Update on treatment as prevention of HIV illness, death, and transmission: sub-Saharan Africa HIV financing and progress towards the 95-95-95 target

Purpose of review After over 40 years, the HIV pandemic is amongst the deadliest in history - 100% fatal without treatment, HIV has infected over 84 million people, and has caused over 40 million deaths. Global HIV spending between 2000 and 2015 totaled over a half trillion dollars. Delays in harnessing scientific advances, including 'test and treat' and treatment as prevention of illness, death, and transmission (TasP) provide a cautionary tale applicable to other pandemics. Resource allocation has also been problematic with many highest burden countries spending less than 50% on care and treatment. Recent findings Between 2002 and 2021, over $94 billion was budgeted for HIV in 40 sub-Saharan African countries, with 19 countries over $1 billion. In 2021, 8.1 million (32%) People Living with HIV (PLHIV) are still not on treatment; viral suppression data, the most important programme success indicator, is unavailable for 50% of countries. Of 19 countries with at least one billion dollars budgeted, seven have below 80% ART coverage, leaving 3.5 million (29%) of PLHIV off treatment and vulnerable to illness, death, and transmitting the virus to partners and children. With additional funding and improved efficiency, achieving the 95-95-95 target to diagnose 95% of all HIV-positive individuals, provide antiretroviral therapy (ART) for 95% of those diagnosed and achieve viral suppression for 95% of those treated by 2030 is feasible and the humane pathway towards ending the HIV pandemic.

Automated summary

This review discusses the goals of the HIV pandemic and the challenges it faces in terms of budgeting, resource allocation, and treatment coverage. Currently, many HIV-positive individuals are still not receiving treatment, and the target of diagnosing 95% of HIV-positive individuals, providing antiretroviral therapy to 95% of those diagnosed, and achieving viral suppression in 95% of those treated by 2030 has not yet been met.