Much has been accomplished over the past two decades in global HIV treatment and prevention. Although in need of renewed emphasis, the worldwide scale-up of antiretroviral therapy (ART) has gone beyond what many imagined possible. Oral pre-exposure prophylaxis (PrEP) is available in many high-income countries and in some lower-income and middle-income countries. The US President's Emergency Plan for AIDS Relief (PEPFAR) and other funders are expanding access to rapid or same-day ART initiation and piloting PrEP programmes in international settings.
Despite these reasons for optimism, unless we move beyond the status quo, the global community will fall far below the goal of ending AIDS.1, 2 The vital step is implementation, but even the first stage goals of the UNAIDS 90-90-90 targets—that 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression—may not be achieved by 2020.3 And perhaps the greatest implementation challenge of all is engaging men.