In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) announced its ambitious treatment target to end AIDS as a major public health epidemic by 2030[i]. To achieve this, countries were asked to work towards the goal of “90-90-90” by the year 2020. This means that 90% of people living with HIV should know their HIV status; 90% of people who know their HIV-positive status should be on treatment; and 90% of people on treatment should have suppressed viral loads.
HIV treatment is a critical tool towards ending the AIDS epidemic, but it is not the only one. While taking action to maximize the prevention effects of HIV treatment, urgent efforts are similarly needed to scale up other core prevention strategies.
The Fast Track Cities Initiative[ii] [iii] (www.iapac.org/cities) was also launched in Paris on World AIDS Day in 2014. Today, more than 70 cities around the world have signed the Paris Declaration on Fast-Track Cities Ending AIDS, engaging political leadership, affected communities, civil society, city health officials, clinical and service providers, and other stakeholders to accelerate their local AIDS responses. Cities with clear commitment towards fighting HIV include Amsterdam, Paris and San Francisco. They have taken a leadership role to share their experiences and strategies to end HIV transmission. Many cities are now recording significant reductions not only in the number of cases of AIDS, but also in the number of new HIV infections[iv] [v] [vi] [vii] [viii] .
Cities that have joined this movement have put in place effective partnerships between government, community, and local health departments. Their programmes have clear objectives and measurable targets to ensure HIV services and resources are optimally utilized and directed towards those most in need, have the greatest impact, are the most cost-effective, and have the goal of not only preventing HIV-infected persons from developing AIDS, but also stopping HIV transmission altogether.
Action for AIDS strongly believes that Singapore is well placed to end AIDS and to stop the transmission of HIV. Strategies and programmes needed to reach these objectives should include the following:
- Support and promote HIV testing, especially for hidden populations at risk, including those with unsuspected HIV and those presenting with late diagnosis.
- Increase the focus on vulnerable key populations viz. MSM, through adequate allocation of resources and programmes that meet their needs.
- Refine and re-energise media and communication strategies to promote safe sex and HIV testing for key populations.
- Introduce and support the scale-up of the highly effective prevention strategy Pre-Exposure Prophylaxis (PrEP) and ensure it is affordable to those who need it.
- Harness innovative service delivery models including expanding the reach and breadth of community based services, not just for testing and education, but also for PrEP.
- Improve access to and affordability of anti-retroviral treatment and care.
Plan and implement an HIV Response Blueprint that has clear deliverables and targets, objective monitoring and evaluation, provide strategic resources, and ensure close collaboration and coordination among stakeholders and partners.Singapore has a well-educated population, world-class healthcare system, advanced communications infrastructure, and access to the best experience and expertise to be one of the first cities to end AIDS and stop the spread of HIV.