Belgium meets UNAIDS targets, political uncertainty threatens further progress

Belgium is one of the few EU countries to meet UNAIDS’ 95-95-95 targets, but political uncertainty and budget concerns are hindering progress. Ending the epidemic across the EU by 2030 could still be the legacy of the next EU Commission.

Driven by the goal to end HIV/AIDS as a public health issue by 2030 and advance the Sustainable Development Goals, UNAIDS set 2025 interim targets, including the 95-95-95 target. Belgium has exceeded these, achieving 97-95-98. The EU/EEA region is nearing its target but requires more political action.

“Although Belgium is one of the few EU countries that have met the ambitious 95-95-95 targets set by UNAIDS, we keep monitoring and looking for the challenges that might evolve over time,” Belgium’s Health Minister Vandenbroucke told Euractiv.

“For example, the recent decline in the use of protection by young people or the difficult access to healthcare for vulnerable people like sex workers. It is important to eliminate the barriers to prevention and care, especially for vulnerable groups,” he explains.

Vandenbroucke believes only an integrated approach can reduce the diagnosis of HIV we see each year, and so a national HIV strategy was developed between the different policy levels.

Legacy in the fight against AIDS

"Belgium has achieved the 2030 ambition and serves as a role model. However, now policymakers in Belgium and Europe must prioritise HIV on the public health agenda, ensuring political commitment, sustainable funding, and support for innovation and diverse care models," Andrea Zanaglio, Senior Director of EU Government Affairs at Gilead Sciences, told Euractiv.

Despite progress, challenges remain in Belgium, with over ten new HIV diagnoses weekly and 33% at a late stage in 2022. Additionally, 627 cases went undiagnosed that year.

“Building on its EU Council Presidency and national legacy in combating AIDS, Belgium should leverage its influence to make the EU the first region to end the HIV epidemic. With less than six years to achieve this goal, the European Commission, European Parliament, and national governments’ commitment will be crucial,” said Zanaglio.

He stressed that one of the final legacies of the next Commission and Parliament could be ending the epidemic across the EU by 2030.

Barriers to ending AIDS: awareness, access, and stigma

Significant barriers remain in the fight against HIV/AIDS worldwide. Antonio Flores, senior HIV/TB advisor at Médecins Sans Frontières, highlighted to Euractiv that while global access to treatment has improved, prevention efforts lag behind.

“Far too few people at risk around the world have access to prevention. In addition, the criminalisation of certain groups continues to drive them away from services, greatly increasing their risk of acquiring HIV or not benefiting from needs-driven care,” Flores said.

Key obstacles include limited awareness and education about PrEP (Pre-Exposure Prophylaxis) – a preventive strategy where people at high risk of HIV take medication to avoid infection, persistent stigma, discrimination, criminalisation, issues with access and affordability, healthcare system limitations, cultural and religious barriers, policy obstacles, insufficient funding, low-risk perception, and gender inequality.

“These factors collectively hinder the widespread adoption and effective use of PrEP, particularly in resource-limited settings and among vulnerable populations at high risk of acquiring HIV,” Flores added.

Future prospects 

The U.S.-based biopharmaceutical company Gilead has recently generated excitement with its advancements in HIV prevention, releasing full results from the PURPOSE 1 trial on the efficacy of twice-yearly injectable lenacapavir for HIV prevention.

Médecins Sans Frontières has expressed optimism about lenacapavir’s potential as a long-acting injectable PrEP. “Lenacapavir, as a newer prevention strategy—long-acting injectable PrEP—offered in a larger menu of options, is expected to be a game-changer if made widely available and scaled up,” Flores told Euractiv.

However, the cost of innovative treatments remains a significant concern. At the International AIDS Conference, a coalition of activists, including Médecins Sans Frontières, called for immediate global action to break Gilead’s monopoly on lenacapavir.

New data showed that generic lenacapavir could be produced at a fraction of Gilead’s price of $42,250 per year. “Such innovative options must be widely available where they are needed. For that to happen, the cost of such drugs must go down, and generics must be made available,” Flores emphasised.

Gilead disputes the published data and has committed to supplying lenacapavir for HIV prevention in high-need countries until low-cost versions are available through voluntary licensing partners. The company is urgently developing a licensing program to expedite access in high-incidence, resource-limited countries.

Speculation about pricing

In response to media reports on lenacapavir, Zanaglio emphasised that many factors, such as stigma and access to services, limit PrEP use, and the focus should be on improving accessibility, especially for underserved populations.

Gilead clarified that lenacapavir for HIV prevention isn't approved globally, and its regulatory filing will include results from both PURPOSE 1 and PURPOSE 2 trials, with the latter expected in late 2024 or early 2025.

Until the Phase 3 trial is completed and a potential FDA filing occurs, it's too early to determine pricing. Gilead is committed to access pricing in high-incidence, resource-limited countries, with no reference to current pricing for its approved use. 

The recent report “Going the Extra Mile to End the HIV Epidemic” calls for innovative tools and targeted interventions to address disparities. It advises high-income countries to focus on four areas: promoting PrEP, opt-out HIV screening, expanding community-based care, and measuring health-related quality of life, all within a national HIV strategy.

[Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy lab]