Michelle is the Pacific Program Manager at ASHM. She has worked in the field of HIV and Sexual and Reproductive Health for nearly a decade in a number of different countries including Fiji and Solomon Islands. Originally from the UK Michelle has been living and working in Australia as a researcher and program manager on and off for the past 6 years. She is particularly interested in the social aspects of health and the delivery of services to reach the needs of vulnerable and marginalised populations.
HIV Targets - Aspirational or Realistic?
This morning I read the headline ‘world leaders pledge to achieve gender equality by 2030’. This was timely given I had just attended the session entitled ‘Bingo: The use of targets in HIV policy’ chaired by Professor Heather Worth, the day before. This headline reinforced the arguments put forward in the session about use of targets. Can we really achieve gender equality, something that is tied up in complex political systems, social norms and beliefs within the next 15 year? The target filled me with hope and gave me an extra spring in my step as I headed to the conference. But the points made at yesterday’s debate lingered. Are we really able to achieve such aspirational targets such as UNAID’s 90-90-90 target in which 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression within the next 5 years? And if such targets aren’t achievable should we be setting them?
The panel put forward differing argument on a debate which essentially focused on aspirational targets vs. more realistic evidence based targets. Professor Charles Gilks spoke about the 3X5 Initiative and said that whilst the target of 3 million people living in low and middle income countries being provided with ART was not achieved by 2005, this aspirational target provided a driving force and focusing of efforts so that it was achieved two years later in 2007.
David Fowler, a self-proclaimed cynic when it comes to aspirational targets argued that targets should be evidence based and realistic. Whilst Professor Peter Aggleton put forward the notion that targets have been reduced to ‘sloganeering’. Peter indicated that he wasn’t opposed to aspirational target setting at it ‘motivates our hearts and head’, but also argued that targets need to be realistic, owned by the community and that we also need to look beyond targets and be driven by ‘doing the correct thing’.
There were other interesting discussions about how to set targets with Charles arguing they need to be realistic and based on the cost required to achieve them. Midnight Poonkasetwattana proposed that global targets are inappropriate as we need to look at individual community wants and needs rather than producing sweeping global targets.
The debate reminded me of another great session by John Kaldor I had attended. John had touched upon what he considered unhelpful dichotomies in disease control such as; technology vs. environment, action vs. evidence, government vs. community driven, medical vs. social and public good vs. human rights. He argued that these things should not be pitched against one another but recognized as both helpful and necessary. I couldn’t help but wonder whether aspirational vs realistic targets should be added to the list and whether it is possible that they could be one and the same thing? What do you think?