South Africa: HIV and AIDS - 'We Need to Involve Men in Discussions Around Sexual Violence'

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19 June 2019
interview

Durban — Ahead of the 9th SA AIDS Conference, Doctors Without Borders (MSF) shared their success with its 'Bending the Curves' project.  Started in 2011 before the 90-90-90 targets were set by UNAIDS, it aims to bend the curves of new HIV infections, HIV-related illnesses and deaths. Findings from a follow-up survey of the community-based HIV/TB project in Eshowe, KwaZulu Natal, shows that the project has achieved the UNAIDS targets of 90-90-90 one year ahead of the 2020 deadline. The results were 90-94-95 or simply 90% of people living with HIV know their status, 94% of those were on anti-retroviral treatment and 95% of those had a suppressed viral load.

allAfrica's Sethi Ncube spoke with Dr Liesbet Ohler, the medical referent for the project.

We know the UNAIDS 2020 targets of 90-90-90. With so much HIV/AIDS information being circulated on media platforms and in health facilities, what's stopping countries from reaching 100-100-100?

When you look at many countries, even reaching 90-90-90 in itself is a big challenge. There are many things contributing to it, one of the biggest challenges I would say is the huge stigma that is still there around HIV. That is really stopping people from going to get tested. Some people don't go to get tested not because they think they are HIV negative but because they are afraid they are HIV positive. We need to overcome the huge stigma.

Another thing I would say is the cost that goes with being HIV positive, and with that, I don't mean the drugs or the lab tests because they are free of charge, but all the additional costs that contribute to people reaching the health facility. I am working in Eshowe and Mbongolwane, Mbongolwane is such a rural setting that even when you refer people to hospital they sometimes don't go there because they just don't have the money. So I think there are things outside the health system that play a role also in not getting these under control.

I would say another thing is co-morbidity, when people don't only have HIV but have it in addition to other diseases like TB or diabetes, and that impacts on the way they react to HIV. We have to really see it at global level and reaching 90-90-90 is a challenge in itself. I think Botswana is the closest to getting there at national level, in South Africa we are still quite far from that but I am positive we will reach there.

HIV/AIDS treatments are getting more advanced every year since the beginning of the epidemic. Does this mean we are getting closer to finding a cure?

There are 4 promising vaccines that scientists are working on and we are expecting results of those studies within two years. By 2021 we will probably know if those vaccines are ready to become commercial. That would be great news and I think if among those vaccines there a few that are really working well that would be ... maybe not the way to the cure but that would be a way to big prevention.

Right now, I don't see something in the pipeline to really cure people with HIV yet.

We've heard that the fact that young men with HIV remain out of reach of the health system. Is enough being done to expose them to HIV/AIDS awareness programmes?

What we've seen in Eshowe and Mbongolwane where I work is that young women are still at the highest risk of getting infected and young men still seem to stay out of reach of the health care system. So indeed, it is difficult for young men to know their HIV status and once they know they are HIV-positive, it's difficult for these young men to be linked to care. Once they are in care and you see they are doing well, they have viral load suppression, meaning you can't find the virus in the blood and for us, that's a very big thing to follow up because people with suppressed viral load are less at risk to transmit the virus to other people.

What we've discovered is what men appreciate the most in a clinic is confidentiality. They don't like long queues, especially if the waiting area is full of women and crying babies. Men are more comfortable to discuss health issues with male health care providers. It's not that men don't want care, but they think that the system is not set up to answer to what they specifically want.

It has been established that one in five female HIV infections in South Africa can be attributed to sexual violence. What can be done about it?

We have been addressing the challenge of sexual violence a lot with women, I think the way to go is to involve men in the discussions around sexual violence.

What needs to be done to ensure that people who have been assaulted adhere to PEP therapy?

One challenge is that many people still don't know it exists - we should teach people to demand it. Another thing is that victims in need of PEP are often afraid that if they go for PEP the nurses might force them to report the assault to the police, so there is a strong connection of the legal and medical part for the same patients.

Lastly, how does the quality of leadership/governance affect the fight against HIV/AIDS?

Governance is important to make sure that the right guidelines are in place. I'd say on that point we are very lucky in South Africa because we really have good strong guidelines. Also, for HIV/AIDS we see that South Africa is often at the forefront. South Africa is now introducing Dolutegravir, which is the new ARV drug which has fewer side effects, and lessens the risk of developing resistance to it. South Africa is really a country that is at the forefront when it comes to the fight against HIV.

But governance is more than just having good guidelines. It's also making sure that they are well implemented and that's where we often see that things become more challenging. There are not enough human resources when you go to very rural areas like Mbongolwane - they have medical doctors in the hospital but I would say they could do with extra medical doctors to run the hospital 24/7. Primary health care clinics are run by nurses and they are doing a great job but they can't do everything, there  are things for which they need advice from medical doctors. They have a lot of targets they have to reach, thereby putting them under a lot of pressure.

So the implementation of these great guidelines is often lacking on the ground, and that's a pity because South Africa would be really great if they implemented the guidelines they have.

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