV transmission.2 For people living with HIV, virologic suppression and reduced mortality could be achieved by administering ART.2
The global incidence of new HIV infection has slightly decreased to 1.7 million cases in 2018.3 Early access to life-saving ART worldwide resulted in the great decline of AIDS-related deaths.3 Despite the remarkable achievements in the development of ART and the recent advances in HIV prevention, the decline rate is insufficient to reach the 2020 target set by the United Nations. This reveals a gap between the resources for controlling the HIV epidemic and actual requirements. Based on an analysis of six regions, experts have summarized four key strategies towards the successful interruption of the HIV epidemic.1
HIV testing should be scaled up and easily accessible.1 A strong partnership approach in Australia between affected communities, government, clinicians, and researchers has led to the lowest rate of HIV notifications in New South Wales since the surveillance began in 1985.1 In London, the number of HIV diagnoses had fallen by almost half, mainly due to increased availability of interventions that focus on men who have sex with men (MSM) and bisexual men in particular.1 Simplifying the consent for HIV testing has also helped San Francisco to attain higher accessibility.1
Treatment for HIV should be free and available to all people living with HIV.1 Since providing ART to all HIV-infected individuals helps suppress the viral load and control transmission of the virus, the “test and treat” approach was recommended and implemented in many regions.4 In 2010, San Francisco made headlines by advising people to initiate treatment at HIV diagnosis irrespective of CD4 level.1
The prevention strategies should also be scaled up and targeted at high-risk communities.1 Difficulties in combating the HIV epidemic are region-dependent and require specific measures to be imposed. Some regions in Sub-Saharan African countries launched and expanded the voluntary medical male circumcision programs to control HIV transmission in addition to providing PrEP.1 And the public PrEP roll-out in San Francisco, London and New South Wales further helped reducing the number of new HIV diagnoses.1
Stigma and discrimination should also be eliminated for delivering respectful services.1 High-risk groups such as MSM and sex workers might not feel comfortable to conduct HIV testing, receive treatment or obtain preventive medications if the service providers lack the sensitivity and respect for them. The public health experts even suggest to eliminate the anti-LGBT legislation, extend healthcare benefits to sex workers, and empower African females with equal education opportunity, so as to end the HIV epidemic.1
1. Translating progress into success to end the AIDS epidemic. amfAR, AVAC, Friends of the Global Fight. (Accessed September 27, 2019, at http://endaids.org/wp-content/uploads/2019/07/EndTheEpidemicBrouchure.pdf)
2. Jones J, Sullivan PS, Curran JW. Progress in the HIV epidemic: Identifying goals and measuring success. PLoS Med. 2019;16(1):e1002729.
3. Fact sheet – global AIDS update 2019. UNAIDS. (Accessed September 27, 2019, at https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf)
4. Chihana ML, Huerga H, Van Cutsem G, et al. Impact of “test and treat” recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries. PLoS One. 2018;13(11):e0207656.