Over the last few months, on the small screens of numerous regional trains connecting Paris to its suburbs, a short video with key information surrounding HIV and its prevention has been showing up. For a French person, such a thing might carry as much importance as every other government advertisement. After all, these last few years, more than a few campaigns concerning HIV prevention have been circulating all over public spaces, especially in big cities like Paris. In London and New York, famous campaigns like Do It London and New York Knows have also used these spaces to get the message across.
A lot has been accomplished…
For decades already, prevention has been advocated by talking mostly about condoms and testing. The particularity of these new campaigns, however, is that prevention treatments like PrEP (Pre-exposure prophylaxis) are finally being put in the spotlight. PrEP, which has been recommended since 2012 by the World Health Organization (WHO) for at-risk populations, is known to drastically reduce the risk of catching HIV when exposed to it. Taken mostly in the form of a daily pill, the treatment has come a long way since countries like the United States started authorizing it in the beginning of the 2010s. At the start, it was mostly developed countries that could access the treatment, due partly to its high cost. The United Kingdom and France, for example, adopted a government-funded policy where PrEP is fully reimbursed. However, Sub-saharan Africa, which is the region most heavily impacted by HIV, is where PrEP has really taken the strongest foothold. In less than five years, tens of thousands of people in countries like Kenya, Nigeria and South Africa have managed to access PrEP, as a result of policies and international funding that have made the treatment available to the general population. This gain in popularity is simply astonishing when looking at the numbers; according to the Global PrEP Network, about 630 000 people in 76 countries managed to access the treatment at least once in 2019, a massive boost from the 370 000 in 2018.
But there’s still a long way to go
Although HIV prevention has progressed impressively in many countries and deaths due to HIV have been reduced by a third in under ten years (in part due to PrEP), there is still an incredible amount of action to be taken, especially since COVID-19 took a toll on health services and government’s priorities. In Mexico, for example, PrEP is still extremely hard to find. In the few metropolitan areas where the treatment is available, access to it is simply too costly for the average person. In other developing countries where access to health services and education is very unequal, and where governments have not adopted the WHO’s recommendations surrounding PrEP in national guidelines, it is not hard to understand why HIV prevention actions have not progressed the same way everywhere. On top of that, general stigma and shame surrounding HIV and other STDs still exists throughout the world, impeding key information surrounding prevention to circulate sufficiently. In addition to that, the COVID-19 pandemic has triggered a decrease in testing and prevention treatment, which is expected to boost HIV cases around the world.
Today’s targets on HIV prevention and treatment
While celebrating the advancements surrounding HIV prevention back in March, the Secretary-General of the United Nations (UN) said that HIV remains a « pandemic of inequalities », calling for countries to think of differentiated, new approaches to accelerate progress. Gaps in testing, sexual education, affordability of prevention treatments like PrEP and the stigma surrounding HIV are all problems that can be surpassed with the right amounts of initiative and precise government policies. In his 2021 report leading up to the High-Level Meeting on AIDS – set to take place in June – the UN’s Secretary-General has proposed a series of ambitious recommendations to all countries, urging them to reach a 95-95-95 target in 2025. This means that 95% of people living with HIV should be aware of their status, be able to access treatment, and have reached a low enough viral load in order to be undetectable (when the virus cannot be transmitted anymore) in five years’ time.
While HIV treatment and prevention are a complex subject due to profound inequalities, it is certain that change can and has been made. And while the world goes through a crisis, it might just become the starting point for HIV related policies’ acceleration around the world. Like the Secretary-General says in his report, « the COVID-19 pandemic has highlighted the agility of the HIV response and how HIV investments improve health systems ». We can only hope things will move in the right direction, but for the time being, individual actions and information spreading can go a longer way than one could ever imagine.