Maria Prins, profesora de Salud Pública y Epidemiogía de Enfermedades Infecciosas del Academic Medical Center de Amsterdam, mostrará en su ponencia inaugural el tema ‘Striving for zero new HIV infections in Amsterdam: The public health perspective’
What role can and should cities play in achieving UNAIDS 90-90-90 targets?
Cities should take the lead. As pointed out by UNIADS more than half of the world’s population currently live in cities and cities account for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases.
Even if your national level isn’t helping, there are important steps you can take as a city
By your experience, what advice would you give to Spain and especially to such important cities as Madrid, Barcelona, Valencia or Seville?
Political and community leadership and commitment at the city level are key to success. investment is also key
Closely working together with all stakeholders works.
- Identify gaps in prevention and care at the city/local level with all stakeholders
- Start innovative projects/pilots that are feasible
- Integrate novel projects in existing interventions
- Use outcomes from the projects for adjustment or implementation of services in routine HIV prevention and care
Amsterdam seems ready for challenge 95-95-95 of 2030. What has been your secret to become a reference in the fight against HIV?
From the beginning of the HIV epidemic, the Amsterdam approach to combatting the HIV epidemic has been acknowledged as one of the most successful. So, this starting point helped. It included national support for HIV programmes in low income countries, the approach in which all partners involved in HIV care and prevention work closely together, and low threshold services and programmes targeting key populations.
The effectiveness of this strategy is exemplified by the approach taken to tackle drug use in Amsterdam in the 1980s. The city made treatment and harm-reduction services easily accessible for PWID, while integrating these services into its larger strategy of addressing drug use and dependence. Heroin-assisted treatment, methadone provision, and needle provision were made available through various facilities in the city, including police stations, prisons, and mental health centres in the 1980s. The city’s harm-reduction response achieved high coverage in the city and created a supportive environment for the HIV response. Declining trends in both injection drug use and sexual risk behaviour had been accompanied by a substantial decline in new HIV infections, to the point where people who use drugs were considered to have low transmission risk within the city’s epidemic.
The policy of health care providers in Amsterdam to offer treatment to all people found to be living with HIV has contributed significantly to reaching the so-called 90-90-90 target.
Although these results achieved were among the best in the world, the health system was neither optimally designed nor able to identify the relatively small group of around 400-500 people in Amsterdam who remain unaware of their HIV status in 2014, and thus to stop the spread of HIV. The only way to drastically decrease the number of new HIV infections in Amsterdam at this stage was to develop and implement the innovative strategies initiated by H-TEAM to find the HIV unaware residents as fast as possible and successfully link them to care, and, at the same time, offer the most up-to-date prevention methods, including PrEP, to residents who are not infected but at increased risk of acquiring HIV, whilst making sure that these innovations become fully integrated in a sustainable manner into the city’s existing health structures.
Our current figures are: 94-93-95. Zero new infections are the next stop. The last mile on the road to zero new infections poses the biggest challenge.
Do you think that the vast majority of the cities will be able to achieve the goals set for 2020 in the Paris Declaration? What is the main handicap facing the fight against HIV on a global scale? In your opinion, what criteria should be followed to improve in this regard?
Not sure whether it is the vast majority, but sure many cities can. On a global scale legal barriers, criminalisation and stigma are major handicaps. Also there is a lack of sustained financing of the HIV response on the global level.
Again political and community leadership and commitment at the city level are key for reaching success worldwide. If cities cooperated internationally, urban centers around the world would greatly benefit from exchanging success stories and lessons learned in striving for zero new infections.