90-90-90 and ending AIDS: necessary and feasible.

www.thelancet.com Vol 390 July 22, 2017 341 More than three decades into the global HIV pandemic, there are still 2·1 million new infections each year and 36·7 million people are living with HIV. By mid2016, 18·2 million people were on antiretroviral treatment—about 50% of people living with HIV. Yet in 2015, 15 million people living with HIV were estimated to be unaware of their status and 1·1 million died of AIDS-related complications, despite the fact that US$19 billion was invested in HIV in low-income and middle-income countries. Although its history is complex, the HIV pandemic can be characterised by three phases: devastation; discovery and action; and ending AIDS (figure). The initial response was defined by overwhelming devastation of marginalised individuals and their communities, the root causes of which were widespread denial, ignorance, stigma, fear, and neglect. It was a time when affected communities and beleaguered health-care providers struggled in isolation to minister to the sick and dying while governments, experts, and other authorities exercised little if any political will to address a burgeoning health crisis or exacerbated the crisis through their policies. Out of this suffering emerged a determined community response that demanded leadership and resources from governments. The discovery and action phase resulted from the growing community, scientific, and political response that unravelled the secrets of HIV. Despite remarkable progress, the accepted wisdom was that ending AIDS was not feasible without a vaccine or cure. Without effective treatment, the focus was on prophylaxis and treatment of opportunistic illnesses, palliative care, ensuring human rights, tackling stigma and discrimination, community support for people with HIV, and prevention methods. The development of life-saving, triple drug therapy in 1996 gave hope along with the realisation that most of the people infected with HIV lived in low-income 90-90-90 and ending AIDS: necessary and feasible