SUPPRESSION
More people living with HIV than ever before are aware of their HIV status, are receiving antiretroviral therapy and have suppressed their viral load to undetectable levels. Strong gains in HIV testing and treatment access over the last 15 years have transformed the way that HIV is perceived across the world: what was once a death sentence is now, for most people, a chronic—but still dangerous—health condition that requires careful management. The fact that people who are virally suppressed cannot transmit HIV sexually has also changed the way that countries approach HIV prevention (1, 2).
There remains considerable room for improvement.
More than 20% of people living with HIV are not aware of their HIV status, and nearly half of all people living with HIV have unsuppressed viral loads. In some settings, the number of people living with HIV who
were initially on treatment but have subsequently been lost to follow-up is larger than new treatment enrolment. The gaps along the HIV testing and treatment cascade are particularly large for men, young people and children. The global target of providing antiretroviral therapy to 1.6 million children by 2018 has been missed.
Countries need to optimize their mix of HIV testing services to reach the populations and locations that currently are left behind. Urgent investment in comprehensive services is needed to support linkage and retention in care and sustained viral load suppression, including treatment literacy, food and nutrition support, community dispensing of antiretroviral medicines, adherence clubs, viral load testing, and switching to second- and third-line regimens after confirmed treatment failure.
AT A GLANCE
Almost two thirds of all people living with HIV in 2018 were receiving life-saving antiretroviral therapy, and more than half had suppressed viral loads.
Fifteen countries have reached the threshold of at least 73% of people living with HIV virally suppressed, including six countries that report achieving all three of the 90–90–90 targets.
Testing and treatment programmes in several regions are substantially off-track. Access to testing and treatment is particularly low in eastern Europe and central Asia, the Middle East and North Africa, and western and central Africa.
Gaps in the HIV testing and treatment cascade tend to be larger among men, young people and children. The global target of providing antiretroviral therapy to 1.6 million children by 2018 has been missed.
THE CASCADE FROM HIV TESTING TO VIRAL SUPPRESSION
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FIGURE 4.1 HIV testing and treatment cascade, global, 2018
0
People living with HIV
who know their status People living with HIV
on treatment People living with HIV who are virally suppressed
Number of people living with HIV (million) Gap to reaching
thefirst 90:
4.3 million Gap to reaching
thefirst and
Source: UNAIDS special analysis, 2019; see annex on methods for more details.
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PART TITLEFIGURE 4.2 HIV testing and treatment cascade, global, 2015–2018
2015 2016 2017 2018 Source: UNAIDS special analysis, 2019; see annex on methods for more details.
People living with HIV who know their
status People living with HIV on treatment People living with HIV who are virally suppressed
2015 2016 2017 2018 70%
People living with HIV
who know their status People living with HIV
on treatment People living with HIV
who are virally suppressed
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FIGURE 4.3 Progress towards 90–90–90 targets, global, 2018
of people living with HIV know their status
of people living with HIV who know their status are on treatment
of people on treatment are virally suppressed 86%
Source: UNAIDS special analysis, 2019; see annex on methods for more details.
People living with HIV who know their status People living with HIV who know their status and
are on treatment
People on treatment who are virally suppressed
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77 Steady gains across the HIV testing and
treatment cascade
Nearly four in five people living with HIV globally knew their serostatus in 2018. It is estimated that 62%
[46–74%] were receiving antiretroviral therapy, and that 53% [43–63%] were virally suppressed (Figure 4.1).
There have been steady gains in recent years across the HIV testing and treatment cascade (Figure 4.2).
This reflects the growing number of people who, once diagnosed with HIV infection, are successfully linked to and retained in HIV care, as well as improvements in the effectiveness of HIV treatment.
A large proportion (86%) of those on HIV treatment in 2018 were virally suppressed, bringing the world closer to reaching the 90–90–90 targets by 2020:
90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment have suppressed viral loads (Figure 4.3). However, a worryingly large proportion of people diagnosed with HIV—more than 20%—had not yet initiated treatment in 2018, and the world was still 7.7 million people short of reaching 73% of all people living with HIV having suppressed viral loads, which equates to achievement of all 90–90–90 targets.
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A sex worker learns her HIV status in Kyiv, Ukraine.
Credit: Convictus
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0 Number of children on antiretroviral therapy
Global Global target
FIGURE 4.5 Number of children living with HIV (aged 0–14 years) accessing antiretroviral therapy, global, 2000–2018 and 2018 target
Global Target value
Source: UNAIDS 2019 estimates; 2018 Global AIDS Monitoring.
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PART TITLE0 5 10 15 20 25 30 35
Number of people on antiretroviral therapy (million)
People with HIV living on antiretroviral therapy Target value
FIGURE 4.4 Number of people living with HIV accessing antiretroviral therapy, global, 2000–2018 and 2020 target
Number of people living with HIV on antiretroviral therapy Target value Source: UNAIDS 2019 estimates; 2018 Global AIDS Monitoring.