World Aids Day 2019: Communities make the difference
World AIDS Day, held each year on December 1, is an opportunity to celebrate and support global efforts to prevent new HIV infections, increase HIV awareness and knowledge, and support those living with HIV.
Since World AIDS Day was first observed more than 30 years ago, progress in preventing and treating HIV has been extraordinary. HIV medicines are available to help people with HIV live long, healthy lives and prevent HIV transmission.
Also, effective HIV prevention methods, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are available. The theme for the 2019 observance is "Ending the HIV/AIDS Epidemic: Community by Community."
Communities are a unique force behind the success of the HIV response
On World AIDS Day 2019, World Health Organisation (WHO) is highlighting the difference the communities are making to end the HIV epidemic while drawing global attention to the need for their broader engagement in strengthening primary health care.
Key messages
1. Today 4 in 5 people with HIV get tested, and 2 in 3 get treatment: communities played a major role in achieving this success.
• Of the estimated 37.9 million people living with HIV at the end of 2018, 79% were diagnosed, 62% received treatment, and 53% had achieved suppression of the HIV with low risk of infecting others.
• One of the key contributors to this success in all countries has been the thousands of members of HIV and "key population" community networks and community health workers, many of whom are living with or affected by HIV.
2. WHO recommends countries to adopt community-based HIV testing, prevention, treatment and care as a core strategy.
• WHO recommends a strategic mix of approaches for testing, including community-based testing, self-testing, and provider-assisted referral to reach people at the highest risk of HIV.
• Countries like South Africa and Rwanda have shown how trained peers or community health workers have delivered rapid diagnostic tests with same-day results, enabling more people to know their HIV status.
• WHO recommends increased rapid testing in community settings for key populations in Europe, Asia, and the Americas to replace laborious approaches causing weeks of delays in test results and treatment initiation.
3. Community-based HIV treatment and monitoring saves money and reduces workloads for doctors, nurses, and other health care professionals.
• WHO recommends countries train and mobilise community health workers, including people living with HIV, to provide decentralised and differentiated HIV treatment and care.
• Evidence shows more people continue with HIV treatment when peer educators counsel and support each other.
• WHO also recommends that community health workers support monitoring and data collection.
4. Expanding the role of communities and community-based health care will help countries meet global HIV and UHC targets.
• Health services are struggling to provide all people with HIV services they need. Global fast-track targets for HIV for 2020 are unlikely to be met unless more support becomes available.
• The most glaring gap is seen in prevention. In 2018, 1.7 million people were newly infected with HIV – this number must reduce by three-fold to meet the 2020 target of 500 000.
• Testing and treatment coverage is off-track, too – especially for key populations and children. For example, more than half of all new infections are among key populations and their partners; only half of the children in need are receiving ART, of which only half achieved viral suppression due to the use of suboptimal medicines.
5. Community and civil society engagement must remain a key strategy to boost primary health care.
• Activism and civil society action have been key resources in the HIV response from the early days, inspiring the global health community to galvanise efforts for increased equity, respect for health and human rights, and scientific innovation.
• In September 2019, global leaders signed the first-ever UN declaration on UHC with a central focus on primary health care, tailored for and built through empowered and engaged communities.
• Today, people-centred care, community, and civil society engagement are included in three Sustainable Development Goal targets.