European countries are pioneering techniques to end the HIV epidemic by 2030. Yet progress varies widely from country to country – and even from community to community within from the same country.
POLITICO Studio spoke with Neil Mulcock, vice president of international government affairs at Gilead Sciences, to learn about the latest best practices in testing, prevention and treatment, and how Europe can move forward to end the epidemic, once and for all.
This Q&A is part of POLITICO Telescope: The New AIDS Epidemic, an ongoing exploration of the disease today.
Question : What success have we had so far in reducing the spread of HIV?
A: We have already made enormous progress in the fight against this disease. HIV is now a manageable disease, not a death sentence. People living with HIV who are diagnosed early after infection and begin treatment can now live long, healthy lives. And because the medications reduce the amount of virus in their blood to undetectable levels, they are no longer at risk of passing HIV to anyone else.
This very important idea is known as “U=U*”, which stands for “Undetectable = Untransmittable”. And it’s a powerful public health message in the fight to end the HIV epidemic. The more people realize that there is a huge benefit to getting tested and starting treatment if they test positive – or accessing prevention, including PreP, if they don’t – the sooner we will reach UNAIDS targets to end new infections by 2030.
Question : What needs to be done now to completely eliminate HIV?
A: The world has signed up to what is called the UNAIDS 95-95-95 targets. The goal is, by 2030, that: 95 percent of people living with HIV are tested and know they are living with the virus; 95 percent of those taking medication; and 95 percent of them have an undetectable viral load, meaning they cannot transmit HIV to anyone else.
In Europe, we are making good progress towards achieving these goals, but we are not there yet and time is running out. Some countries, such as Switzerland, the United Kingdom, France and Germany, have reached or are close to reaching 95 percent in all three areas. But others still have a way to go, especially when it comes to testing. Poland, for example, has only tested 80 percent of the estimated number of people living with HIV in the country. In Bulgaria this figure is around 78 percent and in Moldova it is 65 percent. However, even in countries making good progress toward these goals, data suggests that some groups, such as migrants, are not being tested, diagnosed or starting treatment as much as others, representing a key problem to solve.
There are several reasons for these varied results. The first is the availability and accessibility of testing. A number of countries in the bloc have made testing as widespread as possible by approving many different methods for taking an HIV test. In Spain, for example, in addition to going to a clinic and being tested by a healthcare professional, you can go to a community center or get tested at home, similar to a COVID test -19 or pregnant. But other countries are more restrictive about where and how you can get tested. The other reason is that stigma and fear deter some people from getting tested, and in some European countries there are even laws that criminalize people who are HIV positive.
Question : What proportion of people are unaware of their status in Europe? Why aren’t we reaching these people yet?
A: Across Europe, the number of new HIV infections and the number of AIDS-related deaths remain high. One reason is that around one in eight people living with HIV in the EU/EEA are unaware that they have the virus. In addition to stigma, limited testing and access to HIV care services, some groups are simply not reached by campaigns that encourage people to get tested. For example, I would include migrants on this list, who may not be sure that, if they test positive, they will receive healthcare, as well as trans people, people from certain ethnic minorities and men having sex with men in countries where there are cultural or legal restrictions on LGBTQ+ communities. There are also groups who do not believe HIV affects them, such as heterosexual men and women. We need to work harder to reach all of these key populations.
Question : What can we do to reach people who don’t have access to tests and treatments?
A: We have already learned that a very important factor in reducing HIV transmission has been what are called “combination prevention” programs. These are programs that amplify the importance of multiple prevention options – biomedical and behavioral – in the context of each community’s needs. This could include addressing challenges faced by certain groups or offering testing in different environments, for example in a community setting rather than a clinic, but it could also involve developing innovative new drugs with new mechanisms administration and different frequencies of use. If someone knew, for example, that they could take medication less frequently if they tested positive, which would help them keep their HIV status more confidential, that could be a game-changer and encourage them to get tested by first place. In this context, innovation plays a key role in ending the HIV epidemic, with more options better suited to people’s needs.
Question : What can countries in the EU and beyond learn from each other?
A: There are already many good practices in Europe. The NHS in England, for example, introduced a routine opt-out program in 33 hospital emergency departments in very high prevalence areas to diagnose and re-engage people in care, meaning that it has become common for people to present to these emergency departments. get tested for HIV. In the first 12 months of the program, 343 people living with HIV were diagnosed, and an additional 209 people who had already been diagnosed but had not received HIV services were identified. This program also addresses health inequities, as 54 percent of people diagnosed in the first 100 days were of Black African, Caribbean or other Black ethnic backgrounds. Portugal did the same at the Cascais hospital and saw late diagnosis of HIV in emergency situations – those people who discover they are living with the virus only when they are at risk of falling ill – fell d ‘about 80 percent to 40 percent. Other member states are also considering expanding the availability of different testing options.
Europe could be the first region in the world to end HIV. The Spanish Presidency is really leading the way, and we hope that the next Belgian Presidency will continue the political momentum, but we need everyone – EU and Member State government bodies, industry, professionals in the health and HIV communities – are all working together to end the epidemic. this epidemic. Everyone must get involved to highlight best practices in one place and spread them across the bloc, encouraging investment in testing, innovation in prevention and treatment options, and fighting against Stigma.
European institutions also have a key role to play in educating citizens about HIV, as well as guiding, motivating and supporting Member States in their efforts to end the epidemic. UNAIDS’ goals can be achieved – they are realistic and within reach – but everyone needs to go the extra mile, and the time is now.
Question : What can Gilead do to reach 95-95-95?
A: Gilead has been at the forefront of HIV research and development for over 30 years and we continue to invest in innovative approaches to testing while ensuring continued innovation in treatment and delivery. prevention, including clinical trials that will help reach those whose needs are unmet. satisfied with current HIV interventions.
We partner with many organizations to increase access to testing and improve links to care and treatment. For example, we partner with the Elton John AIDS Foundation on the RADIAN Model Cities program, which works with communities in Eastern Europe and Central Asia to improve services for people affected by HIV.
And we work with governments to ensure that HIV remains a public health priority and support their efforts to end the HIV epidemic, including by advocating for funding for these efforts.
There is real potential for Europe. The region could be one of the first in the world to globally achieve the 95-95-95 targets and end new infections by 2030. However, this will require a global, coordinated and sustained effort, with emphasis on evidence-based interventions, scientific innovations, political commitment and strong partnerships with affected communities, industry and stakeholders. We’re not there yet, but by working together we could get there soon.
*U = U is true to two premises: Taking anti-HIV medications as prescribed and becoming and remaining undetectable for at least 6 months prevents transmission of HIV to partners through sex. Undetectable means the virus cannot be measured by a viral load test (viral load <200 copies/mL)