The time is now to move beyond viral suppression, to ensure wellbeing and health-related quality of life for people living with HIV

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At the height of the HIV pandemic in the mid-1990s, mental health was not a priority. As the virus spread and the death toll climbed, attention centred on understanding the disease and stopping its spread. Promoting preventative measures and the hunt for effective management of HIV infection absorbed the energy and resources of a community faced with a global crisis that had a personal impact on millions.

Times have changed. Innovation has contributed towards changing the equation: people are living longer with HIV today and the risk of HIV transmission can be reduced . Such progress ensured that HIV is now a manageable condition and no longer the death sentence it once was. Today, existing HIV treatments can reduce the viral load to undetectable levels, leading to a close to zero risk of onward transmission* (Undetectable=Untransmittable- “U=U”)1. However, new challenges have appeared related to ageing with HIV. At the same time, many of the ‘old’ HIV problems – stigma, discrimination and isolation – persist.

Gilead Sciences is working with partners to ensure policies and services keep pace with the needs of people living with HIV. Through the multistakeholder initiative HIV Outcomes2, momentum is being built to advance health-related quality of life (HRQoL) as a priority on the policy agenda.

HIV Outcomes hosted on World AIDS Day 2020 a high level conference3 focused on “Delivering Good Mental Health for People Living with HIV”. The event brought together key policymakers from Europe, along with patient advocates and representatives of global organisations, including the WHO and UNAIDS.

As people living with HIV are more likely to develop anxiety and depression4 than the general population, political action is needed to elevate mental health and wellbeing in HIV services. This was highlighted by the European Commissioner for Health and Food Safety, Stella Kyriakides, who called for a holistic approach and greater emphasis on HIV co-morbidities – including mental health.

“We have to strive for more than just the absence of death,” Commissioner Kyriakides said. “I am not satisfied with HIV patients simply living a long life. They deserve to live a fulfilling, happy life, too.” This was echoed by Members of the European Parliament, academics and national policymakers, who called for more integrated services for people with HIV and stronger measures to address stigma and discrimination in both healthcare settings and wider society.

Looking beyond viral suppression: change can happen in the HIV response

The same theme emerged from a Focus Group Discussion5 with key stakeholders, co-hosted by HIV Outcomes and UNAIDS, ahead of the new UNAIDS Global AIDS Strategy beyond 2020, expected later this year. Together, the group agreed on six recommendations for action. Among these are a call to formalise the commitment to prioritising: (i) improvements in quality of life (QoL), (ii) management of multimorbidity and (iii) reducing HIV discrimination, by establishing specific metrics and methods to measure progress towards these targets.

The Focus Group also called for the removal of all social and legal barriers to HIV services that result from stigma and discrimination in the healthcare system and beyond. This would advance the social acceptance of people living with HIV and address one of the contributing factors to anxiety and depression.

This becomes even more relevant in light of practical challenges for people living with HIV deriving from the COVID-19 pandemic – such as risk of increased isolation and anxiety6. It is time for a change in how HIV infection will be managed in the coming decade, to adequately tackle HIV comorbidities and ensure health-related quality of life for people living with HIV.

Supporting collaboration & innovation

Gilead Sciences firmly believes that partnership and stakeholder collaboration is the way forward, to end the HIV epidemic, while addressing the challenges faced by people with HIV. At Gilead, we are committed to play our part and continue innovating in HIV.
Both innovation and reimagined policies addressing the challenges faced by people living with HIV have a key role to play if, globally, we are to meet the UN Sustainable Development Goal 3 of ending the AIDS epidemic by 2030.

* Disclaimer: While effective viral suppression with antiretroviral therapy has been proven to substantially reduce the risk of sexual transmission, a residual risk cannot be excluded. CDC (Centers for Disease Control and Prevention) states that there is effectively no risk of sexual transmission of HIV in individuals with an undetectable viral load.