José M.

Zuniga, PhD, MPH

President/CEO, IAPAC &
UNAIDS Special Advisor on Fast-Track Cities

City of Austin – Signing of Paris Declaration on Fast-Track Cities

Central Austin Library – June 20, 2018
 July 2014 – City‐focused HIV/AIDS initiative first discussed by 
UNAIDS, IAPAC & select Mayors at AIDS 2014 in Melbourne
 August 2014 – Fast‐Track Cities partnership conceptualized 
between UNAIDS, IAPAC, UN‐Habitat & City of Paris
 December 2014 – Fast‐Track Cities initiative launched World 
AIDS Day 2014 in the City of Paris
– 26 cities sign Paris Declaration on Fast‐Track Cities Ending the AIDS 
Epidemic committing to fast‐track AIDS responses & attain 90‐90‐90
 NORTH AMERICA

 Baltimore  Mexico City  Oakland

 Baton Rouge  Miami  Phoenix
 Birmingham  Minneapolis  Providence
 Boston  Montréal  San Antonio
 Chicago  New Orleans  San Francisco
 Denver  New York City  Washington, DC
 RIGHT THING, RIGHT PLACE

Right Thing  Right Place
• Prioritize 90‐90‐90 (90‐81‐73)
• Aim for 95‐95‐95 (epidemic control)
• Strive for Getting to Zero
• Embrace U=U
• Optimize HIV care continuum
• Stigma/discrimination
• Prevention (PEP/PrEP)
• Testing & linkage to care
• Test‐and‐treat; same‐day ART
• Long‐term viral suppression
• Retention in care
• HCV coinfection
• Quality of life
 
• 200 cities account for ~60% of PLHIV
• In many countries, 1 city accounts 
for ≥40% of PLHIV in country
• “Laboratories of innovation”
• Local accountability for sustainable 
response
• Local “hotspots”
• Targeted response based on 
geolocated/sub‐city data 
• Network analyses (NEW GROUND)
•Micro‐epidemics (NEW GROUND)
• Molecular clusters 
INTERVENTION POINTS
 DATA FOR ACTION

 Technical stakeholder 
meetings to develop city 90‐
90‐90 strategies 
 City dashboards to monitor 
progress, promote 
stakeholder accountability 
(www.fast‐trackcities.org) 
 “Learning collaboratives” on 
data generation, analysis, 
and reporting

www.fast-trackcities.org
Amsterdam New York City
 Range of entry points for HIV   HIV programming re‐
testing & sexual health conceptualization:
 Harm reduction services  o HIV status neutral prevention 
integrated into HIV strategy & treatment cycle
 Annual HIV diagnoses down  o Repurposing of STI clinics for 
sexual health
nearly half from 2010 (but still 
too many diagnoses among  o Continuous engagement in 
people with advanced HIV) treatment & prevention 
services, including PrEP & PEP
 Attained 90‐90‐90 (2016):
 90‐90‐90 progress (2016):
o First 90: 93% → 94%
o First 90: 94% → 95%
o Second 90: 88% → 90%
o Second 90: 88% → 86%
o Third 90: 94%
o First 90: 90% → 93%
Nairobi County Kyiv
 Fast‐Track Roadmap &   Strong political leadership & 
Strategic AIDS Plan (aligned  effective partner coordination
with National Strategic AIDS   Full community engagement
Framework)  Strategy for 2017‐2021 aiming 
 HIV testing campaigns &  to have 86% of PLHIV on ART
community‐based services   132% increase in state budget 
increased coverage to 71%  for ARVs & streamlined 
(2015)
procurement process
 90‐90‐90 progress (2016):
 90‐90‐90 progress (2016):
o First 90: 66% → 77%
o First 90: 48% → 55%
o Second 90: 79% → 96%
o Second 90: 58% → 66%
o Third 90: 12% → 55%
o Second 90: 82% → 83%
 MAXIMIZING IMPACT
Infrastructure and 
human resource 

HIV
investments to 
facilitate 
integrated service 
HBV & HCV
delivery

Global network of 
cities for sharing of  Political advocacy 
lessons learned  and accountability
and best practices

Investments

NCDs
Web‐based 
 Depression
Capacity‐building 
around 
platform to   Diabetes
Tuberculosis surveillance and 
program 
measure and 
monitor relevant   Hypertension
indicators and 
implementation
progress