The long-term health and well-being of people living with HIV goes ‘beyond viral suppression’ and requires person-centred care, prevention of other medical conditions, and tackling stigma and discrimination. This is the main message of the call to action by the HIV Outcomes Initiative, which presented its latest findings at a roundtable discussion hosted by several members of the European Parliament on November 26th, just ahead of World AIDS Day. Importantly, the event also launched The Lancet HIV Series on HIV Outcomes Beyond Viral Suppression, a series led by HIV Outcomes co-chairs Jeffrey V Lazarus, associate research professor at ISGlobal, an institution supported by “la Caixa” and Jane Anderson, from Homerton University Hospital NHS Foundation Trust, London.
“People with HIV are living longer, but we now need to ensure they can lead healthy lives,” explains Lazarus, who provided the closing remarks at the roundtable in Strasbourg and co-authored two of the reviews in the Series. “This means improving access to services for the prevention, treatment and management of other chronic conditions, as well as mental health support and sexual health advice,” he adds.
The roundtable’s aim is to ensure political leadership in the fight against HIV, and bring together key stakeholders to discuss the latest findings from the HIV Outcomes Initiative. Many European countries are close to the UNAIDS 90-90-90 goals (90% of patients diagnosed, 90% of diagnosed patients treated, and viral suppression achieved in 90% of treated patients). The HIV Outcomes report calls for the addition of a fourth goal – quality of life – and better data collection on how to measure it.
Indeed, The Lancet HIV Series warns that the health systems are not prepared to meet the needs of a growing number of people with HIV. “An estimated 62% of the 38 million people living with HIV are now taking antiretroviral therapy. This means that health systems will have to ensure care for an increasingly large number of ageing people living with HIV,” explains Lazarus.
“To meet this challenge, we need to reorient our health systems through action in four areas: integrating HIV services and non-HIV services, reducing HIV-related discrimination in health-care settings, identifying indicators to monitor progress of health systems toward new goals, and catalysing new forms of civil society engagement,” adds Kelly Safreed-Harmon, researcher at ISGlobal and first author of the first review of the series.
“In 2019 it is not enough that people living with HIV are alive. They should also be living well,” write The Lancet HIV editors Peter Hayward and Philippa Harris in a linked editorial. “As the health-care needs of people living with HIV continue to move beyond specialist services, good quality care free from stigma and discrimination, is essential. Achieving these aims will require changes across health and social care,” they add. The Series authors stress the need to involve people living with HIV in the process.