Introduction

HIV Plan Belgium
More than five years ago, the first national HIV Plan 2014-2019 was drawn up by numerous public health and community organisations. Over the past years, the HIV Plan has served as a valuable guidance for actors in the field, and it resulted into a number of important achievements. This HIV Plan 2014-2019 has come to an end and a new HIV Plan has been developed to guide the HIV response, taking into account epidemic trends and the recent evolutions in the HIV domain.

General principles

The proposition for the HIV Plan 2020-2026 includes guiding principles to support a high-quality, evidence-based and equitable response to HIV. The HIV Plan is built upon the participation of all stakeholders in the HIV field. Perhaps most critical is the ongoing and meaningful participation of people with HIV, as well as the involvement of organisations targeting key populations. This is central to the partnership approach and is key to the success of this HIV Plan.

The general principles of the HIV plan are the following:

  • Respect human rights, sexual and reproductive rights;
  • Embrace combination prevention and health promotion;
  • Devote particular attention to STI;
  • Ensure participation of relevant stakeholders;
  • Ensure the meaningful involvement of people living with HIV (PLWH);
  • Ensure the participation and empowerment of key populations;
  • Endorse guiding principles such as interdisciplinary quality services in prevention, treatment and care, and equity in access to all services;
  • Ensure research and surveillance to inform evidence-based policies for all pillars as well as for evaluation purposes;
  • Adopt principles of good governance.

Goals & targets

This plan aims at improving the various aspects of the quality of life and medical situation of people living with HIV, from infection to diagnosis, treatment and care, across their life course with special attention to their well-being and within the framework of universal access to treatment and care. This plan also covers the prevention of HIV acquisition while promoting the conditions for healthy and responsible sexuality.

The plan is guided by the aspiration to reach the targets defined by UNAIDS as a means to end the HIV/AIDS epidemic by 20304. These include the 95–95–95 targets: by 2025, 95% of people living with HIV know their HIV status, 95% of people who know their status are receiving treatment and 95% of people on HIV treatment have a suppressed viral load, so their immune system remains strong and the likelihood of their infection being passed on through sexual contact is greatly reduced. UNAIDS has also set targets for primary prevention and targets for zero discrimination, which contributes to ending HIV and reaching an optimal quality of life of people living with HIV.

As the HIV Plan is the main instrument to frame the HIV response in Belgium, targets are important for assessing both accountability and the progress made through monitoring and evaluation. Therefore, specific targets grounded in the Belgian epidemiological and social context were designed to cover the multiple facets of the lives of people at risk of acquiring or living with HIV.

The targets related to the prevention of HIV acquisition and improvement of sexual health aim to ensure that all people at risk for HIV infection are aware of, have access to and receive the prevention tools adapted to their specific needs. Yet, for the actions relating to testing, treatment, care and quality of life, the choice of the targets was guided by the continuum of HIV care approach, completed by the fourth pillar on quality of life.

The following key-targets are proposed:

  • Increase the number of people from key populations informed about existing prevention measures towards HIV and STI;
  • Increase the number of people who receive prevention services (including condom use, counselling on risk reduction strategies, chemsex, HIV testing);
  • Ensure that all people at high risk of HIV acquisition have access to PrEP;
  • Ensure that all care providers receive training on combination prevention tools and up-to-date socio-epidemiological information on HIV to support testing;
  • Reach 95% of all people living with HIV knowing their status by 2025 (first UNAIDS target for the continuum of HIV care);
  • Reduce the number of HIV infections diagnosed late;
  • Ensure that undiagnosed most-at-risk/key populations are reached by community-based HIV testing;
  • Ensure access of people living with HIV and PrEP users to regular STI screening;
  • Ensure prompt linkage to HIV care following diagnosis and subsequent retention in HIV care;
  • Ensure that 95% of people living with HIV diagnosed with HIV receive ART by 2025 (second UNAIDS target for the continuum of HIV care);
  • Ensure that more than 95% of people living with HIV on ART reach undetectable viral load by 2025 (third UNAIDS target for the continuum of HIV care);
  • Ensure that tools to monitor patients’ health-related quality of life are developed and implemented in HIV care settings;
  • Ensure that all people living with HIV have access to peer support through patient organisations according to their needs;
  • Reduce stigma and discrimination against people living with HIV.