UNAIDS 90-90-90: the fourth 90
Commentators have questioned why good health-related quality of life should only be a relevant target for virally suppressed people living with HIV.
In his blog, Lazarus stated that “it clearly shouldn’t”. He clarified that “in presentations and discussions about how to move the HIV care agenda beyond a narrow focus on treatment to suppress viral replication, it has become routine for us and other stakeholders to talk about establishing a health-related quality of life target for all people living with HIV from the point of diagnosis onwards.”16
Lazarus has since suggested a new model to ensure a broader group of people living with HIV are achieving good health-related quality of life.16
UNAIDS LGBTI survey
In May 2019, UNAIDS and Manchester’s LGBT Foundation launched an 82-question online survey on happiness, sex and quality of life for LGBTI people.17,18 It featured questions on health-related quality of life (HRQL). This was the first time the topic had been addressed according to a report published in the medical journal, The Lancet in June 2019.19 The move was welcomed by those who believe that a fourth 90 should be added to the current UNAIDS 90-90-90 target. The survey was aimed at all lesbian, gay, bisexual, transgender, and intersex (LGBTI) people and was not specific to HIV. That said, 11% of respondents identified as living with HIV.19
Topics surrounding HRQL covered in the survey included:18
- Family support
- Sexual satisfaction
- Physical health
- The internalisation of homophobia
UNAIDS says that this survey is trying to determine whether scores on these measures are correlated with risk-taking behaviours that drive HIV infection and other health risks.19
Join the debate
It’s clear that the debate around a fourth 90 is still very much alive. With the new strategy from the WHO and the recent UNAIDS online survey, it seems that targets for high quality of life among people living with HIV are finally being established.
Find out more about living with HIV and how exercise and diet have a positive impact.
- 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Available at: https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf [Accessed: August 2020].
- The 3 by 5 Initiative. Available at: https://www.who.int/3by5/en/ [Accessed: August 2020].
- “15 by 15”: A global target achieved. Available at: https://www.unaids.org/
sites/default/files/media_asset/UNAIDS_15by15_en.pdf [Accessed: August 2020].
- Global Health Sector Strategy on HIV 2016-2012. 2016 Available at: https://apps.who.int/iris/bitstream/handle/10665/246178/WHO-HIV-2016.05-eng.pdf;jsessionid=AB177BD2F48F2D8F4BD0954BF5FCCC01?sequence=1 [Accessed: August 2020].
- AIDS and the sustainable development goals. Available at: https://www.unaids.org/en/AIDS_SDGs [Accessed: August 2020].
- Marsh K, et al. AIDS. 2019;33:S213–S226.
- Global AIDS update 2020. Seizing the moment: Tackling entrenched inequalities to end pandemics. Available at: https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf [Accessed: August 2020].
- HIV in the UK: towards zero HIV transmissions by 2030. Press Release. 2020. Available at: https://www.gov.uk/government/news/hiv-in-the-uk-towards-zero-hiv-transmissions-by-2030 [Accessed: August 2020].
- Lazarus J, et al. BMC Med. 2016;14:94.
- Costagliola D. Curr Opin HIV AIDS. 2014;9: 294–301.
- Kooij K, et al. AIDS. 2016;30:1771–1780.
- Schouten J, et al. Clin Infect Dis. 2014;59:1787–1797.
- Schouten J, et al. AIDS. 2016;30:1027–1038.
- Erdbeer G, et al. J Int AIDS Soc. 2014;17:19673.
- Miners A, et al. Lancet HIV. 2014;1:e32–40.
- Depicting a New Target For the HIV Response: How Do You See the ‘Fourth 90’? Available at: https://www.isglobal.org/en/healthisglobal/-/custom-blog-portlet/visually-depicting-a-new-target-for-the-hiv-response-how-do-you-see-the-fourth-90-/5511380/0 [Accessed: August 2020].
- UNAIDS and the LGBT Foundation launch groundbreaking study on happiness, sex and quality of life for LGBTI people. Available at: https://www.unaids.org/en/resources/presscentre/
[Accessed: August 2020].
- 1st Global LGBT Foundation and UNAIDS Survey on Happiness, Sex and Quality of life. Available at: https://www.research.net/r/LGBTHappinessResearch [Accessed: August 2020].
- Webster P. Lancet. 2019;393:2188.