30 November 2018

Africa: Still Many Miles to Go 30 Years Later


IN DECEMBER 1988, the world marked the first World AIDS Day. Besides offering support to those living with HIV, the day also remembers the lives cut short by AIDS-related illnesses.

As is widely recorded, many lost the fight because the stigma, discrimination and criminalisation of key populations curtailed access to HIV services.

I must reflect on some challenges which I believe the day has addressed. In the early 1990s, I had a colleague who was on the verge of earning an American journalism scholarship. I was still celebrating his good fortune when he decided to pull out of the race. In his defence, he said, "I don't know my HIV status, and I feel better that way." On another day, I was listening to a radio programme when a listener surprised the expert panel with the following proposition: "I cut myself with a knife; the wound is healing. Am I HIV-negative?" Without a doubt, the spectre of a positive HIV diagnosis changed lives and communities.

An HIV expert at the University of Utah Health, Dr Adam Spivak, has observed that "from its first descriptions of AIDS in 1981 through the mid-'90s, this was a death sentence for patients." As the world marks the 30th anniversary of World AIDS Day tomorrow, combined global efforts have moved the pandemic into a manageable condition.

In a 2016 speech, prime minister Saara Kuugongelwa-Amadhila suggested that the "fight against HIV transmission should be mainstreamed into the school curriculum." The prime minister's prescient call was a harbinger of this year's theme of World AIDS Day - Know Your Status. Indeed, part of the message from UNAIDS executive director Michel Sidibe notes that "after 30 years, AIDS is still not over. We have miles to go. If people don't know their HIV status, people living with HIV can't start treatment, and people who are HIV-negative can't get the knowledge and skills they need to keep it that way."

There are successes to celebrate. According to UNAIDS, three in four people living with HIV know their status. HIV testing has thus grown phenomenally. Global HIV-AIDS Overview reports that "in 2017, over twenty-one million people living with HIV (59%) were on antiretroviral therapy (ART) globally, an increase of 2, 3 million since 2016, and up from 8 million in 2010. It also observes that "AIDS-related deaths have been reduced by more than 51% since the peak in 2004."

The positive developments, however, have significant drawbacks. For example, UNAIDS is concerned that "there is still a long way to go for those living with HIV but do not know their status (because) only when they know, can they be linked to quality care and prevention services." Furthermore, in spite of expanded HIV testing facilities, confidential HIV testing is still an issue. In many ways, the fear and foreboding associated with HIV-AIDS in 1981 remain. Consequently, UNAIDS has expressed the regret that "many people only get tested after becoming ill and symptomatic." Former World Health Organisation director general Margaret Chan's exhortation was that "if the world is to achieve its goal of ending AIDS by 2030, it must rapidly expand and intensify its efforts. To continue the fight against HIV prevention, there is a need to tailor prevention programmes so the right services reach the groups which are most vulnerable and affected."

Prime minister Kuugongelwa-Amadhila cautioned that HIV thrives in "the undesirable conditions of ignorance, poverty, stigma, and unequal and violent gender relations." It is instructive to note that the Global HIV-AIDS Overview exposition buttresses this concern. It estimates that "1, 8 million individuals worldwide became newly infected with HIV in 2017 - about 5,000 new infections per day. This includes 180 000 children (below 15 years). Most of these children live in sub-Saharan Africa, and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. The vast majority of people living with HIV are in low- and middle-income countries. Last year, there were 19,6 million people living with HIV (53%) in eastern and southern Africa; 6,1 million (16%) in western and central Africa..."

The gravity of these figures assumes greater clarity when viewed against Africa's other challenges. "The HIV epidemic not only affects the health of individuals, but it also impacts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity and other serious problems."

After attending the 22nd International AIDS conference held in Amsterdam in July this year, John McMannis raised possible impediments that may detract from the progress of the past 30 years. The conference was attended by political leaders, researchers, people living with HIV (PLHIV), advocates and many others committed to ending the epidemic.

The conference theme of Breaking Barriers, Building Bridges focused on increasing access to treatment and prevention services. Among the observations made by McMannis were (a) reduction of global HIV funding by eight of the 14 donor governments in 2017, (b) conference speakers and participants agreed that a single country or organisation could not underwrite the fight against AIDS, and hoped that next year's Global Fund replenishment would challenge world leaders on their seriousness in fighting AIDS, and (c) young people took their rightful place at AIDS 2018.

And it was for a good reason: 30% of all new infections occur in people between the ages of 15 and 25. The developing world is experiencing rapid growth in the number of young people. Treatment and prevention programmes must address these new demographic challenges. As McMannis recalls, throughout the week, youth advocates stuck to the chorus of 'nothing for us, without us' and finally, (d) the need to pay heed to the new UNAIDS report, which delineates the unique challenges faced by adolescent girls and young women around the world in the AIDS epidemic. Last year, 6 600 young women between the ages of 15 and 24 years became infected with HIV every week.

The AIDS 2018 conference welcomed the launch of a new initiative called The MenStar Coalition. MenStar will focus on expanding HIV diagnosis and treatment among men in Africa because "recent data shows that men between the ages of 24 and 35 are major drivers in spreading the disease to adolescent girls and young women."

The AIDS 2018 conference also underscored the need to integrate responses to TB and HIV. This call is premised on the findings that TB "is the leading cause of death among PLHIV. Ultimately, if we do not address the TB epidemic, we cannot hope to address the AIDS epidemic, and vice versa."

Dr Spivak is upbeat. He extols the work which has produced "four or five first-line regimens that are one pill, once a day. Within that pill are three different medicines. They are co-formulated, with minimal side-effects. And this has freed people to live their lives... "

While exalting the work which has been done since 1988, experts quickly point to the sobering fact that there is still no cure. The commitment to reinvigorate HIV-AIDS work should spur present and future experts into newer research for HIV prevention and treatment methods. Indeed, an equally loud call is simultaneously being made for multi-disease testing.

*Lawrence Kamwi is a former broadcast journalist


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