Depicting a New Target For the HIV Response: How Do You See the ‘Fourth 90’?

[By Jeffrey V. Lazarus and Kelly Safreed-Harmon]

This may be surprising to hear from researchers, but we don’t mind getting things wrong from time to time. Being wrong draws us into interesting conversations with people who have different skills and perspectives. It also reminds us that advancing public health is a shared enterprise.

Many stakeholders in the HIV field have found fault with how the piece conceptualised the 'fourth 90' target

Case in point: in the two years since we joined collaborators in co-authoring Beyond viral suppression of HIV – the new quality of life frontier, many stakeholders in the HIV field have found fault with how the piece conceptualised the 'fourth 90' target that we proposed to complement the UNAIDS 'three 90s' target.

The problem is perfectly encapsulated in the following figure from the article:

Why should good health-related quality of life only be a relevant target for virally suppressed people living with HIV?

What has been pointed out to us seems obvious in retrospect: why should good health-related quality of life only be a relevant target for virally suppressed people living with HIV (PLHIV)?

It clearly shouldn’t. In presentations and discussions about how to move the HIV care agenda beyond a narrow focus on treatment to suppress viral replication, it has become routine for us and other stakeholders to talk about establishing a health-related quality of life target for all PLHIV from the point of diagnosis onward.

However, the above figure continues to be reproduced or adapted in presentations in a wide range of fora, which leads us to think that it is time to explore alternatives. The specific impetus for this blog was a tweet by our friend Dr Tristan Barber in response to seeing our problematic depiction of the fourth 90 during an AIDS 2018 presentation.

To our delight, Tristan tweeted the following:

Tristan then tweeted that an alternative might be putting the arc under the three boxes to form a smile!

Well Tristan, thanks for making us smile. More importantly, thanks for prodding us to revisit the question – what is the most suitable way to visually depict the fourth 90?

After a fair amount of head-scratching, this is the proposal we have come up with:

How do you think a new global target for good health-related quality of life for PLHIV should be depicted?

But, well, we’ve been wrong before. So this time we are putting it to the social media-sphere: How do you think a new global target for good health-related quality of life for PLHIV should be depicted?

When you respond please use #4th90 and #BeyondViralSuppression.