Make HIV, TB and Hepatitis great again (F4)

Time flies. And when we get close to predetermined deadlines, we tend to panic.

The morning session “Reaching the SDG targets on health by 2030” was a call back to reality. The SDG 3.3 targets to eliminate HIV/AIDS and tuberculosis, as well as to combat hepatitis. If we continue what we are doing, and how we are doing it, we will decrease the burden of HIV/AIDS, tuberculosis, and viral hepatitis, but we will be far from reaching the Sustainable Development Goals set in 2015.

The panelists in our session unanimously argued that, if this goal is quite radical, it is only because we have the appropriate tools to achieve it. Indeed, science is on our side, having provided us with appropriate tools to prevent and treat these diseases.

However, considering how they have evolved in the EU in the last years, and the expected trends for the near future, it doesn’t look good. We are not doing well enough. There may have been decreases in HIV/AIDS and tuberculosis incidence, but at this rate we will not eliminate them by 2030. For hepatitis, the situation is even worse: we don’t really know how we are doing, since the data are fragmented and highly dependent on the country’s diagnosis and reporting systems.

Another challenge for Europe are the existing geographic inequalities. For instance, while the western European countries are well on track for achieving the SDG set goals, the HIV/AIDS incidence rate in the UNAIDS Region Eastern Europe and central Asia is still growing. Countries in this region are responsible for the majority of all new cases reported in EU/EEA countries. The 90-90-90 target indicators also reflect further disparities. Briefly, this target aims that 90% of people infected with HIV are diagnosed, of which 90% are under antiretroviral therapy, of which 90% are virally suppressed (viruses cannot be detected in their blood). Whereas in the western European countries, 72% of people living with HIV in 2018 are virally suppressed, this figure is 45% in central European countries and only 26% in Eastern Europe.  
The speakers discussed several strategies to address these issues. Ricardo Baptista Leite presented the successful example of Portugal’s drug decriminalization in 2001. Against many opponents’ predictions, there was not only a decrease in crime and drug-related imprisonments, but also a decline of new HIV and Hepatitis C infections. Both Vinay P. Saldanha and Freek Spinnewijn agreed that targeting the “lower hanging fruit”, i.e. the most accessible population, will not solve the situation. Everyone must be reached, particularly the most marginalized groups such as migrants and the homeless. A “door-to-door” approach could also be a potential strategy to achieve true elimination of HIV/AIDS and Tuberculosis epidemics.

Indeed, we have everything in our hands to be able to achieve the SDGs on these three infectious diseases. Our actions so far have not been sufficient to make a substantial change to reach these goals. It seems that we are not putting these diseases in our political agendas anymore, as opposed to what was happening 20 or 30 years ago. But we are almost there – let us make one final effort, and make these disease matter again until we get rid of them.

ECDC director Andrea Ammon, the very dynamic session moderator, and invited speaker Vinay P. Saldanha, UNAIDS Regional Director for Eastern Europe and Central Asia

 

This Blog was written by the Young Gasteiner Maria Moitinho de Almeida

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