Portugal on fast track to achieve HIV targets ahead of 2020 deadline
Portuguese Minister of Health Dr Adalberto Campos Fernandes announced on 5 July 2018 that Portugal has achieved 2 of the 3 HIV targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS), known as the 90–90–90 targets. This puts the country on track to reach all 3 targets ahead of the 2020 deadline.
The Minister’s announcement is based on data from 2016:
- 91.7% of people living with HIV are diagnosed;
- 86.8% of people diagnosed are on treatment; and
- 90.3% of people on treatment achieve HIV viral load suppression.
“Portugal has become one of the pioneer countries in the WHO European Region in moving towards ending AIDS by 2030,” says Dr Masoud Dara, Coordinator for Communicable Diseases at WHO/Europe. “Its success is built on a thorough implementation of evidence-based measures, high-level commitment and a true whole-of-government and whole-of-society approach in line with the Sustainable Development Goals.”
Comprehensive and inclusive prevention approaches effectively reduce new HIV infections
In the late 1980s and early 1990s, Portugal was among the European countries with the largest number of new HIV infections, relative to its population size. Since the emergence of the epidemic, Portugal has shown its commitment to mounting a strong HIV response based on evidence, adopting people-centred approaches and promoting the involvement of civil society, including people living with HIV.
At the peak of the epidemic in the late 1990s and early 2000s, HIV infections in Portugal were mainly associated with injecting drug use. A needle and syringe exchange programme for people who inject drugs had already started in 1993. Progressive drug policy, including the decriminalization of all personal drug use in 2001, moved the focus from criminal justice to public health.
These steps, together with a high level of coverage through a comprehensive prevention, treatment and care package and a multisectoral approach focused on engaging civil society organizations, led to the reduction of the proportion of new HIV infections associated with injecting drug use to as low as 1.5% in 2016.
New HIV infections were halved over 10 years in Portugal, falling from 2167 in 2007 to 1030 in 2016, as reported in the joint WHO–European Centre for Disease Prevention and Control (ECDC) report “HIV/AIDS surveillance in Europe 2017”.
Since 2017, Portugal has also implemented HIV pre-exposure prophylaxis (PrEP), recommended by WHO as an additional prevention choice for people at substantial risk of HIV infection within combination approaches to HIV prevention.
Introducing HIV self-testing to reach those who are still undiagnosed
To build upon its successes in combating HIV/AIDS, Portugal plans to introduce, with WHO guidance and support, HIV self-testing as a complementary measure to the current health care-based and community-based testing strategies.
This approach is in line with WHO recommendations to improve early testing by adding self-testing to HIV testing services. Self-testing can reach people with undiagnosed HIV in a timely manner, including those at ongoing risk who are in need of frequent testing.
Towards achieving all targets
In 2015, Portugal adopted the WHO-recommended “treat all” approach, offering free treatment and care to anyone diagnosed with HIV, including undocumented migrants, regardless of the stage of infection.
Through an integrated care approach, diagnosis, treatment and care of tuberculosis, HIV and viral hepatitis are provided simultaneously. This is expected to enable Portugal to achieve the remaining UNAIDS 2020 target – to have 90% of people diagnosed on treatment.