A Leading Global Funder Helps Unlock the Power of HIV Self-Testing

The advent of antiretroviral therapy to treat HIV/AIDS broke both ways. Yes, the treatment transformed what was once a death sentence into a manageable chronic condition. But it also lowered the temperature on the public perception of the urgency of a global health crisis that has now claimed 39 million lives. And the danger is far from over. Today, the U.N. estimates that there are 37.9 million people living with the virus. Only 80 percent of them know their status.

When people living with HIV aren’t tested, they put not only themselves at risk, but create concentric circles of risk around them, from sex partners to their children. There are a number of barriers to taking the first step. Some people don’t have access to testing facilities, or can’t cover costs. Others don’t want very personal information to become public, and have valid concerns about how the stigma of testing positive may affect their lives and livelihoods.

A growing solution is HIV self-testing (HIVST), which allows people to test themselves where they want, when they want and how they want—privately, or surrounded by personal or professional support. At a recent conference, the Children’s Investment Fund Foundation (CIFF) announced a $25 million investment in scaling the option more broadly, particularly in parts of the world like sub-Saharan Africa, where the largest number of people don’t know their status.

Meeting Global Goals

Inside Philanthropy has been covering funder backing of self-testing since 2016, the year the World Health Organization (WHO) published supplemental global guidelines on HIVST. The report both validated the new approach and recognized a need for regulation as kits were hitting the market through pharmacies and the internet. Since then, 77 countries have adopted self-testing policies, while others are still in development.

In 2015, the United Nations announced ambitious “90-90-90” global HIV treatment targets to end the epidemic by 2020. The first goal is for 90 percent of people living with HIV to know their status. The second is for 90 percent of those testing positive to begin antiretroviral therapy (ARV). And the third will be met when 90 percent of people receiving treatment achieve viral suppression.

Accelerating access to HIVST can help governments make real strides toward meeting the first goal, and contain the threat to public health in a way that’s both cost-effective and respectful.

CIFF’s Commitment

Co-founded in 2004 by U.K. activist investor Chris Hohn and his then-wife, Jamie Cooper, the Children’s Investment Fund Foundation (CIFF) describes itself as “the world’s largest philanthropy that focuses specifically on improving children’s lives.” Its commitment to HIV/AIDS funding reflects the profound toll that this ongoing epidemic inflicts on children. Around 1.1 million children aged zero to nine are living with HIV, nearly 90 percent of them in sub-Saharan Africa, according to UNICEF. And as of 2018, roughly 14.9 million children under the age of 18 had lost one or both parents to AIDS.

CIFF champions HIVST and other forms of self-care as “one of the most powerful ways for youth, women and men to take control of their sexual and reproductive health.” Miles Kemplay, CIFF’s executive director, Adolescence, says that the foundation’s investment in HIV self-testing is “part of our growing portfolio that aims to empower individuals with new ways to avoid unplanned pregnancy, prevent HIV and sexually transmitted infections, and make these choices far more accessible, convenient and affordable to millions of young women and their partners.”

CIFF expects seeding and scaling self-testing to provide a convenient and confidential way to overcome obstacles to getting tested, advance efforts to control HIV as a public health threat, and achieve the first 90-90-90 target, status awareness. Investment geographies are still being defined, but CIFF feels the work has added urgency in countries like Nigeria—which has the second-largest HIV epidemic in the world—and Uganda, where women and girls are disproportionately affected.

MenStar Coalition

CIFFs commitment builds on the goals of the MenStar Coalition it launched at last year’s International AIDS Conference with six partners: the Elton John AIDS Foundation, the U.S. President’s Plan for Emergency AIDS Relief (PEPFAR), Unitaid, the Global Fund, Johnson & Johnson and Gilead Sciences. The collective announced $1.2 billion in initial planned funding targeted at expanding the diagnosis and treatment of HIV infections in men aged 24 to 35. Men in that cohort represent 30 percent of new infections globally, expanding the spread to adolescent girls and young women. MenStar also committed to supporting new approaches, like a rapid increase in testing, treatment and viral suppression.

Though PEPFAR, the United States contributed $800 million to the initiative, with plans to reach 1 million men this year. With the new commitment of $25 million, CIFF’s investment is now at $60 million. Working together, the partners hope to end AIDS as a public health threat by 2030.

An Urgent Progress

Despite the concerted efforts of the global community and funders like the coalition, meeting all three 90-90-90 goals by next year doesn’t appear realistic. Still, there has been significant progress. Eighty percent of HIV-positive people know their status, only 10 percent short of the first goal. On the second, three of five people living with HIV are on antiretroviral therapy. But goal three, viral suppression, is only halfway there at 53 percent.

While those numbers may seem high, they actually represent a remarkable achievement that the WHO attributes to a scale-up of treatment and the use of rapid diagnostic testing. A case in point: Back in 2005, only 10 percent of Africans with HIV knew their status, and testing was only available to 12 percent of the people who wanted it.

Despite that, it’s not time to dial down the urgency. Nearly 2 million people were newly infected last year, including more than 100,000 children aged zero to nine, and 770,000 people died of AIDS-related illness. Meeting all three of the U.N.’s goals can only begin when people get tested. Making that easier is a step in the right direction.

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