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
By Dr. Karin Hatzold, STAR Initiative Project Director and Acting Director, HIV and TB Programs, PSI; Stephen Tang, Member, Board of Directors, PSI
As part of the Sustainable Development Goals established in 2015, the global health community committed to ending the AIDS epidemic by 2030. Since then, there have been global pandemics, climate crises, political and financial turmoil, and competing priorities that stand in the way of achieving this goal.
So, are we on track to end AIDS by 2030? In short, yes, we are, but only if we put in the work.
The new UNAIDS-authored report titled ‘The Path that Ends AIDS’ describes ending this epidemic as a political and financial choice – and countries that are committed politically and financially are seeing extraordinary outcomes. This report acts as a call to action for world leaders to prioritize investing in HIV prevention, testing, treatment, and care to achieve the “95-95-95” targets. That means 95% of all people living with HIV know their status, 95% of all people diagnosed with HIV are on lifesaving antiretroviral treatment (ART), and 95% of all people receiving ART are virally suppressed.
It starts with knowing your status
People will not seek treatment for a disease they do not know they have. Awareness of one’s HIV status is the first step towards receiving treatment to prevent AIDS. 86% of all people living with HIV knew their status in 2022; however, 5.5 million people still did not know that they were living with the virus.
Not only do people need to know their status, but they need to know it early enough to avoid health complications and spreading it to others. Early detection is essential, but difficult to achieve due to the social stigma and limited access to testing and health services that hinder people’s ability to get tested.
Knowledge of HIV status is also important to access effective prevention interventions such as pre-exposure prophylaxis (PrEP) that protects people without HIV from acquiring it by close to 95%.
Our solution, HIV self-testing
HIV self-testing (HIVST), which can be used whenever and wherever, supports people’s access to personalized, accessible prevention and treatment services. For people who are at elevated risk of HIV infection and need frequent testing, or those who cannot or will not get tested by a health provider, self-testing is a convenient, discreet alternative.
Since 2015, PSI has led a global consortium of partners in implementing the Unitaid-funded STAR Initiative, the largest multi-country study on self-testing to date. The project launched with three key goals:
- Catalyzing the global market for HIVST, evaluating optimal distribution models for scale up globally, evaluating and optimizing use of different HIV self-test products, reducing the price for HIVST kits through cost transparency and market competition.
- Generating evidence on the feasibility and acceptability of HIVST, and information about how to distribute HIVST products effectively, ethically, and efficiently.
- Creating an enabling environment to scale up HIVST by informing national-level policies and regulations.
With HIVST, early detection is possible. Self-tests can be offered as part of testing services at health facilities, increasing their capacity for testing. By offering HIVST to consumers, providers are no longer required to individually administer each test.
The World Health Organization (WHO) now promotes the global scale-up of simplified PrEP delivery, focusing on reducing the need for frequent facility visits, including through streamlining HIV testing requirements. Offering HIVST as an alternative strategy can be an innovative way to increase PrEP uptake and its effective use. Self-testing can also reassure people without HIV that their prevention practices are effective.
Scaling self-testing
While HIV self-testing has been recommended by the WHO as an additional testing approach since 2016, it is not widely accessible, particularly to those who need it most. To end AIDS by 2030, we need to make HIVST easily available to everyone who wants to use them. We can scale self-testing by prioritizing:
- Community engagement – We need community-level engagement at health facilities, workplaces, marketplaces, and private sector pharmacies to increase awareness of HIVST and its benefits.
- Social network testing – We need to expand the offer of social network testing approaches by engaging sexual and drug-injecting partners and social contacts of people with HIV and of those who are HIV-negative and at ongoing risk, in voluntary testing services.
- Personalized care – We need to align the ways we communicate about HIVST and how to access it with consumer needs.
- Consumer options – We need to provide consumers with self-test kit options, such as blood-based or oral fluid tests, that work best for them and that they can afford.
While these priorities are at the core of the STAR Initiative’s work, the ambitious goal of ending AIDS can only be achieved with collective action by global and national stakeholders. This requires a commitment from donors and funders to implementers, researchers, the private sector, policymakers and national program leads, advocates and affected communities – and taking the first step of educating one another on the state of the epidemic and aligning on can be done to help.
PSI draws inspiration from leaders like Reverend Maxwell Kapachawo, who opened his life and church in Zimbabwe to those living with HIV that have faced stigma and discrimination. His work to combat stigma and build community around people living with HIV is one of many examples of positive change to end AIDS.
Let us keep pushing forward on this journey with determination and optimism so that everyone can live a life free from HIV and AIDS. It is possible if we put in the work – together we will end AIDS.
For more information on HIV self-testing and the path to ending AIDS, contact Karin Hatzold ([email protected])
